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Without addiction treatment, opiate addicts striving for recovery have a very poor track record, but when psychotherapy gets combined with medications like methadone or Suboxone, the odd of avoiding relapse go up substantially. Learn more about opiate replacement therapy, about the differences between methadone and Suboxone and find out if medicated opiate addiction treatment is right for you

Simply put, if you are addicted to strong opiates, nothing works better than methadone and/or Suboxone to keep you free from the abuse of opiates, free from withdrawal symptoms and drug cravings and able to focus on getting your health and happiness back on the right track.

What Is Opiate Replacement Therapy?

Opiate replacement therapy is a very effective treatment for opiate addiction. If you are addicted to opiates (like heroin or OxyContin) then you need to take these drugs multiple times a day to get high – and to avoid feeling symptoms of opiate withdrawal.

On opiate replacement therapy, you substitute a once daily dose of a medication like methadone or Suboxone (buprenorphine) for the opiates you usually take to get high. Once you’re on a daily dose of methadone or Suboxone:

  • You no longer feel opiate withdrawal symptoms
  • You no longer get an opiate high
  • You can get back on track with your life

Once you’re appropriately dosed, you’ll feel clear headed and you’ll be freed from the daily prison of cycling between feelings if intoxication and withdrawal. You’re freed from worry about where your next hit will come from and from worry about how to get the money you need each day to maintain such an expensive habit. Once on methadone or Suboxone, you’ll be clear headed and feeling well – feeling ready to start rebuilding a life damaged interrupted by a period of opiate addiction.

Opiate replacement therapy is no magic-bullet solution to addiction, but it does enable you to focus once again on what’s important in your life, and lets you get back to work on achieving meaningful goals.

Research shows that people using opiate replacement therapy are more likely to avoid relapse to opiate abuse than people who try recovery through alternate methods, like detoxification and rehabilitation.

Methadone Quick Facts

  • Methadone has been used as an addiction treatment medication for more than 50 years. It is a very potent and long lasting medication; taking just one dose daily provides a full 24 hours of relief from opiate withdrawal symptoms and drug cravings.
  • Although people that abuse methadone (take higher than directed doses) may experience intoxication, taking the medication as directed will not result in any euphoria or intoxication
  • Methadone is potent enough that at appropriate doses, it can provide full withdrawal symptoms relief to anyone, regardless of opiate tolerance
  • Methadone has one of the lowest cost-barriers to entry of any form of addiction treatment. A daily dose of the medication will generally cost between $10 and $20
  • Methadone has been extensively studied for decades and it has been proven safe and effective even when used for decades. Methadone is even safe for pregnant women

Some Disadvantages of Methadone Treatment

  • Because methadone can be abused and because it has a ‘street value’ people new to a methadone treatment program will have to travel to a clinic each day to take their dose under supervision. In time, those that follow clinic rules can earn increasing take home doses – up to a month at a time.
  • Methadone sometimes has side effects that some people find difficult to tolerate. Examples of side effects include constipation, heavy sweating, weight gain and others.
  • Because of its long half-life, methadone can induce a lengthy period of intense withdrawal symptoms in people who decide to stop using the medication

Suboxone Quick Facts

Suboxone has some advantages, that you won't have to travel to a clinic every day to take your medicine is a big one, but it's not right for everyone. Learn more and see if it's right for you.

  • Suboxone is a relatively newly FDA approved medication for the treatment of opiate addiction. It is also a long duration medication and 1 or 2 pills per day will provide a full day’s relief from opiate withdrawal symptoms and drug cravings.
  • Suboxone is a pill with 2 active ingredients, buprenorphine (which is an opiate) and naloxone (which is added to prevent abuse). The naloxone has no effects unless the medication is abused (injected) at which point it can induce a state of full opiate withdrawal symptoms
  • Because Suboxone is less easily abused, it can be prescribed in a doctor’s office in month long take home doses.
  • Suboxone is more expensive than methadone, but still much less expensive than an addiction to short acting opiates like OxyContin or heroin
  • Suboxone has a dosage ceiling. After a certain dosage, taking additional quantities of this medication produces no further effects. Because of this dosage ceiling, Suboxone is not strong enough to provide full withdrawal symptoms relief to people with very high opiate tolerances (these people will need to use methadone instead)
  • The withdrawal symptoms of Suboxone are much less intense than methadone’s withdrawal symptoms.

Advantages of Treatment with Suboxone or Methadone

Once appropriately medicated on Suboxone or methadone you will:

  • Experience no drug cravings or withdrawal symptoms
  • No longer need to use short acting opiate multiple times daily
  • No longer need to come up with significant amounts of money each day to fund an opiate addiction (Methadone treatment is very affordable)
  • Reduce your exposure to risky behaviors, such as injection drug use, risky sexual practices, crime etc.
  • No longer need fear arrest (the use of these substances, when prescribed, is totally legal)
  • No longer experience daily cycling between intoxication and withdrawal – you can get your life back together and take care of family, school or employment responsibilities

Are You Still an Addict While on Methadone or Suboxone?

