Quick Summary
Methadone and buprenorphine (the medication in Suboxone) are both proven treatments for opioid use disorder, and neither is the right answer for everyone. Studies show both can cut overdose deaths. Methadone tends to keep more people in treatment, but buprenorphine is often easier to get because it can be prescribed in a regular office. The best choice depends on your health, your daily life, and what your prescriber recommends after a full evaluation.
Key Takeaways
- Both medications can reduce cravings and withdrawal, and both are linked to fewer overdose deaths while a person stays in treatment.[4][2]
- In a large review of clinical trials, methadone kept more people in treatment than flexible-dose buprenorphine. Among people who stayed, opioid use dropped about the same on both.[1]
- Methadone is only available through approved opioid treatment programs. Buprenorphine can be prescribed by many doctors, nurse practitioners, and physician assistants.[4]
- Each medication has its own safety points, such as heart rhythm risks with methadone, drowsiness and an alcohol warning with buprenorphine, and a start that your prescriber directs for both.[5][6]
- Choosing between them is a decision to make with a qualified prescriber. Both work best alongside counseling and support.
How Methadone Works
Methadone is an opioid medication that has been used for more than 50 years to treat opioid use disorder. According to the National Institute on Drug Abuse (NIDA), it activates the same receptors in the brain as heroin and fentanyl, but it does so more slowly and stays in the body longer. The result is less intense pleasure, fewer withdrawal symptoms, and fewer cravings.[4]
In the United States, methadone for opioid use disorder is only available from approved opioid treatment programs. People usually visit the program every day or almost every day at the start. NIDA notes that since 2020, many people who have been in treatment for a while can take home up to 28 doses, and that NIDA-funded studies found more take-home doses are safe and may help people stay in treatment.[4] SAMHSA updated the federal rules for these programs again in 2024. Under certain conditions, patients can now receive take-home doses from the first week of treatment, and the program makes that call based on clinical judgment and safeguards.[9]
How Buprenorphine and Suboxone Work
Buprenorphine also activates the brain’s opioid receptors, but to a lesser degree than methadone. It can also reduce the effects of other opioids. Like methadone, it can reduce cravings and withdrawal without causing a strong high.[4]
Suboxone is a brand name, not a separate drug. It combines buprenorphine with naloxone, an opioid antagonist that is also the ingredient in overdose rescue medication. Taking Suboxone is not a substitute for emergency naloxone or for calling 911 in an overdose. MedlinePlus describes buprenorphine as an opioid partial agonist-antagonist and naloxone as an opioid antagonist.[6] Other buprenorphine products exist too, including tablets and extended-release injections, so what you are prescribed may not be Suboxone.[4]
Unlike methadone, buprenorphine can be prescribed by many doctors, nurse practitioners, and physician assistants after an evaluation, without going to a special treatment program. NIDA also notes that prescribing by telehealth has been allowed since the COVID-19 pandemic (rules can change, so ask what is available to you), and that buprenorphine can be started in an emergency department after an overdose.[4]
Which Works Better? What the Research Shows
The honest answer is that it depends on what you measure. A Cochrane review pulled together 31 trials with 5,430 participants. It found that buprenorphine worked better than placebo at keeping people in treatment. It also found that when buprenorphine doses were adjusted to each person’s needs, methadone kept more people in treatment (a risk ratio of 0.83 for buprenorphine). For people who stayed in treatment, there was no clear difference in how much opioid use dropped between the two medications.[1]
Keep the limits in mind. The review searched studies up to January 2013, so newer research may add to the picture.[1] Even so, NIDA’s summary lines up with it: methadone and buprenorphine can be equally effective at reducing opioid use, both help people stay in treatment, and methadone may help some people stay longer.[4]
| What you are comparing | Methadone | Buprenorphine (including Suboxone) |
|---|---|---|
| Where you get it | Approved opioid treatment programs only | Many doctors, nurse practitioners, and physician assistants, including by telehealth |
| How often you go | Daily or near daily at first, with take-home doses added over time | Usually a prescription, with visits set by your prescriber |
| Staying in treatment | Kept more people in treatment in the Cochrane review | Kept fewer people than flexible-dose methadone, but more than placebo |
| Reducing opioid use | Similar among people who stayed in treatment | Similar among people who stayed in treatment |
| A safety point to know | Can affect heart rhythm; breathing risk is higher early on and after dose increases | Has its own risks and is started with care by a prescriber |
Overdose Risk: Why Staying in Treatment Matters
Safety is one of the most important factors in this decision, and your health history, access, and past response to treatment matter too. That is why a prescriber should guide the choice. A meta-analysis in the BMJ combined 19 eligible cohorts that followed more than 138,000 people. Overdose deaths were 2.6 per 1,000 person-years during methadone treatment and 12.7 per 1,000 person-years out of treatment. For buprenorphine, the rates were 1.4 per 1,000 person-years during treatment and 4.6 per 1,000 person-years out of treatment.[2]
The same review found the risk of death is higher right after leaving either treatment, and during the first weeks of starting methadone. The authors also noted that more research is needed to compare the two medications fairly, because the studies were not designed for a head-to-head test.[2]
A Massachusetts study looked at 17,568 adults who survived a nonfatal overdose. Compared with getting no medication, methadone was linked to about 53% lower all-cause death and buprenorphine to about 37% lower. Those are relative differences after adjusting for other factors, not the chance that any one person will be helped. Only a minority of the people in the study received any medication, and this was an observational study, so it shows an association, not proof of cause.[3]
NIDA points out that fewer than 1 in 5 people with opioid use disorder receive these medications.[4] That gap is one reason to start the conversation with a prescriber now, even before you know which medication you want.
