Methadone vs. Subutex – How are they different?

Opioid dependence is an epidemic that negatively impacts public health and social and economic well-being. As a result, many treatment alternatives have been created to curb the national surge in opioid misuse, addiction, and fatal overdoses. There are currently three medications approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder (OUD), including buprenorphine, methadone, and naltrexone. 

Opioid maintenance treatment (OMT) is one of the most widely utilized treatment programs that address opioid addiction. OMT involves using opioid medications in conjunction with counseling, behavioral therapies, and aftercare support to achieve prolonged recovery. The two primary medications used in OMT programs involve methadone or buprenorphine (Subutex). 

Even though methadone and Subutex are both recommended for the same causes and produce the same results when used as prescribed, they possess distinctive differences that can influence your treatment choice. As a result of these distinctions, one medication may be more suitable for you than the other.

What Is Subutex?

Subutex is a sublingual tablet approved by the FDA in 2002 to treat opioid dependence. Subutex contains the active ingredient buprenorphine hydrochloride, a partial opioid that binds to opioid receptors in the brain. Subutex treatment helps reduce withdrawal symptoms and cravings for opioids such as heroin and prescription painkillers. And it’s an effective alternative for people who cannot tolerate or should not be exposed to the naloxone found in Suboxone.

Subutex is a Schedule III controlled medication that’s generally prescribed during the acute withdrawal phase. Subutex is prescribed as a daily dose that is placed under the tongue till it completely dissolves. Subutex can be prescribed by any healthcare practitioner licensed to dispense the medication under the Drug Addiction Treatment Act of 2000.

What Is Methadone? 

Methadone is a synthetic opioid medication sold under the brand names Methadose and Dolophine, among others. Methadone consists of a similar chemical structure to morphine and is used for chronic pain management and methadone maintenance treatment (MMT). Methadone functions by activating opioid receptors in the brain to reduce withdrawal symptoms and cravings. 

Methadone is available in the forms of:

• Oral tablet
• Oral solution
• Oral concentrate
• Injectable solution
• Oral dispersible tablet

Methadone is a Schedule II controlled medication that can only be dispensed and administered through an opioid treatment program (OTP), when prescribed for opioid use disorder. Methadone is also used in other aspects of medicine as a potent pain reliever.

Methadone vs. Subutex – Potency of Effects

Methadone is a full opioid medication that binds tightly to opioid receptors and has a wide range of effects that increase as the dose increases. On the other hand, Subutex is a partial opioid, and although it binds to receptors in the brain, it does not have the same potency as methadone. Subutex takes 15-30 minutes to take effect, peaks after three to four hours, and can last anywhere from 24 to 72 hours. Methadone’s effects are felt within 30 minutes upon ingestion, peak around three hours, and last for eight to 12 hours.

While the effects of methadone increase as the dose increases, the effects of Subutex only increase up to a certain point. The opioid effects of Subutex plateau even if a person takes more medication after reaching a certain dose threshold; this “ceiling effect” helps reduce the risk of misuse and negative effects. And it also makes Subutex a safer option than methadone for individuals with a mild to moderate opioid use disorder. At the same time, it also makes it less effective for those with a high tolerance to opioids. 

Side Effects of Subutex

Some of the negative effects associated with Subutex fade as your body adjusts to the medication. Your doctor may be able to advise you on how to avoid or lessen some of these side effects. Consult your doctor if any of the following side effects persist or become troublesome.

The most common side effects of Subutex include:

• Nausea
• Vomiting 
• Constipation 
• Diarrhea
• Indigestion 
• Headache
• Back pain  
• Stomach pain
• Weakness
• Chills
• Profuse sweating
• Insomnia 
• Runny nose 
• Cough 
• Watery Eyes
• Nervousness 
• Drowsiness 
• Anxiety 
• Depression 

Severe side effects may occur if Subutex is combined with other substances that cause slowed breathing or drowsiness. Although most individuals on Subutex hardly experience any serious side effects, they may require medical attention if they do occur.

Side Effects of Methadone

Methadone can cause certain negative effects in addition to its beneficial effects. Some of these side effects may fade or disappear over a few days or weeks.

The most common side effects of methadone include:

• Headache
• Dizziness
• Constipation
• Nausea
• Sleepiness
• Vomiting
• Stomach pain
• Slow breathing
• Tiredness
• Profuse sweating
• Itchy skin
• Increased tolerance
• Dependence

The severe side effects of methadone can be life-threatening. If you experience any of the following symptoms, contact your health care provider immediately.

