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Treatment
Suboxone vs Methadone: Understanding Your Options
Both Suboxone and methadone treat opioid addiction, but they work differently. Here's how to understand which might be right for you.
If you’re looking into medication-assisted treatment for opioid addiction, you’ve probably heard of both Suboxone and methadone. They’re both effective, but they work differently and have different requirements.
This guide breaks down the key differences so you can understand your options.
What they have in common
Both Suboxone and methadone are FDA-approved medications for treating opioid use disorder. Both reduce cravings and withdrawal symptoms. Both allow you to function normally while you work on recovery.
And both work. Research shows that people on MAT are more likely to stay in treatment, less likely to overdose, and more likely to rebuild their lives.
How Suboxone works
Suboxone contains buprenorphine (a partial opioid agonist) and naloxone (an opioid blocker).
What that means: Buprenorphine attaches to opioid receptors in your brain just enough to reduce cravings and withdrawal, but not enough to get you high. It has a ceiling effect — taking more doesn’t make you feel higher.
Naloxone is included to prevent misuse. If you try to inject Suboxone, the naloxone causes withdrawal.
How you take it: Film that dissolves under your tongue, once a day.
Where you get it: Doctor’s office or clinic. You can take it home.
How methadone works
Methadone is a full opioid agonist. It fully activates opioid receptors, which eliminates cravings and withdrawal.
What that means: Methadone works more like the opioids you were using, but it’s long-acting and doesn’t create a high when taken as prescribed.
How you take it: Liquid you drink, once a day.
Where you get it: Methadone clinic only. You have to go to the clinic every day to take your dose under supervision (at least initially).
Key differences
Access
Suboxone: You can get it at a doctor’s office, community mental health center, or specialized clinic. You take it at home.
Methadone: You have to go to a licensed methadone clinic every single day. The clinic is open specific hours (usually early morning). You take your dose there and leave.
Flexibility
Suboxone: After you’re stable, you might only need to come in weekly or monthly for check-ins and refills. You manage your medication at home.
Methadone: You start by going to the clinic every day. After months of stability, you might earn take-home doses for weekends or a few days at a time. But you’ll still need to come in regularly.
Overdose risk
Suboxone: Lower risk of overdose because of the ceiling effect. Taking more doesn’t increase respiratory depression beyond a certain point.
Methadone: Higher risk of overdose, especially when starting or if you take more than prescribed. Methadone can slow breathing.
Withdrawal when stopping
Suboxone: Easier to taper off. Withdrawal is generally milder.
Methadone: Harder to taper off. Withdrawal can be more intense and longer-lasting.
Mixing with other substances
Suboxone: Safer (but still not recommended) if mixed with alcohol or benzodiazepines.
Methadone: Very dangerous if mixed with alcohol, benzos, or other sedatives. High risk of overdose.
Cost
Suboxone: Covered by most insurances, including Medicaid. Generic versions are available.
Methadone: Usually cheaper out-of-pocket, but you have to pay the clinic fee daily. Medicaid covers it.
Who Suboxone might be better for
- You have a job or school schedule that makes daily clinic visits hard
- You live far from a methadone clinic
- You want more independence in managing your recovery
- You’re stable enough to take medication at home
- You prefer fewer restrictions
Who methadone might be better for
- You’ve tried Suboxone and it didn’t work
- You need more structure and daily accountability
- You’re using high doses of opioids and need something stronger
- You benefit from the daily routine of going to a clinic
- You’re pregnant (methadone is often preferred during pregnancy)
What about Vivitrol?
There’s a third option: Vivitrol (naltrexone injection).
How it works: Blocks opioid receptors completely. If you use opioids while on Vivitrol, you won’t feel anything.
Key difference: You have to be fully detoxed (7-10 days off opioids) before starting Vivitrol. With Suboxone and methadone, you can start while you’re still using.
Who it’s for: People who have already detoxed and want to prevent relapse.
Southern Highlands offers Suboxone and Vivitrol, but not methadone.
Can you switch between them?
Yes, but it requires careful planning.
Switching from methadone to Suboxone: You have to taper down your methadone dose first, then wait until you’re in withdrawal before taking Suboxone. If you take Suboxone too soon, it causes precipitated withdrawal (which feels worse than regular withdrawal).
Switching from Suboxone to methadone: Easier. You can start methadone the day after your last Suboxone dose.
Switching to Vivitrol: You have to be completely off opioids (including Suboxone and methadone) for 7-10 days before getting the Vivitrol shot.
What if you’re not sure which is right?
Talk to a doctor or counselor. They’ll consider:
- How much you’re using
- Your daily schedule and responsibilities
- Whether you’ve tried MAT before
- Your support system
- Your preferences
There’s no wrong choice. The best medication is the one you’ll stick with.
The stigma around both
There’s stigma around all forms of MAT. People say things like “you’re not really sober” or “you’re just trading one drug for another.”
Ignore that.
Both Suboxone and methadone are evidence-based treatments recommended by every major medical organization. They save lives.
What about counseling?
Whether you choose Suboxone or methadone, counseling is required. Medication alone isn’t enough.
Counseling helps you:
- Understand triggers
- Learn coping skills
- Address underlying issues
- Build a support system
- Plan for long-term recovery
Frequently Asked Questions
Is one more effective than the other?
Both are effective. Research shows similar outcomes for people who stay in treatment. The best one is the one that fits your life and that you’ll stick with.
Can you get high on methadone?
If you take it as prescribed, no. Methadone is long-acting and doesn’t create a high. But if you take more than prescribed or mix it with other substances, it’s dangerous.
Why do methadone clinics require daily visits?
Federal regulations. Methadone is tightly controlled because of its overdose risk. You have to earn take-home doses by proving stability.
Can you work while on methadone?
Yes. Many methadone clinics open early (6-7 AM) so you can dose before work.
Which is easier to get off of?
Suboxone is generally easier to taper off than methadone. But both require a slow taper under medical supervision.
If you’re interested in Suboxone or Vivitrol treatment in Southern West Virginia, you can call Southern Highlands. Suboxone: (304) 425-9541 ext. 1277. Vivitrol: (304) 425-9541 ext. 1525. They serve Mercer, McDowell, and Wyoming counties.