Suboxone (buprenorphine) and methadone are the two leading medications available for the treatment of opioid addiction. They are both opioid replacement therapies that, when taken regularly, will prevent an individual from experiencing opioid withdrawal sickness. Suboxone was approved by the FDA in 2002, and this allowed local physicians to begin prescribing Suboxone from their offices to opioid addicted patients seeking help.
This was a landmark achievement in consumer choice and provided people another very useful option for dealing with opioid addiction. To treat a patient with suboxone, a physician must first complete a comprehensive course, and become approved, before being allowed to prescribe the medication.
Since opioid replacement medication by itself addresses only the underlying physiological dependence (but not the related psychological contributors to addiction), patients are required to obtain substance abuse counseling as a part of their suboxone treatment. This additional requirement helps to ensure that patients are receiving education & training in understanding their addiction, and in identifying methods for preventing opioid relapse in the future.
Many suboxone-approved physicians do not provide this supplemental addiction counseling, and will consequently refer their suboxone patients to local providers who offer drug treatment services.
While suboxone and methadone are similar in action, they are unique enough to offer distinctly different advantages. You can review our comparison chart to examine some of the differences between the two medications. Both methadone and suboxone are slow acting, long lasting opioid agonists that bind to the body's opiate receptors. This particular action eliminates opioid withdrawal sickness very effectively, and thus allows individuals to resume their daily lives.
Suboxone is actually a branded medication & product of the pharmaceutical company, Indivior. Suboxone is currently available as a thin film that is held under the tongue until the medication dissolves. Once dissolved, the medication is naturally absorbed through the tissues under the tongue and into the bloodstream. The newer film formulation dissolves somewhat more quickly than the previously available tablet form.
Suboxone is generally taken once per day although some patients with a milder opioid dependency may be able to take the medication every other day and remain comfortable. Suboxone does not produce a drug high for tolerant users, and does not interfere with one's daily activities. Many patients report feeling very comfortable while being maintained on suboxone and also during their gradual taper off of the medication.
What is in Suboxone?
Suboxone is a combination of buprenorphine and naloxone. Buprenorphine (an opioid agonist) is the ingredient that binds to opiate receptors and provides relief by blocking withdrawal symptoms (very similar to methadone). Naloxone is an opioid antagonist that reverses the effects of opiates and will cause withdrawal. This seems like a strange paradox having both ingredients in one tablet. However, do not worry. Remember, Suboxone is dissolved and absorbed under the tongue. The antagonist, Naloxone, becomes inert (has no effect) when dissolved under the tongue. So one only experiences the benefit of the Buprenorphine.
Why is Naloxone Added to Suboxone?
Specifically to discourage & prevent injection use of suboxone. Some addicted individuals may try to inject suboxone to obtain a drug high. When they do so, the Naloxone becomes immediately active (since it's being injected directly into the bloodstream), and it brings on sudden withdrawal symptoms making the individual feel very sick. This reinforces a person for using suboxone the proper way (under the tongue), and prevents future attempts at injecting suboxone.
How Do I Know if Suboxone is Right For Me?
This is a great question although a little difficult to answer. Suboxone tends to be effective for a considerable number of people addicted to opioids. Many of those who do well with suboxone are people who have a relatively shorter duration of opioid addiction or whose addiction is based on a comparatively smaller amount of daily opioid use. Heavy opioid users with a longer history of addiction sometimes respond better to methadone. However, there are notable exceptions.
Suboxone has a ceiling effect around 24-32 mg of medication daily. 32 mg is generally considered to be the dose at which maximum withdrawal relief is provided. For most addicted people, taking more than 24-32 mg of suboxone daily will not provide any more additional relief. Methadone has no such ceiling effect and its dosage levels can be raised much higher, consequently providing a greater level of comfort and symptom relief for more severe opioid dependencies.
In conclusion, 8 mg to 32 mg of suboxone may provide excellent relief for someone new to medication-assisted recovery. If they find that suboxone is not strong enough to manage their withdrawal symptoms, then methadone most certainly will since it has no "ceiling effect".
Taper programs aim to stabilize an opioid addicted individual on suboxone for a brief period of time and then taper their dosage down over a 60 to 90 day period. This taper period is not set in stone and can vary depending on the individual's need. The primary goal is to stabilize with suboxone and to then taper off with the end result being complete freedom from opioids and opioid replacement medication. Some patients do very well with a scheduled taper. Other patients may find that tapering is problematic and will switch to a period of maintenance. Maintenance with suboxone is effective and safe, just like with methadone. Upon first entering the market, Suboxone was mostly used for tapering off of opioids. However, it is commonly used today for extended maintenance in similar fashion to methadone.
For more on Suboxone Doctors, read: www.Methadone.us/suboxone-doctors/
Behavioral Health Group (BHG) currently provides 54 top flight opioid addiction treatment centers in the United States. The company specializes in medication-assisted treatment using methadone, buprenorphine, and buprenorphine/naloxone.
BHG takes a patient-centered approach to treating addictive disorders offering counseling as a fundamental component of the overall treatment model. Because of this individualized treatment approach, 97% of patients surveyed indicate they would recommend BHG Recovery to a friend or family member suffering from opioid addiction.
Additionally, 99% of patients report that their mental health and quality of life improved since their BHG admission. 60% of unemployed patients were able to obtain employment after one year of treatment.
