How Easy Is It to Switch From Buprenorphine to Methadone?

The first line treatments for opioid maintenance therapy include both methadone and buprenorphine treatment.

What Are Methadone and Buprenorphine?

There is enormous societal and economic suffering caused by opioid use disorder (OUDs) relapses, which is a chronic and recurrent condition. Among all drug-related fatalities, opioid overdose is still the leading cause of mortality, followed by suicides, accidents, and communicable infections.1 

Methadone is an orally active synthetic complete mu-opioid agonist with a very high binding affinity for opioid receptors. Unlike methadone, buprenorphine drugs have a greater affinity for mu-opioid receptors and an antagonistic action on kappa receptors.2

Buprenorphine Treatment

How Are Buprenorphine and Methadone Used?

Methadone is typically used to treat opioid addiction and chronic pain. It is sold under several trade names, including Dolophine and Methadose. The FDA has licensed buprenorphine to treat acute, chronic, and opioid-related pain.3

Buprenorphine, however, has fewer side effects than stronger medications like heroin and methadone. The effects of buprenorphine for opioid use disorder grow with each dosage until they plateau at moderate levels, even after increasing doses. This "ceiling effect," reduces the likelihood of overuse, dependence, and negative effects.

Understanding Buprenorphine and Methadone

It has been shown that this substance reduces the use of alcohol; consequently, buprenorphine alcohol treatment is another treatment that utilizes the opioid. Some of buprenorphine's other names include Sublocade, Belbuca, and Subutex. The half-life of buprenorphine is long, ranging from twenty-four to forty-two hours.4 

In an opioid-tolerant patient, the methadone half-life is around twenty-four hours; however, for a patient who has never used opioids, it is around fifty-five hours. Thus, people newer to opioids have a longer duration of the symptoms.

How Do Methadone and Buprenorphine Treatments Differ?

Using methadone and buprenorphine for opioid addiction differ in the following ways:

  • While methadone generally comes as a drink, buprenorphine (naloxone) is typically taken as pills that are absorbed under the tongue.
  • There's a decreased risk of overdose with buprenorphine compared with methadone.
  • Buprenorphine for pain may be prescribed by any doctor, whereas methadone can only be prescribed by doctors who have finished specialized training.
  • Buprenorphine therapy may be more easily accessible than methadone treatment, which is most typically found in specialist treatment centers.
  • While buprenorphine just takes a few days to attain a completely effective dosage, methadone might take weeks.
  • Generally, buprenorphine will have fewer and milder adverse effects than methadone.

Are There Any Interactions Between Buprenorphine and Other Substances?

Buprenorphine drug interactions may be quite problematic. It may be very risky to combine buprenorphine or methadone with other medicines that slow down the central nervous system (CNS). Avoid alcohol, benzodiazepines, and other opioid painkillers (e.g., clonazepam, Ativan, Restoril, Xanax, Valium). This substance may wear off more rapidly if you consume other substances while on opioid agonist therapy, putting you at risk for severe buprenorphine withdrawal symptoms.

Do Methadone and Buprenorphine Have Overdose Potential?

Buprenorphine and methadone have a high potential for overdose, but the risks of methadone overdoses are much greater.

When you begin therapy and stop taking an opioid like buprenorphine for a while, and then suddenly begin taking it again, there is considerable danger. A deadly overdose is also more likely when opioids are mixed with other drugs.

What Are the Side Effects of Buprenorphine?

Before beginning therapy with buprenorphine, you should speak to your doctor about the medicine, its adverse effects, and any other treatment alternatives that may be available. Buprenorphine side effects can include:

  • Headache
  • Vertigo
  • Sedation
  • Slow breathing
  • Dizziness
  • Vomiting
  • Constricted pupils
  • Nausea
  • Hypotension
  • Sweating

How Buprenorphine Works

As mentioned above, buprenorphine is an opioid that works as a partial agonist and has various negative side effects.

It is safe and effective to take buprenorphine as directed by a doctor or pharmacist. Buprenorphine’s mechanism of action and its pharmacological properties make it the best medication-assisted treatment for opioid dependence. It works by reducing the physical side effects of opioid dependence, including cravings and withdrawal symptoms. It also helps to boost safety in overdose situations and reduce the overall risk of abuse.

What Is Buprenorphine Treatment (BT) Like?

The three stages of buprenorphine treatment will be detailed below.

The Induction Phase

Buprenorphine therapy might start in a doctor's office under medical supervision. If you are in the early stages of opioid withdrawal and have not used the addictive substance in the last twelve to twenty-four hours, buprenorphine is your best choice for treating the withdrawal symptoms. However, if you are not in the early stages of withdrawal and have other opioids in your system, buprenorphine side effects may be acute.

The Stabilization Phase

This phase begins following cessation or substantial reduction in drug usage, and when the patient no longer suffers cravings or other negative effects of other substances or drugs. Dosage adjustments may be necessary during this time, as it often depends on how much the patient used to use drugs. 

The Maintenance Phase

Once a person taking buprenorphine is doing well on a steady dose, they will move on to the maintenance phase. The length of the maintenance phase is based on what each patient needs. By working closely with a health professional, you or your loved one can get a better idea of how long you will need to stay in this phase.

Buprenorphine Treatment

Should You Switch From Buprenorphine to Methadone?

You cannot ignore buprenorphine and methadone addiction risks when using either of them, despite them being primarily used for addiction recovery. However, for opioid use disorder treatment, buprenorphine therapy has become more commonly accessible than methadone treatment. Nonetheless, studies have shown that methadone treatment works better at lower doses. A flexible methadone dosage seems to outperform a flexible buprenorphine dose regarding participant retention.6

How Do You Switch?

When you've received your final dosage of buprenorphine, you should begin methadone around a day later.7

Generally speaking, keep in mind the following:

  • Unlike other opioid blockers, methadone does not contain an opioid blocker itself.
  • Wait at least two days following your previous buprenorphine dosage to start methadone.

Is Methadone Stronger Than Buprenorphine?

Methadone and buprenorphine seem indistinguishable in efficacy when they’re used at medium or high dosages. Methadone is not always more potent than buprenorphine, however. Both drugs effectively reduce the brain's desire for opioids without the high associated with morphine, oxycodone, or other drugs.8

Is Methadone More Effective?

The benefits of using buprenorphine are varied, as it has a higher safety profile than methadone in improving the outcomes of those with opioid use disorders, although methadone is generally superior and can be used in more circumstances.9

Get Help for Switching from Buprenorphine to Methadone at Soledad House

Both buprenorphine and methadone have a high potential for overdose, but the risk of buprenorphine overdose is much greater. If you want assistance transitioning from buprenorphine to methadone, please contact Soledad House, where highly regarded healthcare experts will treat you.

Contact Soledad House to Learn More

Our team is standing by to discuss treatment options with you. Your call is completely confidential and no obligation is required.