Suboxone or Methadone for Long Term Treatment
anonymous Asks ...
If a person is going to use an opiate substitution for long term maintenance (like maybe for forever) is there any reason to choose methadone over Suboxone or Suboxone over methadone? Right now I am thinking methadone because it’s a lot cheaper and it has been studied for a long time and it seems very safe for long term usage. Can you advise me one way or another?
Anna Deeds Says ...
Thank you for your question. I really can't say if methadone or Suboxone would be better for you without knowing more about you and your situation. What I can do is review each medication so you can make a better informed decision. I'm not going to say which are the pros and cons because while I may think something like going every day for treatment is a plus, you may see it as a con.
It will effectively keep you from having withdrawal symptoms.
It can relieve cravings for opiates.
It does not relieve all cravings since many cravings are psychological so some people use other drugs on methadone which can be dangerous.
It can be taken only once a day.
It is safe to take long-term. SAMHSA has done a lot of research on the use of methadone and its safety.
You will be required to have counseling which can help with the psychological aspects of addiction.
You will only be given a daily dose in the beginning so you have to go to the clinic every day. This can be a plus to teach you to not abuse the medication by taking it early but if transportation is an issue, this can cause more problems.
You can earn privileges to take more medication home over time.
You will be tied to the methadone clinic for your medication so vacations or out of town travel may have to be approved by the facility.
It can effectively treat withdrawal symptoms.
It can be taken once a day.
It can reduce cravings for opiates but not for other drugs and you may still have psychological cravings or the urge to get "high."
You have to wait two to five days after taking opiates or opioids before beginning treatment. If you start taking it before you begin having withdrawal then it will cause you to have withdrawal.
Most people get one to two weeks or up to a month of medication at a time. This can be a pro if you work or have transportation problems but it can be a con if you cannot manage that much medication without abusing it or diverting it to others. (Many addicts get more Suboxone that they take and will sell or give it to others.)
If you get your medication every two weeks or up to a month, you have more freedom to take vacations or travel.
There may or may not be requirements for counseling. Some insurances require counseling before they pay for treatment. However, if you pay cash, you may not be required to have counseling. I recommend counseling even if it is not required because it can help with psychological aspects of addiction and can help you put your life back together.
On a personal note, I would recommend that if you choose methadone, you stay on the lowest dose possible that you can go 24 hours withdrawal free. I was on methadone for many years and I found it to be sedating. I felt I lacked motivation and drive to do something with my life until I got on a lower dose. The amount of a "low" dose varies per person. Just remember to take increases slowly because it takes about 5 days for each increase to have its full effect.
Good luck and I hope it works out for you whichever you choose. If you should choose to give each a try to see which works better for you, I recommend trying Suboxone first because it is easier to switch from Suboxone to methadone because Suboxone has more of a blocker. When someone switches from methadone to Suboxone, they have to wait as much as five days and feel the full effects of withdrawal before beginning Suboxone treatment.
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