Although both methadone and Suboxone are opiates, once you start using them as directed in an addiction treatment program, you are no longer considered to be addicted - here's why.

Both methadone and Suboxone are opiates, and when using these medications as a form of addiction treatment you remain dependent on opiates. This means if you suddenly stop using methadone or Suboxone, you will experience opiate withdrawal symptoms.

While taking methadone or Suboxone once daily as directed by a doctor, however, you are no longer addicted – no longer a drug addict.

The hallmarks of addiction include:

  • Compulsive use
  • Taking a substance even though it does you great harm
  • Drug cravings

Once appropriately medicated on Suboxone or methadone you should experience no drug cravings, your health should improve and you will use only once a day in controlled doses (not compulsive). Once using methadone or Suboxone for addiction treatment – you are no longer a drug addict.

Opiate Replacement Therapy during Pregnancy

Although moms-to-be often want to maximize health and well being during pregnancy (and often this means wanting to break free from all opiates) opiate withdrawal symptoms are very hard on the fetus and can lead to miscarriage. For this reason, pregnant women are not advised to attempt to detox off opiates.

The use of methadone during pregnancy has been extensively studied and it is proven safe for mom and baby. Women on methadone are far more likely to receive appropriate prenatal care and to give birth to health, full term babies. Methadone is considered the gold-standard treatment for opiate addicted pregnant women.

Suboxone is less commonly recommended as a medication for pregnant women as there are only a few studies in existence to confirm the safety of this medication for use during a pregnancy. Under some circumstances, (such as when methadone is unavailable or when a woman is already on Suboxone) doctors will prescribe Subutex during pregnancy. What limited evidence there is points to Subutex being a safe and effective medication for pregnant women.

Dangers of Opiate Replacement Therapy

Methadone is an opiate that works in the brain very similarly to heroin or OxyContin and just as you can OD on such drugs, so too can you OD on methadone. Methadone must be used exactly as directed and should never be combined with certain other substances. Suboxone is a far safer medication, although it too has resulted in overdose deaths when combined with benzodiazepines.

Methadone can result in fatal overdose and fatal overdose deaths involving methadone are on the rise (From 790 deaths in 199 to 5420 in 2006)1 although much of this increase is likely attributable to the increased use of methadone as a prescription analgesic.

Methadone is a very potent opiate with a very long half life and so it must be used with respect and with caution, and always exactly as doctor prescribed. The risks of methadone overdose and death increase dramatically when methadone is used with other drugs, such as with other opiates or with benzodiazepines and other sedative drugs. For people using methadone as a therapy for opiate addiction, the risks are greatest in the initial dose induction phase.

Methadone must also be stored as directed, completely out of the reach and access of children. A single daily dose of methadone is more than enough to kill a small child, and there are too many such tragedies every year in America. (While an opiate dependent adult may require 100 mg or more a day, just one tenth of that amount, 10 mg can prove lethal to a child and 50 or 60 mg can kill a fully grown adult without an opiate tolerance)2

Other than the risk of overdose, methadone is a very benign substance, whish does the body little harm, even when used in high doses over long periods of time ) A study of adult patients maintained on high doses of methadone for 14 years found no adverse health effects attributable to this use of methadone)*. People on methadone are sometimes bothered by non dangerous side effects, such as unusually heavy sweating, constipation, weight gain and a loss of libido.


Due to its dosage ceiling (after a certain point, taking additional quantities of Suboxone has little additional result) Suboxone is a far safer medication than methadone. This increased safety profile is one of the major reasons why you can take it home in month long doses.

Although it is safer, it still needs to be used as directed. People have died after mixing buprenorphine with sedative drugs, like benzodiazepines. 

The Effectiveness of Opiate Replacement Therapy

You have a better chance of breaking free from an addiction to short acting opiates and improving health and wellbeing by using methadone or Suboxone than by using treatments that do not involve opiate replacement therapy, such as detoxification and non medicated drug rehab.

Some research studies which illustrate the benefits of methadone and Suboxone include:

  • A 2003 Cochran Review of 11 double blind studies comparing methadone treatment to treatments that did not involve opiate replacement found that methadone worked significantly better in keeping people involved in treatment and away from the abuse of illicit opiates. In fact - a consistent problem in the studies reviewed was the difficulty experimenters had in keeping people assigned to non-methadone using control groups from dropping out of the experiment!3
  • In a 1991 National Institute on Drug Abuse (NIDA) study on heroin and methadone users in New York City, researchers found that the average yearly societal cost of an opiate addict on the street was $43 000, incarcerated it was $34 000, in a residential drug rehab program it was $11 000 and in a methadone maintenance program it was $2 400.4
  • A study of adult patients maintained on high doses of methadone for 14 years found no adverse health effects attributable to this use of methadone.5
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Page last updated Nov 20, 2015

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