If you are currently taking methadone as a treatment for opioid addiction, there may be several reasons you want to switch to Suboxone or another form of buprenorphine. A major reason is that people don’t usually feel as sedated on Suboxone and can function better in daily life. Methadone is much more similar to opioids and can cause some euphoria and cognitive impairment, although still much less than, say, heroin.
Another big reason for switching is that methadone treatment requires you to come to the clinic every day for several months, whereas you can get a prescription for Suboxone and take it on your own. There is also now a subdermal time release version of buprenorphine called Sublocade that only needs to be taken once a month, which is even more convenient. Finally, Suboxone is safer. There are fewer side effects, less risk of heart damage, and less risk of overdose.
Switching from methadone to Suboxone is not a seamless process. The two drugs are chemically different, so switching medications is more involved than a simple taper. Suboxone binds more strongly to opioid receptors than methadone. Therefore, you have to partially taper off of methadone before starting Suboxone or you risk going into withdrawal. You will have to drop your methadone dose to 30mg per day or less before switching to Suboxone, and it’s not a good idea to drop your methadone dosage by more than 5mg per week.
If you do decide to switch medications, you should plan it in advance and allow plenty of time for the adjustment. Discuss it with your doctor to make sure you’re aware of the risks and benefits and that you’re making the transition safely.
Some people want to switch from methadone to Suboxone because they believe it will let them avoid withdrawal from methadone. While you don’t have to detox completely, you will have to taper, which will entail some withdrawal, although not nearly as bad as quitting completely. Also, Suboxone can be extremely difficult to quit. People can and do taper off of Suboxone, but it’s not necessarily easier than tapering off of methadone. The good news is that Suboxone is safer to use long-term.
Whether you decide to stick with methadone or switch to Suboxone, it’s important to remember that medication is only one component of treatment. Methadone and Suboxone can make detoxing from opioids easier and reduce cravings, but long-term recovery requires sticking to a recovery plan that includes therapy, social support, and healthy lifestyle changes. Although opioids are extremely addictive, addiction involves a number of factors. If you rely on MAT to the exclusion of the other factors, you’re only addressing part of the problem.