Addiction Medicine

Methadone Versus Suboxone

The major treatment for opioid dependence is opioid replacement therapy.

Two big options exist. Both are given daily under observation.

Methadone

  • Only opioid agonist activity, not antagonist
    • Can be dangerous if IVDU while on methadone
  • Works in special groups
    • Mental health
      • Safe in mental health issues, like schizophrenia
    • Pregnant
      • Not teratogenic
    • Homeless
      • As have more chaotic lifestyle
  • Longer half-life
    • Increase dose more slowly, such after 4 days

Suboxone

  • Combined partial opioid agonist and antagonist
    • Buprenorphine plus naloxone
  • First-line in normal situations
    • Given methadone in pregnancy
      • Buprenorphine has no studies on safety
      • Naloxone is teratogenic
    • Suboxone is considered weaker than methadone
  • Given sublingually
    • So goes to blood
    • Not effective if taken orally through gastrointestinal system
    • Naloxone works as antagonist in blood, not gut
    • Thus, is good if IVDU patient
  • Can increase dose every day, such as after 24 hours

References

  • Doctor from Centre For Addiction Medicine
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