We get lots of questions from people who are looking to switch from methadone to Suboxone. Patients want to make the transition from for many reasons. Methadone programs are typically very restrictive, making patients come in on a daily basis, making it difficult when patients have jobs and families and lives.
Patients also say they want to switch to Suboxone because they get tired of the methadone feeling. They say they get a heavy feeling from being on methadone that they don’t get from Suboxone. Methadone is a full agonist. It activates the patient’s opioid receptors at 100% and can give patients a euphoric effect. Suboxone on the other hand is a partial agonist. It activates the receptor only partially and patients report feeling “normal” when taking it.
Suboxone has a "ceiling" effect on respiratory depression so it is relatively safe when taken properly. Methadone has no ceiling effect on respiratory depression so it can be a dangerous medication if taken in too hight a dose, which is why it is much more tightly regulated. Suboxone can become dangerous when combined with other medications, but by itself has been shown to be relatively safe. Suboxone has been formulated with naloxone in it to lessen it’s abuse potential. Both medications are highly diverted making prescribers' and clinics' jobs of monitoring these medications challenging.
Suboxone, from the get-go in an outpatient treatment program, allows patients more freedom. Patients can obtain a prescription from their doctor, fill it at a pharmacy and take the medication from the privacy of their home. They usually only need to check in with their doctor weekly, initially, then eventually as they stabilize, on a monthly basis.
Some patients need more monitoring and methadone programs can be better suited for their recovery. Often, that is true when patients are at the initial stages of their recovery. Many patients, however, quickly find themselves in a restrictive methadone program, with no clear exit.
Patients find it very challenging to transfer from methadone to Suboxone as a result of methadone’s long half life and strong attachment to the opioid receptors. Patients need to reduce their dose down to thirty to forty milligrams of methadone then take their last dose 72 hours before taking Suboxone. Both of these tasks can be difficult for a methadone patient. 72 hours can feel like a very long time to go without any opiate replacement therapy. Thirty to forty milligrams of methadone can feel like a very low dose.
The patient who successfully makes the switch from methadone to Suboxone is a highly motivated patient.
We are here to help and provide support, but its likely that you will need significant counseling support during the gap between your methadone and Suboxone therapies.