Exploring the Transition From Methadone to Suboxone for Effective Treatment

For anyone considering a switch to Suboxone from a more traditional use of methadone for an opioid (painkiller) use disorder (OUD), this detailed guide talks about all the necessary information. Discussing the pros and cons of moving from one medication to another allows one to make an informed choice in different patient circumstances. Traditionally methadone has been a popular medication-assisted treatment (MAT) for combating drug abuse, but its requirement of frequent clinic visits for everyday intake can burden individuals going through recovery.

On the other hand, Suboxone is a unique choice offering more flexibility and freedom to shape recovery around people’s schedules. Besides that, factors like user experiences of the two medications are important to consider, and only by closely evaluating these factors can patients draw valuable insights to aid their decision-making process. Let’s explore all these considerations to finding an effective and personalized path to recovery.

The Use of Suboxone Offers Patients More Freedom

The methadone program has generally been the most popular and a much older form of medication-assisted treatment (MAT) to help against drug misuse. However, it requires a frequent—even daily—intake of methadone from a clinic. Thus a patient undergoing this recovery must visit the said methadone clinic regularly.

Suboxone, on the other hand, is a slightly different form of medicine that can be taken by the patient, even at home, according to their own will. This means the patient doesn’t have to receive the drug from a clinic daily.

For some individuals with solid, reliable recovery and a strong recovery course, going to the clinic so frequently is a burden. These individuals will appreciate the change to daily buprenorphine (Suboxone), freeing up their time and allowing them a normal lifestyle while still being on a MAT to support their recovery from dependence. Hence, if the affected person is busy with their family or work, they might consider switching to Suboxone.

Chances of Misuse in the Case of Suboxone Treatment Are Relatively Low

One of the reasons that methadone is commonly given to people from clinics is to prevent its misuse. If the patient decides to take the methadone treatment from home, the risk of methadone misuse increases. The patient receives mental relaxation similar to that of the painkiller drug methadone when they use it without supervision. This affects their journey against opioid addiction and, in some cases, may even cause them to relapse and re-adopt their previous drug-taking habits.

However, curing opioid addiction using Suboxone dramatically reduces this risk. Misuse of Suboxone is not possible in most cases due to what is known as the “ceiling effect.” This means that the effect of Suboxone increases with the increase in its dose, but only to a certain point. Once this level is reached, a further increase in the dose will not increase the effect the person gets from it. This maximum amount is the “ceiling” of the effect derived from using Suboxone.

Once the patient is aware of this quality of Suboxone, they avoid using it in excess, preventing its misuse. This is the primary reason why it is safe for people to receive the suboxone treatment at home without supervision. Recoverers who are unreliable and more likely to misuse recovery drugs can benefit from Suboxone.

Other Benefits of Suboxone Over Methadone

Research and user experience strongly suggest that methadone is much stronger than Suboxone. This partly has to do with the workings of each of these drugs. Methadone works gradually in the long run and aims to control the withdrawal symptoms experienced by the patient. Suboxone, however, can be used for similar aims and to control the cravings for the painkiller drug.

Methadone is a “full agonist” targeted to activate a person’s painkiller receptors at 100%. Thus, the heavier feeling is experienced to a maximum level by the user. Some users develop a dislike for this sort of ongoing euphoric feeling in the longer run. Suboxone, on the other hand, is a “partial agonist” and activates these receptors partially, leading to the user feeling and behaving normally. This is primarily why many users regard the use of Suboxone much more comfortable and adaptive.

Also relevant is the state policy concerning the prescription of Suboxone in an emergency. Suboxone is a drug that can be easily accessible in the case of an emergency from a medical professional. According to the new 3-day regulations made by the government, Suboxone has been made more widely accessible to cure dependency even without prescriptions in some cases of emergency. This means that the reliance on recovery drugs using Suboxone is rising with the endorsement of state-level organizations.

How to Switch from Methadone to Suboxone

Once patients switch from methadone to Suboxone, they must consult a medical professional, as switching from one addiction treatment method to another can be challenging. This is especially true of people who are already taking high doses of methadone. The nature of methadone being a full agonist means that the receptors in the body are heavily dependent on large doses of methadone. Therefore, a person may experience withdrawal symptoms if they stop using methadone all at once. A decision must be made through communication with a medical professional to determine the levels of methadone that the person takes over time.

Once the patient has stopped the intake of methadone completely, a dose of Suboxone must be taken, but with an interval of 36-72 hours between the first dose of Suboxone and the last dose of methadone. During this period, the patient may suffer withdrawal symptoms like anxiety, fever or chills, sweating, shakiness, nausea, vomiting, or diarrhea. The doctor will monitor these effects closely and suggest a good time to start Suboxone. Multiple factors like the unique organ system of the person, drug use history, other medications, and medical conditions may play a role in determining this time further doses of Suboxone that the person must take regularly.

