Despite its success in addiction treatment, over the years, an ugly side of methadone has reared its head, as more and more people find themselves addicted to the very drug meant to help them manage their addiction. The numbers are astounding; in 2012, the Centers for Disease Control (CDC) reported that one-third of all prescription drug-related deaths that year were related to methadone overdose.
Seemingly in response to the growing danger of methadone abuse and addiction, British pharmaceutical company Reckitt Benckiser released a drug called Suboxone in 2002. This drug, a combination of buprenorphine and naloxone, was advertised as a possible replacement for methadone. As a partial opioid agonist (compared to the full agonist methadone), scientists argued that Suboxone would offer individuals the same benefits as methadone without the high potential for abuse.
The premise was exciting, and medical professionals and addiction specialists around the world wondered if Suboxone could be as effective as methadone without the abuse risk. Now, thanks to over a decade of research, we can examine the benefits and side effects of both methadone and Suboxone.
For years, methadone maintenance therapy (MMT) has been a common practice in addiction treatment facilities all over the world. This is because methadone is a very effective painkiller, which offers relief to people struggling with the severe withdrawal symptoms associated with addiction to heroin and other narcotics.The effects of methadone are gradual and mild, which makes the drug a safer replacement for opioids of abuse during treatment. Frankly, the results speak for themselves. A 2012 report in the Malaysian Journal of Medical Sciences is just one of many studies that finds MMT responsible for a significant reduction in heroin and opiate addiction, as well as a decrease in risk-taking behaviors like sharing needles. These results have been replicated all over the world, proving that methadone is an effective treatment for addiction.
Essentially, since methadone occupies opioid receptor sites in the brain, users don’t feel cravings for other opioids, like heroin or prescription painkillers. In addition, uncomfortable withdrawal symptoms associated with opioid detox, such as nausea, vomiting, and other flu-like symptoms, are kept at bay. Since withdrawal is managed, individuals are able to focus on the therapeutic aspect of addiction treatment, addressing underlying issues that led to their abuse of opioids. Over time, supervising doctors slowly wean patients off methadone, with the ultimate goal of total abstinence from all substances. That being said, many patients remain on methadone for months, years, or even for life.
As with any other drug, there are side effects to methadone. These side effects can impact both the body and mind, and they range from mild, such as dry mouth and lightheadedness, to more severe, such as lowered respiratory function.
Side effects of methadone include:
There are also certain risks associated with prolonged use of methadone. A study in the journal Addiction and Health found that long-term use of methadone can cause cholestatic pattern liver injury, and other studies suggest that prolonged methadone use could contribute to reduced attention span. Additional evidence suggests that long-term methadone use could escalate into abuse, ultimately leading users back into a cycle of addiction from which they were initially attempting to escape.
Methadone is a full opioid agonist. This means that the drug binds to opioid receptors in the brain and activates them, creating a chemical reaction that leaves an individual vulnerable to dependence. Methadone is classified as a Schedule II substance in the United States; in other words, it is a medically accepted drug with a high potential for abuse.
The darker side of methadone has been revealed quite a bit in the 21st century. The CDC reported a 22 percent increase in methadone-related deaths each year between 2002 and 2006, and that number has only dropped 6 percent per year from 2006 to 2014. Recent estimates state that methadone abuse and accidental overdose account for up to 5,000 deaths each year. Though methadone can be a saving grace for many people, it seems to be a danger for many others.
Suboxone, like methadone, is a synthetic opioid. Unlike its predecessor, which was created first to kill pain on the battlefield and later discovered to be effective for opioid dependence, Suboxone was created with the primary purpose of helping to fight addiction. This drug is made with 80 percent buprenorphine, a partial opioid agonist, and 20 percent naloxone, a medication used to block the effects of opioids. When someone takes Suboxone, buprenorphine binds to receptors in the brain and activates them only slightly, providing relief from withdrawal symptoms while the naloxone blocks the opioid’s effect, keeping the body from experiencing any kind of high.
Studies have found that Suboxone has a positive effect on the lives of people recovering from addiction. A study published in the Journal of Community Hospital Internal Medicine Perspectives found that Suboxone treatment correlated to up to 45 percent fewer emergency room visits among test subjects. It is believed that the Suboxone was integral to keeping these individuals away from opioid abuse.
Neither buprenorphine nor naloxone are completely free from side effects; however, the side effects associated with Suboxone tend to be relatively mild and predominately physical.
In very rare cases, Suboxone can trigger a more severe response. A 2008 article in the American Journal of Emergency Medicine recounts one case in which a dose of Suboxone led to the onset of serotonin syndrome – a condition that involves high body temperatures, agitation, increased reflexes, tremors, sweating, dilated pupils, and diarrhea. However, these cases are few and far between.
Addiction develops when the reward center in an individual’s brain begins to associate the feel-good effects of a certain behavior – drugs, sex, or food, for example – with the surge of dopamine that comes along with the action. The brain then begins to crave the dopamine, compelling the body to seek out the behavior that triggered it.
With Suboxone, there is very little potential for that instigating that surge of dopamine. The buprenorphine produces a very weak effect on the brain, and the naloxone decreases the chance of feeling a euphoric effect even further. For this reason, many medical professionals today consider Suboxone a safer, less addictive option for treating opioid addiction. Suboxone has even been classified as Schedule III by the DEA, indicating that is possesses a moderate to low potential for dependence.
A 2012 article in the Journal of Neurosciences in Rural Practice analyzed the benefits of methadone versus those of buprenorphine, the primary ingredient in Suboxone. They concluded that, even though buprenorphine is likely “the safer agent,” prescriptions for the drug had “failed to overtake methadone in the UK.” This observation is critical, as it conveys the importance of current, updated education for both physicians and patients.
As methadone addiction rates continue to rise, the doctors and addiction specialists tasked with helping people will need to reevaluate the efficacy of the drugs they prescribe. Methadone has helped many patients over the last 70 years, but Suboxone offers the potential for a smoother, safer addiction medication.
The choice between methadone and Suboxone will vary from case to case, depending on the specific client’s needs and circumstances.