6 Differences Between Suboxone vs. Methadone for Opioid Use Disorder

It’s estimated that opioid use disorder (OUD) affects over 6 million Americans. And in 2022, opioids were involved in over 80,000 deaths due to drug overdose.

Suboxone (buprenorphine / naloxone) and methadone (Methadose) are two medications used to treat OUD. They’re often used as part of a treatment method called medication for opioid use disorder (MOUD), formerly known as medication-assisted treatment (MAT). This treatment method uses medication as the primary tool for treating OUD. In many cases, medications are combined with behavioral therapy and support groups. 

These medications have many differences. Although the best medication for you depends on several factors, we’ll cover six notable differences between Suboxone versus methadone below.

1. Suboxone and methadone work in different ways to treat OUD

Suboxone is what’s called a “partial opioid agonist.” It binds to the same receptors (binding sites) as opioids, called opioid receptors. However, it doesn’t fully activate (turn on) these receptors like typical opioids do. Still, by binding to opioid receptors, Suboxone alleviates opioid withdrawal symptoms and cravings that occur when opioid receptors are left empty in someone who is dependent on opioids. However, it isn’t as likely to lead to an overdose compared to traditional opioids. It’s also less likely to cause a “high” feeling.

Methadone is a “full” opioid agonist. It binds to opioid receptors and has the same effects as other opioids. The difference is that it works more slowly, and lasts longer, than most other opioids. At doses used for OUD, methadone doesn’t cause a high. Rather, it relieves withdrawal symptoms and cravings for opioids.

2. You have to wait to start Suboxone, but you can start methadone at any time

Starting Suboxone too soon after taking opioids can lead to uncomfortable withdrawal symptoms. This is because Suboxone attaches more strongly to opioid receptors than typical opioids. This can force traditional opioids off the opioid receptor and lead to opioid withdrawal symptoms. 

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That’s why some prescribers recommend waiting at least 12 hours to take Suboxone after taking a short-acting opioid, such as those that contain hydrocodone (like hydrocodone / acetaminophen, or Norco). And your prescriber may recommend waiting 24 hours or more to take Suboxone after taking long-acting opioids, such as extended-release oxycodone (Oxycontin) or morphine (MS Contin). Waiting this amount of time before starting Suboxone is called a “standard induction.”

However, according to Dr. Jonathan Avery, MD, an addiction psychiatrist and the vice chair of Addiction Psychiatry at Weill Cornell Medicine and New York-Presbyterian Hospital, prescribers are increasingly moving to a faster low-dose initiation of Suboxone.

“We almost never do the standard induction of Suboxone anymore. We mostly do ‘low-dose initiation,’ also known as the ‘microdosing initiation’ or the ‘Bernese method.’ This is when Suboxone is started at a very low dose and increased over several days, rather than waiting to start.”

Starting at a very low dose helps minimize the chance that Suboxone will worsen withdrawal symptoms. So if you’re prescribed Suboxone, make sure you understand your prescriber’s instructions for when to start it, and at what dose.

You don’t need to wait a certain amount of time after your last opioid dose to start taking methadone for OUD. Since methadone is a traditional opioid, it won’t cause withdrawal if you start it soon after your last opioid dose. Still, follow your prescriber’s instructions for when to start methadone. Taking too many opioids in a short period of time can lead to opioid overdose and be life-threatening.

3. Buprenorphine products and methadone come in different forms

When choosing between buprenorphine products versus methadone for OUD, consider their different forms. 

Buprenorphine comes in many forms, including some with and without naloxone. This includes a tablet or film that dissolves on your tongue. It also comes as an injection that’s administered once a week or once a month.

On the other hand, methadone is usually used as a liquid solution that you drink daily.

Buprenorphine products

Several buprenorphine-containing products are FDA approved for OUD. Buprenorphine-only products include sublingual tablets, an extended-release (ER) injection that’s given weekly (Sublocade), and an ER injection that’s given monthly (Brixadi).

Other products contain both buprenorphine and naloxone. This includes sublingual tablets (Zubsolv) and sublingual film (Suboxone).

For OUD, buprenorphine / naloxone tablets or film are prescribed more often than buprenorphine-only products. It’s thought that the naloxone component keeps people from misusing Suboxone. Theoretically, naloxone should block the absorption of buprenorphine if it were misused (injected). However, this may not be true. Regardless of which buprenorphine product you’re prescribed, it’s important to use it only as instructed by your substance use specialist.

Other forms of buprenorphine are FDA approved to treat chronic pain only. These include a buccal film (Belbuca), transdermal (skin) patch (Butrans), and a short-acting injection. These forms may be useful in people with chronic pain who also exhibit signs of OUD.