Some of the severe side effects of methadone include:

• Chest pain
• Light-headedness
• Slowed or shallow breathing
• Dizziness
• Confusion
• Low blood pressure
• Pounding heart rate
• Swelling of the face, lips, tongue, or throat
• Hallucinations
• Hives or rashes
• Fatal overdose

Methadone Withdrawal

Since methadone is a long-acting opioid that can stay in the system for up to 36 hours, methadone withdrawal symptoms take longer to appear than those caused by other opioids. As a result, methadone withdrawal symptoms usually develop within 24-36 hours after the last dose. The duration varies from person to person but can last anywhere from 2-3 weeks to up to six months.

Symptoms of methadone withdrawal include:

• Tremors or shaking
• Sweating
• Fever or chills
• Muscle aches
• Loss of appetite
• Nausea
• Diarrhea
• Vomiting
• Anxiety
• Irritability
• Depression
• Watery eyes
• Runny nose
• Insomnia
• Restlessness

Methadone withdrawal often resembles flu-like symptoms that can be extremely unpleasant and challenging. However, since methadone is gradually tapered off towards the end of treatment, they are generally less severe and do not cause any negative health complications.

Subutex Withdrawal

Similar to methadone, Subutex can also cause withdrawal symptoms during abrupt cessation.  But since Subutex is much less potent than methadone, these symptoms are generally less severe.

Symptoms of Subutex withdrawal include:

• Nausea
• Muscle cramps 
• Vomiting 
• Diarrhea
• Fever 
• Sweating
• Goosebumps 
• Yawning 
• Irritability
• Insomnia 
• Cravings 
• Anxiety 

Subutex withdrawal symptoms occur 48 hours after the last dose and can persist for up to ten days.

Methadone vs. Subutex – Overdose  

When opioids are involved, there is always the risk of an overdose. Methadone overdose occurs when someone accidentally or intentionally takes more than the recommended dose or combines it with other opioid medications. 

Symptoms of a methadone overdose include:

• Dizziness
• Nausea and vomiting
• Hypertension
• Loss of consciousness
• Loss of muscle tone
• Cold, clammy skin
• Constricted pupils
• Discoloration of the nails and fingertips
• Slowed breathing
• Respiratory depression
• Slow pulse
• Coma

Overdosing on Subutex is less likely due to its ceiling effect. Subutex causes less respiratory depression than methadone and, as a result, possesses a lower risk of causing an overdose. However, the potential to cause an overdose remains if the medication is misused or combined with other substances. 

Symptoms of Subutex overdose include:

• Pinpoint pupils
• Dizziness 
• Weak pulse 
• Blurred vision 
• Uncontrollable body movements 
• Extreme drowsiness 
• Cold or clammy skin

A Subutex overdose is quite similar to a Suboxone overdose. But since Suboxone contains naloxone, the symptoms of a Subutex overdose are more prominent and severe.

Methadone vs. Subutex – During Pregnancy

The safety of opioid maintenance treatment for managing substance use disorders during pregnancy is an important issue, given the potential to cause distress or harm to the fetus. According to the National Center for Biotechnology Information (NCBI), methadone is the only medication recommended for pregnant opioid-dependent individuals. And Subutex should only be prescribed when the benefits outweigh the risks. Therefore, given the substantial experience of its use in pregnancy, methadone treatment remains the medication of choice for many clinicians to treat opioid dependence during pregnancy. 

Treatment with methadone doesn’t cause congenital disabilities, contrary to the popular belief that it can create complications in the womb. However, methadone is associated with an increased risk of neonatal abstinence syndrome (NAS) compared with Subutex. Although some newborns may experience withdrawal after birth, this doesn’t necessarily mean that they are addicted. And breastfeeding is still possible for new moms on methadone maintenance treatment.

Both methadone and Subutex are important treatment options for OUD during pregnancy. Both of these medications can help you focus on your recovery while caring for your baby by minimizing the risk of withdrawal and opioid cravings. However, it’s important to note that individuals taking methadone during pregnancy shouldn’t transition to Subutex, as it carries a significant risk of triggering a withdrawal. Transitioning from Subutex to methadone, on the other hand, doesn’t carry this risk. As always, you should speak to your doctor before changing any medications, especially when pregnant. 

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