According to the Centers for Disease Control, over 80,000 people lost their lives to opioid overdose in 2021. Treatment programs that include effective medication options for opioid use disorder (OUD) have never been more important than they are today. At ReVIDA® Recovery, we believe that quality treatment can prevent senseless and tragic deaths from OUD.
Methadone and buprenorphine (Suboxone®) are both recommended when it comes to treating opioid use disorders (OUD) – but recently, doctors, patients, and insurance companies have been leaning more toward buprenorphine (Suboxone®). buprenorphine (Suboxone®) can cause fewer dependency issues, give those in recovery a clear head, and it can be taken outside of a doctor’s direct supervision. This makes it convenient for the patient. For these reasons and more, many patients are looking to switch from methadone to buprenorphine (Suboxone®).
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What Are the Benefits of Switching From Methadone to Buprenorphine (Suboxone®)?
Buprenorphine (Suboxone®) is in a category of medications called “opioid antagonists”, which means that it blocks the euphoric effects that opioids usually provide. This helps manage cravings and reduce withdrawal symptoms – things that are very important to those seeking recovery or abstinence. Unlike its predecessor, methadone, buprenorphine (Suboxone®) was explicitly created for opioid cessation and withdrawals. It has a “ceiling effect,” meaning it’s very difficult to feel “high” on this medication. The ceiling effect also works to prevent an overdose.
The euphoria someone feels while taking buprenorphine (Suboxone®) is limited. Because of this, the chances of overdosing on buprenorphine (Suboxone®) are smaller than on methadone. This creates a more stable lifestyle for the person using buprenorphine (Suboxone®). There’s less risk of experiencing fatigue or incapacitation when taking buprenorphine (Suboxone®) vs. methadone.
Because of methadone’s sensitivity, patients take it while under a doctor’s direct supervision in the beginning. A doctor needs to monitor a patient to make sure the methadone is not causing distress or discomfort. This can be inconvenient for many, as not everyone has the time to see their doctor whenever they need a dose. buprenorphine (Suboxone®) doesn’t have this roadblock – it can be taken at home. This provides an opportunity for the patient to manage their care independently, in the comfort of their home. While patients will still need to check in with their doctor to ensure the medication is doing its job, it allows for more freedom than a methadone prescription.
It’s easier to get insurance coverage for buprenorphine (Suboxone®) than it is for methadone. Methadone coverage is subject to federal dispensing requirements – licensed opioid treatment programs can only dispense it. If someone is trying to stop taking opioids but they’re not enrolled in a treatment program, they won’t be able to get coverage (or a prescription) for methadone. Because of this, many are switching from methadone to buprenorphine (Suboxone®). While both medications are FDA-approved, methadone usually needs prior approval from an insurance company before it’s prescribed. This makes it harder to obtain.
What Are the Side Effects of Switching From Methadone to Buprenorphine (Suboxone®)?
In a 2008 study published by the National Library of Medicine, researchers monitored 33 patients while they switched from methadone to buprenorphine (Suboxone®). They studied patients who switched from low, medium, and high doses of methadone. They found that for the most part, there weren’t too many side effects. Some patients experienced precipitated withdrawal symptoms, and 21% of the high-dose patients returned to methadone.
Methadone and buprenorphine (Suboxone®) both work similarly in the brain. They both act on the brain’s opioid receptors, and they both attach themselves to the area of the brain responsible for pain, pleasure, and cravings. Switching between the two medications is very low-risk because of this. It’s not going to feel like a huge change.
As the study stated, there is a risk of experiencing some minor withdrawal symptoms when making the change. This is why many physicians recommend tapering down on methadone (to at least 30mg) before making the switch. This can take time. Patients who taper from methadone might feel both physical and mental withdrawal symptoms.
Here are some of the withdrawal symptoms patients might experience when switching from methadone to buprenorphine (Suboxone®):
- Restlessness
- Fatigue
- Muscle aches
- Nausea and vomiting
- Depression
- Anxiety
- Intense cravings
- Gastrointestinal distress
Symptoms will usually peak around 3 days into the process. Once a patient has started buprenorphine (Suboxone®), they should normalize fairly quickly.
What to Expect When Switching from Methadone to Buprenorphine (Suboxone®)
The dosage of methadone you’ve been taking along with your mental health history are factors your doctor will take into consideration before switching you from methadone to buprenorphine/naloxone. If your current prescription is for 40mg or more of methadone, your doctor will most likely help you taper your dose to 30mg before making the switch. For some, tapering to 30mg won’t be low enough. Some people can experience precipitated withdrawals when switching from 30mg of methadone to buprenorphine. If you’re still experiencing withdrawals when you’re down to 30mg of methadone, your doctor might recommend a different tapering schedule to get you down to less.
Doctors could also recommend complete cessation of methadone for 72 hours or more before your first dose of suboxone. It’s important to follow your doctor’s instructions implicitly because this isn’t an easy transition. Taking buprenorphine (Suboxone®) too soon after a methadone dose can be extremely uncomfortable. Taking your time is vital. Minor withdrawals can be expected, but if they get severe, don’t hesitate to call your doctor. Don’t feel like you’re pestering them, or you’re a burden. They want you to be comfortable in this process, and they want to know about any concerns you may have. There are also medications they can prescribe to help you through the withdrawals during your transition.
Remember that by choosing to switch to buprenorphine, you will likely be forgoing the constant check-ins/monitoring that you have with methadone. You must be prepared to take that step towards independence.
If you switch and decide you need the extra layer of accountability, there are other options available. Narcotics Anonymous (NA), for example, can work wonderfully if you regularly attend meetings. It can also provide you with the added level of support you might be missing from your methadone days. If NA isn’t appealing, there are also other treatment programs you can participate in. You can attend intensive outpatient treatment or you can request more frequent meetings with your physician.
Switching from methadone to buprenorphine (Suboxone®) is possible, and it can be done safely and efficiently. As long as you’re coordinating with your providers and following your medication schedule, making the change is doable.
At ReVIDA® Recovery, we know making the switch from methadone to buprenorphine is a big step. We want to empower you on your journey to recovery using evidence-based practices for OUD. Our goal is to deliver clinical excellence and industry-leading outcomes. To learn more or to schedule an appointment, call us at 423-631-0432.
FAQs About Switching From Methadone To buprenorphine (Suboxone®)
How long do I have to wait to take buprenorphine (Suboxone®) after taking methadone?
Most doctors will ask for a 72-hour window between your last dose of methadone and your first dose of buprenorphine (Suboxone®).
How difficult is it to switch from methadone to buprenorphine (Suboxone®)?
Every patient is different, and so are their reactions to changing from methadone to buprenorphine. There are multiple factors at play like what an individual’s current dose of methadone is, what their mental health history is (whether or not they’re prone to anxiety/depression), what their physical health looks like, and how strong their support system is. For some, making the switch comes with minimal withdrawals. For others, precipitated withdrawals can cause discomfort.
Remember: always communicate with your provider because they can help ease certain withdrawal symptoms. They may also have tips for how to make the switch between these two medications easier.
Is buprenorphine (Suboxone®) a better treatment than methadone?
Both methadone and buprenorphine (Suboxone®) are effective at treating opioid use disorders (OUD). Methadone requires more supervision/ a treatment program for a subscription. buprenorphine (Suboxone®) can be prescribed by any clinician. Patients might enjoy the independence that comes with buprenorphine. The ceiling effect of buprenorphine (Suboxone®) also means a smaller chance of overdose.
