Methadone and Buprenorphine are both one main medication options for treating opioid addiction. They belong to the treatment method known as substitution therapy as they’re opiate agonists which block opiate receptors. They do differ, however, having their own benefits and downfalls. Rehabilitation programs will use methadone or buprenorphine as an opioid substitute. As the U.S. battles the opiate epidemic, these medications have become essential tools for patients.
Both these opiate agonists prevent dangerous opiates like heroin or oxycodone from binding to your brain. They may produce the feeling of euphoria as well but the effects are much less. When these medications are used properly, through a tapering method, it can decrease an addicts’ desire for illegal drugs. There is controversy about using a replacement opioid as a means to staving off addiction. When used properly, it is a safer option as it’s less likely that an addict will overdose from prescription drugs.
Methadone vs. Buprenorphine: Similarities as an Opiate Addiction Treatment
Buprenorphine, also known as Subutex and suboxone, and Methadone are both agonists that work at the mu receptor. Although opiate agonists like methadone and buprenorphine can also produce a feeling of high, the effects are less than other artificial opiates. They can be used in tapering doses to help decrease a person’s desire for opiate medications. The question is when methadone and buprenorphine are compared, which one provides better long-term results?
Research has shown that they both have their place for preventing further opioid use. They have both been deemed safe to use for preventing an addict from using harmful opioids like heroin. As both medications have been proven to work, they are considered a means of reducing the overdose mortality rate.
Both drugs are long-acting medications with suboxone lasting from 24-60 hours and methadone lasting 8-59 hours. Methadone and buprenorphine don’t peak like heroin, which is a short-life opioid. This long half-life of the medications is what makes them so useful in treatment opioid dependence.
Benefits of Methadone Vs. Buprenorphine
Methadone relieves symptoms of pain and addiction cravings (which includes withdrawal) without causing the patients to develop a tolerance. This means you can take it daily and you won’t need to increase your dose to get continuous results. Methadone will bind to about 30% of your receptors which frees up 70% of your brain function. You can live a normal life while using this method of stabilizing your addiction.
Methadone fills the cravings opiate addicts have, preventing them from relapsing back to heroin or other dangerous opioids. It has been proven as an effective way to get people off dangerous street drugs that can cause overdose or death.
Buprenorphine can potentially cause respiratory depression and euphoria but the effects are much less than methadone. There is a lower risk of abuse, addiction, and side effects than methadone as well.
How Does Buprenorphine Work?
Buprenorphine is only a partial agonist. This means that it is as effective as blocking the opioid receptor as methadone but has a lower euphoric effect. It is also used to control risks of the withdrawal symptoms during addiction treatment.
Buprenorphine started being used in the 1960’s as treatment for opiate addiction. Pharmaceutical companies were creating new medications and combining them to find the cure for addiction in the 1970’s. The focus continuously went back to opiate agonists as the answer.
Weaknesses of Buprenorphine
The downfall of buprenorphine is that as a partial agonist, it isn’t as effective as keeping patients in treatment. It doesn’t offer an addict the euphoric feeling that they may crave from heroin or other dangerous street drugs. This has been attributed to the mortality rates of addicts who are given buprenorphine as opposed to methadone.
How Methadone Works
Methadone has been used as an effective painkiller in Europe since the 1930’s. It has been used as a means of treating opiate addiction for decades. It was introduced into the U.S. as a detox treatment for heroin addiction. In the 1970’s, it was FDA approved as a daily medication for patients with opiate addiction. Since then, methadone has been proven through clinical studies to reduce the amount of people addicted to opiates. Methadone is effective for pain management and will often be used in patients who suffer from on-going pain. Methadone is designed as a program which includes tapering off the drug eventually.
Weaknesses of Methadone
Methadone is a powerful opioid agonist which is its power and its downfall. It taps into the brain receptors in in a similar way to heroin. To get off methadone, you will have to taper off which can take some time. There will be withdrawal symptoms that are more intense than buprenorphine. With methadone, the withdrawal symptoms can last longer than other opiates.
Buprenorphine Abuse vs Methadone Abuse
Another important difference between methadone and buprenorphine is the risk of abuse. Both drugs can be abused. This is especially true in people that are opiate naïve – that is, those that have never taken other opiate drugs like oxycodone or hydrocodone.
However, there’s a maximum dose at which buprenorphine will produce a high. Normally, a person getting high on opioids or opiates needs to increase their dose. This is because the body gets used to the drug. That means it doesn’t have as strong of an effect. As a result, people looking for a stronger high need more of the drug to get the same effects.
Buprenorphine doesn’t have a stronger effect once you reach around 20mg. As a result, people taking buprenorphine are limited in the “high” they can get from the drug.
Methadone doesn’t have a dose ceiling. This means someone can increase the amount they take to keep getting the high they’re after. That means that methadone has a greater potential for abuse than buprenorphine.
