Methadone vs. Buprenorphine for addiction…
January 22, 2014
There has been much controversy for decades over the treatment of opioid addiction. Methadone has been the mainstay, along with detox, rehab counseling and perhaps outpatient behavioral modification. Methadone has its advantages, such as low cost, and it quite effectively suppresses cravings for heroin and other opioids. The problems with methadone are numerous however, such as the need to show at the clinic daily for sometimes megadoses of liquid methadone. This is a problematic area. Even in profound addicts, methadone is so powerful that the clients become somnolent and then are released to drive themselves home, or wherever. Methadone is indeed a powerful agonist just like heroin, oxycodone, morphine, fentanyl, etc. So such psychic effects should not be unexpected, even though the somewhat slower onset of action of methadone mitigates this side effect a bit. Other very significant side effects involve pregnant methadone users, who deliver babies highly dependent on the opioid and must be routinely treated with weaning doses of an IV opioid in the neonatal intensive care nurseries, often for weeks or months at tremendous taxpayer expense. Finally, methadone is most usually considered simply a replacement therapy for heroin, etc. It is not viewed except, under rare circumstances, as a stepping stone to finally being opioid free.
Suboxone has been touted as a worthwhile alternative to methadone. It is a weak partial agonist with a threshold effect. While methadone and other potent opioids can be taken to a point of severe respiratory depression and fairly rapid death, Suboxone cannot, unless the patient consumes with multiple other concurrent drugs such as alcohol, benzos, and other sedatives, even these cases are unusual. The relative safety of Suboxone allows for the writing of a prescription that frees the patient up from daily visits to the Suboxone center. Also, it appears to be just as effective in craving suppression as methadone, but without the somnolence and adverse effect on neonates born to addict mothers. Time spent in neonatal intensive inpatient care is minimal in comparison to methadone users during gestation – saving taxpayer monies. Naturally, the drug model of treating opioid addiction in isolation does not succeed forever, except in unusual circumstances, unless combined with appropriate psychotherapy; this can take the form of group therapies, IOPs, solo CBT, etc.
There is little doubt that Suboxone treatment of opioid addiction will supplant methadone treatment eventually. The long term financial future of methadone clinics is therefore very murky at best.