Frequently Asked Questions
1. What is methadone and how does it work?
Methadone is an opioid medication commonly used to treat opiate addiction and relieve pain. It is not, however, used to treat other non-opiate drug addictions to substances like alcohol, marijuana or cocaine. Methadone blocks the receptors in the brain that are affected by opiates, such as prescription pain pills and heroin, enabling users to experience a more gradual detox process rather than a more extreme and painful withdrawal process. Methadone is available in the form of a pill or oral solution, and has been available in the US for more than 65 years.
Methadone reduces the drug cravings and harsh withdrawal symptoms that are often associated with a patient’s relapse, without creating the sense of euphoria associated with the abuse of opiates. Methadone’s effects last between 24 and 36 hours, and therefore most patients benefit from a single daily dose.
2. What is buprenorphine, brand name Suboxone?
Subutex and Suboxone (buprenorphine) were approved for the treatment of opiate addiction by the FDA in 2000. It may be used as a short term withdrawal medication or as a longer term maintenance medication. It offers a more flexible and less restrictive form of opiate medication therapy than methadone, but it is equally effective in treating addiction and normalizing brain opiate function. Unlike methadone, physicians may write a prescription for Suboxone which the patient can simply take to any pharmacy. For some patients there may also be less side effects than methadone. Regular physician medication visits should be supplemented by participation in a counseling program.
Suboxone is a combination of buprenorphine and naloxone (also known as Narcan). Naloxone is an opioid antagonist, which is used to counter the effects of an opiate overdose as well as the euphoric feelings associated with opiate use.
3. What is the difference between methadone and Suboxone?
Buprenorphine, the active ingredient in Suboxone, and methadone are both opioids, and activate the opioid receptors on nerve cells. Both are long acting medications, and that makes them very useful for the purposes of opiate addiction treatment. However, there are very key differences that distinguish these two medications from one another.
Methadone is a full mu opioid agonist. This means simply that it will continue to produce its effects on the opioid receptors until all receptors are fully activated or the maximum effect is reached. This is similar to the way heroin impacts the brain as it is also a full agonist. Methadone however, once the right dosage is achieved, can eliminate the euphoric effects felt from illicit use, without allowing the painful effects of having too low of a dose of methadone.
Buprenorphine is what is called a partial agonist, which means it does not activate the mu receptors to the same level as methadone. The effects felt have a ceiling, meaning they will not reach and excessively pleasurable level, no matter how much the dose is increased. Buprenorphine or Suboxone, can still have effects on respiration and minimal euphoric feelings, but not near to the extent of full agonists.
4. Is medication assisted treatment safe?
When used under medical supervision as a part of a treatment program, methadone and Suboxone can safely be taken without any damaging side effects. According to the U.S. Office of National Drug Control Policy, methadone is “a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.” In addition, at the correct dose, there is no impairment to mental function or daily activities. These medications are prescribed or distributed by licensed nurses with the approval of a physician, under strict state and federal guidelines, and only produced by licensed pharmaceutical companies.
Methadone and Suboxone do have serious drug interaction potential that should be discussed with a doctor and fully understood before participating in a medication assisted treatment program. Medications such as benzodiazepines, sedatives, opioid antagonists and other opioid agonists present a danger to the user. Additionally, use of alcohol is prohibited due to dangers of respiratory distress. Be sure to discuss these interactions with your doctor or medication nurse.
5. What are the benefits of Medication Assisted Treatment?
Medication assisted treatment (MAT) has been used to treat opiate addictions for more than 40 years, and countless clinical trials and studies have shown it to be the most effective way to find long-term recovery from an opiate addiction.
The California Society of Addiction Medicine indicates, “Detoxifications and drug free modalities, although appealing to an understandable desire for recovery without medications, produces only 5-10% success rate. Methadone maintenance is associated with success rates ranging from 60 – 90%.”
The success of medication assisted treatment can be primarily attributed to the relief of painful withdrawal symptoms that lead to relapse in so many. Additionally, MAT programs provide and sometimes require counseling which gets to the root of the causes of use, and can provide community resources, support and health care in some cases. Finally, participation in a MAT program often reduces risky behaviors associated with drug use including criminal activity and violence, and exposure to intravenous or sexually transmitted diseases.
6. How long does Medication Assisted Treatment last?
Medication assisted treatment programs are designed to address each individual’s unique situation, so no definitive length of treatment can be provided here. Studies have shown that the greatest chance for success comes to those who participate in a treatment program for a year or more, and sometimes for many years.
7. What are the potential side effects of Suboxone or Methadone?
Side effects of both methadone and Suboxone are known to be minor, with no long-term health risks. Most reduce over time, once a stable dose of medication is reached.
These potential side effects include:
- Weight gain
- Dry mouth
- Cold or flu-like symptoms
- Sleep disturbance
- Mood Swings
- Reduced libido
8. Why is there new terminology being used in substance use treatment and recovery? How does the change help reduce the stigma towards addiction and medication-assisted treatment?
There is a shift in the substance use disorder treatment field to move away from language that perpetuates the stigma associated not only with methadone or buprenorphine treatment, but with addiction itself. The negative connotation associated with commonly used words such as “abuse” and “addict” seem to further the thought that using or becoming dependent on an illicit drug or prescribed medication is a moral failing, lack of willpower or choice that a person makes.
Additionally, words such as “replacement” or “substitution” therapy only serve to validate the belief that methadone, buprenorphine and other medication-assisted treatment options simply replace one drug with another, rather than offering a real solution to a medical problem. Within the treatment programs themselves there is language that aggravates the stigma. Urinalysis being referred to as “clean” or “dirty” rather than positive or negative and “dosing” used in place of medication.
The overarching message of industry doctors, leaders and organizations working to change the language and discussion around treatment and recovery is that when we use negative, stigmatizing language we create an environment where it is shameful to seek help for a proven medical condition. A change in the conversation and more education regarding addiction disorders can change the way we view substance use disorder treatment, and make it more readily available to those who need it.
Examples of non-stigmatizing language includes:
- Substance Use Disorder rather than Substance Abuse
- Opiate or Opioid Use Disorder rather than Opiate Addiction
- Person or Patient with Substance Use Disorder rather than Addict or Abuser
- Positive, Negative, Detected Urinalysis rather than Dirty, Clean Urinalysis
- Use or Misuse rather than Abuse
- Medication rather than Drug, when referring to methadone or buprenorphine