When Is Methadone Better Than Buprenorphine?

In certain instances, buprenorphine can be a beneficial medication for those addicted to and/or dependent on opioid drugs. However, there are times where the newer pharmacological therapy is not a substitute for the longer-used methadone treatment.

Long-term Methadone Users

For the most part, those who have been long-term methadone users are safe to stay on the drug instead of switching to buprenorphine. There has been a push, especially recently, for those who have been on methadone to switch to the other medication, but this is not always necessary, nor is it always beneficial. According to the Substance Abuse and Mental Health Services Administration, “Because the two medications are so different, patients may not always be satisfied with the results” if they do decide to make the switch.

Those who are used to long-term treatment with methadone often have already found a balance that works for them, and unless they have become specifically unhappy with the way the drug is performing, it may not be a good choice to make the change. Some individuals do like the difference of being able to attend treatment at a doctor’s office instead of a methadone clinic, and there could be a possible reason to switch if it would become much easier for the patient to get their medication. However, if there isn’t a real call for this change when someone has been on methadone for a long time, it may be best to stay with that treatment option.

High-Level Opioid Dependence

withdrawal treatment

Methadone is the better option for treating severe withdrawal.

Part of the reason why the switch can be difficult on a person is because buprenorphine is only equally effective to “moderate doses of methadone.” This means it can help treat individuals who have low levels of opioid dependence and who experience less severe withdrawal symptoms and cravings. “Because buprenorphine is unlikely to be as effective as more optimal-dose methadone, it may not be the treatment of choice for patients with high levels of physical dependency.”

Other Times to Choose Methadone

Those who begin opioid addiction treatment without the prior use of either drug may wonder which would be more effective for them. While there is no way to determine what each individual patient will need outside of setting up a treatment plan with a doctor, here are some instances in which a patient may be better suited for methadone treatment:

  • Pregnant individuals may want to choose methadone over buprenorphine, at least for now. According to the Journal of Neurosciences in Rural Practice, “Buprenorphine is not licensed” for the purpose of treating pregnant patients “and, given the substantial experience of its use in pregnancy, methadone remains the opioid of choice for many clinicians in these circumstances.”
  • Methadone can be a better choice for those individuals who need a daily, well-rounded treatment option: one where they visit a facility, take classes, and attend multiple treatments to help with their recovery.
  • The drug can also be better for those who need to have their medication administered by a doctor, as they may not yet be able to do so safely themselves.

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