Hope, Respect, and Caring are tenets of BHG’s treatment program, and their staff strive to provide this from the moment a patient first walks in to receive help. All of BHG’s treatment centers provide care in an outpatient setting.
In 2019, BHG Recovery added (6) additional U.S. clinics to the Methadone.US national directory list …
1. Franklin, VA – BHG Franklin Treatment Center
Acadia Healthcare is a leading provider of addiction treatment and behavioral healthcare services in the USA, the UK, and Puerto Rico. Worldwide, they operate a network of 593 facilities with 18,100 beds in 40 U.S. States. Of these locations, Acadia offer medication-assisted opioid treatment in 127 of their facilities.
In 2019, Acadia added 11 additional U.S. clinics to the Methadone.US national directory list …
1. Aberdeen, WA – Grays Harbor Treatment Solutions
While Acadia are experts in the treatment of opioid misuse disorders, they treat a wide variety of addiction-related problems utilizing traditional outpatient programs up to inpatient detoxification and residential treatment. You can view Acadia’s Levels of Care descriptions to gain a better view of the breadth of their substance abuse services.
Here is a complete listing of Acadia opioid treatment clinics.
Recovery from opioid addiction initially centers around physical stabilization: specifically the management of opioid withdrawal. This is an essential step for the vast majority of opioid addicted people seeking help. Research has shown a 90% failure rate for opioid treatment programs that do not offer medication assistance.
Methadone was the original medication FDA-approved for treating opioid addiction although Subutex has been recently introduced into opioid treatment programs around the country as a viable alternative. Subutex is effective especially for milder levels of opioid dependency.
Subutex is a brand name version of buprenorphine, the partial opioid agonist that reduces withdrawal symptom sickness. Most patients are familiar with “Suboxone” which is a popular buprenorphine-based film that is dissolved under the tongue and is taken once per day. It differs from Subutex in that it contains naloxone so that it cannot be easily abused intravenously.
A number of methadone clinics began offering subutex in the past few years in an effort to expand treatment options for patients. Because subutex can be abused, it is typically administered daily in the clinic by a nurse where it can be supervised.
If you are considering entering a treatment program for opioid misuse, you may want to ask about the variety of medications utilized by the clinic or physician. Some patients have successfully transitioned from methadone to subutex while others enter the program starting with subutex. This is a decision best made in conjunction with your treating doctor who can formulate a treatment plan based on your history of opioid use.
Methadone programs and doctors who prescribe buprenorphine serve a very important function in helping the country cope with the opioid crisis. They are also a life-saving link for patients who have suffered for years with an overwhelming addiction.
Operating a methadone clinic or buprenorphine/suboxone practice is typically a complex endeavor. Clinics that offer medication-assisted treatment (MAT) must comply with a myriad of mandates and policy requirements from the DEA, the local State Methadone Authority, accreditation organizations like CARF and JCAH, SAMHSA (the Substance Abuse and Mental Health Services Administration}, and 3rd party payers who help fund treatment services.
Patients understand that a well-run treatment clinic offers many benefits. Quality services are only delivered when there is an organizational commitment to helping people while also being able to meet all of the operational requirements such as timely documentation of services (paperwork) and appropriate support of staff & counselors,
Sometimes patients will complain about “so many clinic rules” although many patients appreciate their clinic’s dedication to professionalism and its ability to meet the standards of good quality care. Within most treatment facilities are several key staff who oversee its daily operation and the provision of services. These are the Clinical Director, the Medical Director or primary prescribing physician, the Nurse Supervisor, and possibly clinical staff Team Leaders who do the work of coordinating the clinics many daily activities.
While the list of clinic rules can seem long, there is nearly always an important underlying reason for that rule to exist. Most methadone clinics distribute a Handbook for clients that outlines their rights as an opioid treatment patient as well as guidelines for obtaining dosage adjustments and progressing successfully through treatment.
Opioid treatment, and medication-assistance in particular, must be carefully monitored. This is to insure patient safety and to minimize the risk of medication errors. Please support your local methadone or suboxone clinic with words of encouragement and positive feedback when it is earned. Conversely, it is important to speak up as well if serious problems are occurring. Always make an effort to communicate first with the clinic’s clinical and administrative staff if experiencing a problem. If an honest effort to resolve an issue in this manner is not productive, then contacting one’s local State Methadone Authority is sometimes a logical next step for addressing an important concern.
Several organizations in Ohio recently hosted a town hall discussion on the opioid crisis still occurring there and across the country. News commentator, Eric Bolling, was a moderator of the event which was held at Cedarville University.
Eric and his wife, Adrienne, lost their 19 year old son in 2017 due to an accidental overdose with the powerful opioid, fentanyl.
This town hall discussion was designed to continue raising public awareness on the danger of opioid misuse and the continuing need for treatment and recovery support services to help families deal with this perpetual problem.
The Centers for Disease Control (CDC) report that there were 70,237 drug overdoses in 2017 with 47,600 involving opioids specifically. The article linked above states that the state of Ohio ranked 2nd in overdose deaths only behind West Virginia.
There is promising news in that more Americans are now being educated on opioid risks, and consequently are taking better precautions as well as actively accessing methadone & suboxone programs offering helpful medication-assistance and behavioral counseling. Saving lives and offering recovery are messages that are being heard.