There are three medications approved by the FDA to treat opioid use disorder (OUD): methadone, buprenorphine, and naltrexone. All three are considered to be safe and effective. Methadone has been used as a treatment for addiction since the 1960s. Buprenorphine has been available in addiction treatment since the early 2000s. Naltrexone was FDA-approved to treat OUD in 2010. Research especially supports the use of methadone and buprenorphine, both of which significantly reduce the risks of relapse and overdose.
Note: Because the most common way to prescribe buprenorphine for OUD is in a formulation that combines it with naloxone, I’m going to focus on Suboxone (buprenorphine/naloxone) in this post, rather than straight buprenorphine.
Suboxone (buprenorphine/naloxone)
Suboxone is a brand name for buprenorphine/naloxone. Another brand is Zubsolv, and generic options are also available. Because it includes naloxone to prevent misuse, many providers and lawmakers prefer it over methadone as a treatment for OUD.
How does Suboxone work?
The buprenorphine in Suboxone is a partial opioid agonist. As an opioid, it binds to opioid receptors in the brain and partially activates them, relieving withdrawal symptoms and reducing cravings. However, because it only partially activates the receptors, buprenorphine doesn’t cause the “high” associated with opioids like heroin or fentanyl.
Suboxone also contains naloxone (known by the brand name Narcan), which is an opioid antagonist that blocks opioid receptors if the medication is misused.
Is Suboxone a controlled substance?
Yes, Suboxone is a Schedule III controlled substance.
What form does Suboxone (buprenorphine/naloxone) come in?
Suboxone is a sublingual film, and other brands of buprenorphine/naloxone come in the form of sublingual films and tablets. It is critical to allow the medication to fully dissolve under the tongue or against the cheek (not chewing or swallowing) in order to receive the full dosage, as buprenorphine is not absorbed well in the stomach or intestines.
Do I have to stop using opioids to take Suboxone (buprenorphine/naloxone)?
Yes. According to the American Society of Addiction Medicine, you will need to prepare for your first dose of medication-assisted treatment containing buprenorphine. This means stopping using opioids for a specified amount of time before you take Suboxone (buprenorphine/naloxone) in order to prevent unpleasant side effects.
Check with your provider for help estimating how long you’re likely to wait before starting Suboxone. They will discuss how to tell when you’ve reached the appropriate level of withdrawal to begin taking Suboxone without risking precipitated withdrawal.
Do I have to stop drinking if I take Suboxone?
Yes, you should avoid alcohol when you take Suboxone. Combining a central nervous system depressant like alcohol with an opioid like Suboxone can be dangerous and may cause depressed breathing.
Do Workit Health providers prescribe Suboxone?
Yes. When clinically appropriate, Workit Health providers prescribe buprenorphine/naloxone, including Suboxone.
Can Suboxone be taken during pregnancy?
Yes, Suboxone can be taken during pregnancy. Like methadone, it is considered a safer option for the parent and fetus than attempting to quit opioids cold turkey.
What are the side effects of Suboxone (buprenorphine/naloxone)?
Some people experience side effects when taking Suboxone (buprenorphine/naloxone). These may subside over time. Common side effects include:
- mouth redness, numbness, or pain
- dizziness
- headache
- numbness or tingling
- sleep problems
- stomach pain
- vomiting
- constipation
- drowsiness
- difficulty concentrating
Methadone
Methadone is the oldest medicine approved by the FDA to treat opioid use disorder. Despite some lingering stigma, when it is taken as prescribed, methadone is safe and effective. Methadone helps individuals achieve and sustain long-term recovery.
How does methadone work?
Methadone is a long-acting opioid agonist. It binds to and activates the opioid receptors in the brain, but does so more slowly than most other opioids. Because of this, methadone (taken as prescribed) usually doesn’t produce a euphoric effect—the “high” that fuels the dangerous using cycle of illicit opiates—after a person becomes accustomed to their dose. Methadone reduces cravings and withdrawal symptoms, and blunts the effects of other opioids.
Is methadone a controlled substance?
Yes, methadone is a Schedule II controlled substance.
What forms does methadone come in?
Methadone comes in several forms. Taken for OUD, it is available in liquid, powder, and pill forms. It is usually taken once per day.
Do I have to stop using opioids to take methadone?
Yes, you should stop taking opioids if you are using methadone treatment. Combining the two can create a sedative effect and respiratory depression, which can be dangerous and can lead to overdose. Talk to your doctor if you take other opioids while you’re receiving methadone.
Do I have to stop drinking if I take methadone?
Yes, you should avoid alcohol when you take methadone. Combining alcohol with an opioid like methadone may cause depressed breathing, impaired reactions, and coma.
Can methadone be taken during pregnancy?
Yes, methadone can be taken during pregnancy. Like buprenorphine/naloxone, it is considered safer for the parent and fetus than attempting to quit opioids cold turkey.
Do Workit Health providers prescribe methadone?
No, Workit Health providers do not prescribe methadone.
What are the side effects of methadone?
Some people experience side effects when taking methadone. These may subside over time. Common side effects include:
- Restlessness
- Nausea or vomiting
- Slow breathing
- Itchy skin
- Heavy sweating
- Constipation
- Sexual problems
Naltrexone
How does naltrexone work?
Naltrexone is an opioid antagonist that blocks opioid receptors in the brain. It reduces opioid and alcohol cravings, prevents opioids from affecting the brain, and reduces the euphoric effects of alcohol.
Is naltrexone a controlled substance?
No, naltrexone is not a controlled substance.
What forms does naltrexone come in?
Naltrexone comes in the form of a daily oral pill under brand names Depade and ReVia, as well as generic versions. It also comes as a monthly injection under the brand name Vivitrol.
Do I have to stop using opioids to take naltrexone?
Yes. If you take opioids and naltrexone at the same time, the naltrexone will block the opioid receptors in the brain. This causes precipitated withdrawal, which can be especially intense and miserable.
Do I have to stop drinking to take naltrexone?
No, you don’t have to stop drinking if you take naltrexone. Naltrexone is also used to treat alcohol use disorder (AUD) by relieving alcohol cravings and reducing the euphoria people experience from drinking.
Do Workit Health providers prescribe naltrexone?
Yes, Workit Health providers prescribe naltrexone for OUD and AUD, as clinically appropriate.
Can naltrexone be taken during pregnancy?
No, naltrexone is not recommended during pregnancy.
What are the side effects of naltrexone?
Naltrexone is usually tolerated well, but some people experience side effects when taking naltrexone. These may subside over time. Common side effects include:
- Sleep problems
- Dizziness
- Joint pain or muscle cramps
- Nausea and/or vomiting
- Loss of appetite
- Cold-like symptoms, like a stuffy nose, sore throat, and sneezing
I know this was a long article, but I hope you find it helpful as you consider the medications available to help support your recovery from opioids.