Furthermore, nearly all buprenorphine used for ORT has naloxone. This drug blocks all opiate receptor activity. The drug is broken down in the liver when it is taken orally. However, if it is injected, naloxone blocks any type of opiate from working.
Methadone does not have naloxone. That means the ability to inject is another way that methadone has a greater potential for abuse than buprenorphine. This is an important consideration for recovering addicts. The temptation to inject ORT drugs can prevent them from achieving their goal. Specifically, the ORT drug becomes a new way to get high. This works against the goal of using the drug to reduce withdrawal symptoms.
Short-Term Side Effects of Buprenorphine vs Methadone
Buprenorphine and methadone are fairly similar drugs. They are both opioids. Both drugs help fight opioid addiction by reducing withdrawal symptoms. Each drug works by blocking the opiate receptors in the brain and body. However, there are some small but important differences in the short-term side effects of each drug.
Short-Term Side Effects of Buprenorphine
Buprenorphine has several negative short-term side effects. However, these side effects are like those you get from most opiates. They include:
- Respiratory Depression
- Dry mouth
These side effects come from the way that buprenorphine acts on the body. Opiate receptors play a key role in regulating several body functions. These include sleep, metabolism, and mood. Therefore, these are the areas where you are most likely to see short-term side effects from buprenorphine.
It’s important to note that buprenorphine hasn’t been on the market for long. That means that there’s been less research on buprenorphine than on methadone. As a result, there may be other side effects or interactions we just aren’t aware of.
Short-Term Side Effects of Methadone
Methadone has many of the same side effects as buprenorphine. However, we have a better understanding of methadone’s side effects. This is because the medication has been around for more than 50 years. That means scientists and researchers have been able to study it more intensely.
Some of the most common short-term side effects of methadone include:
- Dry mouth
- Stomach cramps
- Sexual impotence
As you can see, the short-term side effects of buprenorphine vs methadone are very similar. However, methadone has a longer list of side effects. It’s not clear if this is because methadone produces more side effects than buprenorphine. We may just know more about the side effects of methadone because it’s been around longer.
Dealing with Short-Term Side Effects of Buprenorphine and Methadone
There are several options for reducing side effects of buprenorphine and methadone. The most common tactic is to change the dose. Side effects are stronger at higher doses. As a result, lowering the dose of medication can help reduce side effects.
Additionally, patients generally see a reduction in side effects as they stay on the medication. This happens because the body gets used to the medicine. It adjusts to prevent side effects from happening.
Finally, a doctor can recommend changing medications if side effects from either buprenorphine or methadone are too intense. Everyone’s body reacts differently to different drugs. Therefore, changing the drug might be the best solution to the problem.
Buprenorphine Vs Methadone: Long-Term Addiction Potential
The methadone maintenance program is designed to counteract the lifestyle of an addict. Sometimes, the best method is to give you a similar high to your drug of choice without the other aspects of addiction. The idea is to decrease the dosage until you no longer have a dependency of the illegal drug. It is expected that because you’re tapering off the maintenance drug, your withdrawal will be minimal. The risks of using needles is reduced as well as the overdose potential. This is the theory but there is also risks in long-term maintenance of methadone.
As buprenorphine is a partial agonist, it is less addictive. They both have pain-killing and addictive effects. Buprenorphine doesn’t activate the mu receptors in the same way as methadone does. The effects will reach a plateau while still giving the addict the ability to stop using illegal drugs with no withdrawal effects. Buprenorphine won’t give any greater effect when you take a higher dose while methadone has no ceiling.
Long-Term Side Effects of Buprenorphine
Buprenorphine was FDA approved as a medication to help opiate addicts get through the initial stages of detox. The drug was approved on the grounds that buprenorphine would be administered by a doctor in a clinic. This was meant to be done in conjunction with either inpatient or outpatient addiction treatment. It is being administered outside of these diameters as a maintenance drug. This has lead people to remain on buprenorphine for up to 10 years.
This is creating a substance abuse to the drug which comes with side effects. As so many patients are taking buprenorphine for long periods of time, the effects compound. When it’s taken for long periods of time, it can cause:
- Joint and muscle pain
- Loss of libido
- Lack of motivation
Long-Term Side Effects of Methadone
Again, methadone is often administered as a maintenance treatment for staying off heroin. There are risks for taking methadone for long periods of time however.
- Dry mouth
- Serious cardiovascular effect
- Higher risk of overdose and respiratory depression than buprenorphine.
- A tolerance to the drug that can increase over time.
- Physical dependence
- Addiction to methadone
- Problems with brain function
- Issues with menstruation in women.
- Addictive characteristics may incur with methadone, causing you to use the way you did before. This includes taking more to experience a high. As your tolerance grows, you take more than what was diagnosed. You become physically dependent so if you tried to abstain, you would experience withdrawal symptoms that include stomach cramps, pain in your bones and muscles, and diarrhea.
