Methadone or Suboxone which is the best option?

Introduction

Methadone is one of the many adolescent drug treatment commonly used today to treat opioid dependence. It works by relieving the narcotic craving, suppressing the abstinence syndrome, and blocking the euphoric effects associated with heroin or any other opioid. Other than methadone, Suboxone has also been used to counter the effect of opioid drugs thus losing the addict's interest in the drug. However, which is the best, methadone or Suboxone? (Oviedo-Joekes, E., Brissette, S., Marsh, 366-78)

Explanation

Methadone vs. Suboxone

Suboxone is an opioid partial agonist. This means that, although Suboxone is an opioid, and thus can produce typical opioid agonist effects and side effects such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone. At low doses Suboxone produces sufficient agonist effect to enable opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symptoms.

The agonist effects of Suboxone increase linearly with increasing doses of the drug until at moderate doses they reach a plateau and no longer continue to increase with further increases in dose—the “ceiling effect.” Thus, Suboxone carries a lower risk of abuse, addiction, and side effects compared to full opioid agonists. In fact, in high doses and under certain circumstances, Suboxone can actually block the effects of full opioid agonists and can precipitate withdrawal symptoms if administered to an opioid-addicted individual while a full agonist is in the bloodstream. (Oviedo-Joekes, E., Brissette, S., Marsh, 366-78)

Suboxone has poor oral bioavailability and moderate sublingual bioavailability. Formulations for opioid addiction treatment are in the form of sublingual tablets. Suboxone is highly bound to plasma proteins. It is metabolized by the liver via the cytochrome P4503A4 enzyme system into norSuboxone and other metabolites. The half-life of Suboxone is 24-60 hours.

Efficiency

In terms of efficacy, high-dose Suboxone has been found to be superior to 20--40 mg of methadone per day. In all cases, high-dose Suboxone has been found to be far superior to placebo and an effective treatment for opioid addiction, with retention rates of 50 percent as a minimum.

Because of its ceiling effect and poor bioavailability, Suboxone is safer in overdose than opioid full agonists. The maximal effects of Suboxone appear to occur in the 16-32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects. (Oviedo-Joekes, E., Brissette, S., Marsh, 366-78)

Opioid Addiction Therapy with Suboxone

This section provides a brief overview of the clinical use of Suboxone (Suboxone® and Subutex®) for opioid addiction therapy. For detailed information on this topic see the Suboxone Clinical Practice Guidelines.

Ideal candidates for opioid addiction treatment with Suboxone are individuals who have been objectively diagnosed with opioid addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to Suboxone therapy, and who agree to Suboxone treatment after a review of treatment options. There are three phases of Suboxone maintenance therapy: induction, stabilization, and maintenance. (Virk, M. S., Arttamangkul, S., Birdsong, ...