Methadone

Methadone comes in several forms, including:

• Liquid solution

• Powder to be dissolved in water

• Tablets to be dissolved in water

• Traditional tablet

The liquid form is most commonly used for OUD. When using the liquid form, your methadone dosage can be easily adjusted if needed.

4. Both medications are effective, but one may be preferred over the other

It’s important to know that both Suboxone and methadone improve outcomes for people with OUD. Possible benefits include: 

• Reduced opioid use 

• Less likely to need medical care for opioid-related problems

• Lower risk of having an opioid overdose

• Reduced risk of death

Importantly, the benefits of methadone or Suboxone are greatest when these medications are used consistently over a sufficient period of time. What’s considered “sufficient” depends on many factors, including the severity of your OUD. You may need treatment for several months, For example, the minimum amount of time that experts recommend methadone for OUD is 12 months. Others might need Suboxone or methadone indefinitely. 

Methadone is the medication that’s been used the longest to treat OUD. We have a lot of research to show that it’s effective. Research shows that suboxone is also effective. Some studies show it’s as effective as methadone at doses above 7 mg per day. Other research shows that people who use buprenorphine-containing products are more likely to continue using opioids and/or drop out of treatment compared to people using methadone. Still, research shows this doesn’t necessarily lead to a higher risk of death.

So the choice of which medication to take depends on your personal preferences and other logistical considerations. Your healthcare team can help you weigh your options.

5. There are more restrictions around methadone prescribing than Suboxone

As of 2023, any healthcare professional with a Drug Enforcement Administration (DEA) license can prescribe Suboxone. No special waiver is required as it was in the past. The only requirement is that when applying for, or renewing, a DEA license, the healthcare professional has to complete 8 hours of educational training on OUD. 

This means that primary care providers can prescribe Suboxone for OUD and it can be picked up at a local pharmacy. But call your pharmacy first to check if they have it in stock, or order it for you if they don’t.

Prescribing and dispensing methadone for OUD can only be done through an opioid treatment program (OTP). These programs are certified by Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services (HHS). Unlike a typical prescription, methadone doses are only dispensed at the OTP (versus picking them up at a pharmacy). When you first start methadone, this requires daily visits to the clinic, which may be difficult for some people. But once you're stable, you may be able to receive a month’s supply at once. 

6. They have some different side effects

As with all medications, Suboxone and methadone have risks to be aware of. We’ll cover some of the most common side effects, and some of the more rare but serious risks, in the table below.

Suboxone and methadone can also interact with several other medications, especially other medications that cause drowsiness or slowed breathing. So make sure to give your pharmacist and prescriber a list of the medications and supplements you take. This will help them check for interactions.

Good to know: Taking either of these medications as prescribed is unlikely to lead to an overdose. But misusing methadone or Suboxone, or combining them with other medications that slow your breathing, can be life-threatening. So if you or a loved one takes methadone or Suboxone, it’s a good idea to carry naloxone (Narcan) or nalmefene (Opvee, Zurnai) on you at all times. These are fast-acting medications that reverse the effects of an opioid overdose. You can ask your prescriber for a prescription, but Narcan is also available over the counter.

When should you avoid Suboxone or methadone?

There are some cases where you may need to avoid Suboxone or methadone. For example, people who have significant trouble breathing, such as people with severe or uncontrolled asthma, may need to avoid methadone since it can increase your chance of trouble breathing. If you have a certain gastrointestinal condition, such as an ileus (paralysis of the bowels), you may need to avoid methadone as well, since it’s known to cause constipation. Those with a seizure disorder may also need to avoid methadone, since it can also increase your frequency of seizures.

With either medication, you shouldn’t take it if you’ve had an allergic reaction to it in the past. And in some cases, you may need to avoid one of these medications if you take another medication that can cause a drug interaction. Your healthcare team can help you check for drug interactions before starting these medications.

So, what’s the verdict? Is methadone or Suboxone a better option?

Both buprenorphine and methadone are effective OUD treatments. Choosing the right medication is a personalized decision based on several factors. Below is a summary of the pros and cons of each medication.

Can you take Suboxone and methadone together?

No, you shouldn’t take Suboxone and methadone together for OUD. This increases your risk of side effects, including overdose.

If you’re taking Suboxone and you are interested in switching to methadone (or vice versa), let your prescriber know. They can help you figure out next steps. You’ll need to establish care at an OTP if you’re switching from Suboxone to methadone. If you’re switching from methadone to Suboxone, your substance use specialist will help you figure out how to make the switch.

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Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

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If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.