Long-Term Buprenorphine Vs. Methadone Drug Rehabilitation Success
Methadone may be considered to have a higher success rate for keeping addicts away from illegal drugs. This is because an addict can achieve their desired feeling with methadone as it’s a full agonist. While it does come with its higher risks, methadone can prevent addicts from turning to more dangerous drugs. Methadone has been used for decades and so the long-term effects are known. This isn’t the case with buprenorphine as it’s relatively new as a maintenance treatment for opioid addiction.
Methadone is considered successful in its own right because it does keep people in the drug rehabilitation process. When the treatment is used in conjunction with holistic healing and therapy, it can be highly effective. The retention rates in the first year of methadone treatment are up to 80% effective. Compared to drugs that contain buprenorphine like Suboxone which has retention rates as low as 56%.
Both drugs are used in a similar way and cause withdrawal when you stop taking them. Buprenorphine may be easier to stop taking than methadone but it hasn’t shown to be as effective for preventing addicts from using again. Methadone has more serious side effects when taken for a long period of time, affecting the heart and lungs. Again, it is hard to know what long-term side effects may arise from Buprenorphine.
Both drugs are highly effective. You and your doctor will want to decide your best option depending on lifestyle, what you’re addicted to, and how addicted you are to it.
Buprenorphine and Methadone Together
Some people wonder if taking suboxone and methadone together is an effective way to fight addiction. After all, if each can work than both together might work even better. However, this is not the case.
Methadone and buprenorphine are different drugs. They each seek to do the same thing. Both drugs block opiate receptors. This prevents patients from getting high on other opiates and opioids while they’re on the drug.
Taking both drugs together prevents each one from working fully. Each of the drugs interferes with the other, rather than working together. People taking methadone should not take suboxone. Likewise, people taking partial antagonists like buprenorphine shouldn’t take methadone.
Buprenorphine vs. Methadone: Risk of Death
When you’re amid getting treatment and you relapse, there is a distinct possibility that you might overdose. The risk of using again is risky at certain phases of your recovery and this is where many of the overdoses occur. As you lose tolerance to heroin, for example, you may take your normal hit which can be too much for your body.
Buprenorphine as a substitute treatment can lower the risk of death due to overdose more than methadone within the first month of abstinence. However, it is more likely an addict will relapse on this drug. For the sake of long-term potential mortality, buprenorphine is also less likely to cause cardiac problems than methadone.
Currently, there are few studies that have compared the long-term results of methadone vs. buprenorphine. It’s not an easy decision to make and you should consider various factors. The dosing schedule, side effects, and risks of death. The decision should really be made with a health professional that knows about addiction.
Methadone and buprenorphine both have their high and low points when it comes to long-term results. With methadone, it has been used for so long that all the side effects are known. While it may seem like buprenorphine is the better alternative, there is still more substantial studies that need to be done.
Perhaps the most important point about methadone and buprenorphine is that it be administered properly. When you take either, there should be a plan with tapering off in a moderate way. Find out if your doctor is familiar with the medications. If they aren’t you may want to seek out a doctor who is. Methadone and buprenorphine should be administered based on aspects of your life. Along with medicine treatment, you should go through a rehabilitation program. Addiction can often come from the need to avoid reality. To truly get off all drugs, both illegal and prescribed, you may have some healing to do.
Which Drug is Best for Opioid Maintenance Therapy
It’s important to make the right choice when it comes to buprenorphine and methadone for opioid maintenance therapy. The best way to make the choice is to understand the benefits and risks of each drug. Moreover, you need an honest understanding of your own relationship to opioids.
Buprenorphine is usually the better choice for people that inject opioids. The fact that it comes with naloxone makes buprenorphine harder to abuse by injecting. However, with methadone there’s the temptation to grind and inject the drug.
Buprenorphine is also a better choice for people who struggle against escalating their high. The dose ceiling that buprenorphine has lowers the risk of abuse compared to methadone. Individuals simply can’t get a bigger effect from the drug by taking more of it. This stands in contrast to methadone. Taking more of the drug creates a stronger effect.
However, there are several scenarios where methadone is the better option. First, methadone is more widely available than buprenorphine. When faced with a choice between methadone now and waiting for buprenorphine, getting help now is always better.
Additionally, budget issues might make methadone the better choice for some people. The drug is generally cheaper and more likely to be covered by insurance. This is an especially important consideration for opioid maintenance therapy. If you aren’t the kind of person who is always looking to get even higher, then methadone offers a safe, cheap way to reduce opioid withdrawal symptoms.
NCBI (Jan-Apr, 2012) J Neurosci Rural Pract. Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Retrieved from,
NCBI, Br J Clin Pharmacol (February, 2014) Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack? Retrieved from,
BMJ (Published April 26, 2017) Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. Retrieved from,
Journal of Addiction Research and Therapy (November 27, 2015) A Comparison of Suboxone and Methadone in the Treatment of Opiate Addiction. Retrieved from,