Taking Methadone and Suboxone at the Same Time

It can be very dangerous to use both methadone and Suboxone simultaneously. Their use simultaneously can trigger severe painkiller overdose, which is relatively the same as the overdose resulting from substance abuse. In addition, there is a profound risk that the naloxone component of Suboxone throws one into methadone cancellation.

Intermixing the two drugs may also bring about more dire consequences. As mentioned in the article, methadone is a full agonist, contrary to Suboxone which is only a partial agonist. Simply put, a substance being an agonist tells how much it contributes to turning the receptors on for its effect. Hence methadone succeeds in turning on all the receptors, while the use of suboxone turns on fewer receptors. On the surface, it might mean that methadone engages with more receptors than Suboxone. However, it must be noted that Suboxone binds more strongly even to the fewer receptors it engages with than methadone. This is the concept of receptor affinity. Suboxone then “kicks” off methadone from the receptors in the brain.

This occurs when a patient suffers discontinuation issues due to the drugs used in MAT or other medications and not from the initial drug substance being abused (in this case, a substance similar to heroin). When faced with this state, the person may experience a range of consequences like muscle aches, chronic pain, fever, cramping, sweating, sleeplessness, and dilated pupils.

In some rare cases, intake of mixed methadone and Suboxone can also lead to heart rhythm issues, which can be very dangerous.

This is why it is recommended to wait for at least 24 hours (ideally 36-72 hours) before switching from methadone to Suboxone to ensure that a person doesn’t have to go through the difficult and prolonged experience of precipitated discontinuation or other conditions resulting from the mixing of methadone and Suboxone.

Possible Side-effects and Risks of Suboxone Administration

Despite being a safer alternative to methadone regarding misuse, it must be remembered that Suboxone is still considered a painkiller and brings possible risks like dependence and overdose. The risks, though still much lower than  methadone or the abused drug itself, are present nevertheless. Hence, some people begin injecting the drug despite the ceiling effect and gain the required “high” while staying within the limits of the ceiling. This directly puts them at risk of developing addiction since they don’t develop a tolerance to the drug. The time-release quality of the drug may be overlooked during this and bring the person close to a possible overdose.

Some of the well-known consequences of Suboxone include diarrhea, migraine, and general uneasiness in the stomach and body, to name a few. Besides that, the risk of possible addiction, as discussed above, is caused by the feeling of relaxation and peace brought on by drug usage.

Due to its nature as a painkiller, it can bring about further side effects like upset stomach, headache, tingling sensation in the mouth, difficulty passing stool, sore tongue, lightheadedness and loss of consciousness, difficulty focusing, abnormal heartbeat, and more.

Another serious negative effect of using Suboxone is that it can cause breathing difficulties, similar to the effects of other painkillers. This happens when inhaling and exhaling slow down, resulting in low oxygen levels. This issue is observed in roughly 1-10% of drug patients. Hence, drug users must consult a doctor when this condition arises, and to keep one safe, the drug levels must be monitored carefully.

Suboxone and Its Interactions With a Variety of Drugs and Foods

Drug interactions include a variety of medications with other substances that can impact the medication’s results on the body. This can lead to the medication being less or more effective than intended, resulting in unexpected and adverse effects.

Hard drinks must be avoided when undergoing treatment, including Suboxone. Combining drugs with Suboxone can increase the risk for life-threatening side effects like laziness, blackout, respiratory depression, and even coma.

Suboxone can also interact with a wide range of other drugs. It can react with benzodiazepines (like Xanax, Valium, and more), treat opioids (like methadone and oxycodone), sleeping pills, muscle relaxants, seizure medications, antipsychotics, certain antidepressants, etc. Suboxone reacts with these drugs, and the effects of these drugs and Suboxone itself are increased to a large amount. When interacting with such substances, side effects similar to using drugs with Suboxone are expected. Therefore a medical practitioner must be consulted to assess the pros and cons of using Suboxone.

Some specific food items may also be avoided when using Suboxone. One such is grapefruit and related items. This may block the breakdown of Suboxone in the body, resulting in greater harm from Suboxone.

Some herbs may also play in with Suboxone. St. John’s wort can result in the body breaking down Suboxone sooner than required, making it useless. Besides, it can increase the chances of another syndrome known as serotonin syndrome. Herbs, further increasing laziness, may as well act with Suboxone. Using Suboxone with one of these may lead to extreme laziness. These include chamomile, kava, and valerian.

So Should One Really Consider Switching to Suboxone?

Ultimately, the answer to this question lies with the individual deciding whether to make this change. They must factor in the benefits of Suboxone against the trouble that one has to go through during the switching process and its side effects. Other factors must also be considered, like whether the person has an alcohol addiction or is in the habit of using drugs that interact negatively with Suboxone. Regardless of their personal views, people should always weigh in with the advice of a professional medical practitioner who fully knows their patient’s medical history and habits.