We’re here to make treatment as accessible and affordable as possible — and are in network with many insurance providers. Not sure about your coverage? We can help.
Side Effects and Safety Points
Both medications can cause side effects, and your prescriber should go over them with you before you start. A few points stand out:
- Methadone and heart rhythm. MedlinePlus states methadone may cause QT prolongation, a rare heart problem that can cause an irregular heartbeat or fainting. Call your doctor right away if you notice a pounding heartbeat, dizziness, or fainting.[5]
- Breathing. Methadone may cause serious breathing problems, especially during the first 24 to 72 hours of treatment and any time the dose is increased. Taking it with certain other medications can add to breathing problems and sedation.[5]
- Buprenorphine and drowsiness. MedlinePlus says buprenorphine may make you drowsy, so do not drive or use machinery until you know how it affects you. It also says you should not drink alcohol while taking it.[6]
- Starting buprenorphine. MedlinePlus describes the start as happening in the doctor’s office, at a low dose that your doctor adjusts. [6] SAMHSA’s TIP 63 says patients should be told they will need to be in opioid withdrawal to receive their first dose, to avoid buprenorphine-precipitated withdrawal.[8] That is why your prescriber decides the timing, and why you should not try to start on your own.
- Other medications and alcohol. Tell your prescriber about everything you take, including prescriptions, supplements, and how much you drink, so they can plan your care safely. Mixing these medications with alcohol or other sedating substances can be dangerous.[5][6]
- Stopping suddenly. Do not stop either medication on your own. Stopping too quickly can cause withdrawal symptoms, and your prescriber will tell you when and how to come off the medication.[5][6] NIDA notes these symptoms are milder than with other opioids and can be managed with a slow, supervised dose reduction.[4]
- Safe storage. Keep methadone and buprenorphine locked up and away from children and anyone else in the home. Methadone can be fatal to other people who take it.[5]
Is This Just Swapping One Drug for Another?
This is the most common worry, and NIDA addresses it directly. Methadone and buprenorphine act on the same receptors as other opioids, which is why some people think they are simply substituting one drug for another. But NIDA explains that when taken as prescribed by someone with opioid use disorder, they prevent cravings and withdrawal without the intense high, and it describes them as less addictive than other opioids.[4]
Both medications do cause physical dependence, the way many long-term medications do. That is not the same as addiction. Addiction involves compulsive use despite harm. Someone taking a stable, prescribed dose can work, parent, and rebuild relationships. Our post on why medication-assisted treatment improves your chances of recovery goes deeper on this.
What About Vivitrol?
Naltrexone, given as the monthly injection Vivitrol, is a third option that blocks opioid receptors instead of activating them. In the X:BOT trial of 570 people, about 72% of people assigned to extended-release naltrexone started it, compared with 94% assigned to buprenorphine-naloxone. More people in the naltrexone group relapsed, mostly among those who never got started. Among people who did start, the two medications worked about equally well.[7] You can read more in our guide to the Vivitrol shot.
Who Might Do Better on Each?
There is no rule that fits everyone. Only a prescriber who knows your history can decide which medication and setting are right for you. Some things that often come up in the conversation:
- Access and schedule. If an opioid treatment program is far away or hard to fit around work or family, a buprenorphine prescription may be easier to sustain. If daily structure helps you, a program setting may be a plus.
- Medical history. Heart conditions, other medications, liver problems, and pregnancy all affect the choice. NIDA states medications for opioid use disorder are safe and effective during pregnancy and breastfeeding.[4] Care during pregnancy should still be planned with a clinician. MedlinePlus notes that babies exposed to methadone in pregnancy can have withdrawal symptoms after birth, so tell your prescriber early if you are pregnant or plan to be.[5]
- Past experience. If you tried one medication and it did not work well, that is useful information, not failure. Dose, timing, and support can change the result, and switching is sometimes the right call.
- Your goals. Some people plan to stay on medication long term. Others hope to taper later. A good prescriber will talk through both without pressure.
When to Reach Out for Help
Reach out now if any of these sound familiar:
- You or someone you love is using opioids and cannot stop.
- Withdrawal symptoms are keeping you from quitting.
- You are using pills, heroin, or fentanyl and are worried about overdose.
- You tried to quit before and relapsed.
If someone is unresponsive, has slowed or stopped breathing, or may have overdosed, call 911 right away. You can also read about opioid detox to understand what the first days can look like.
Talking With a Professional
Bring a short list to your first visit: every medication and supplement you take, any heart or liver problems, whether you might be pregnant, what you have used and how often, and what treatment you have tried before. Ask which medication fits your situation, how the first weeks will go, how long treatment might last, and what counseling comes with it. Asking questions does not commit you to anything. Discovery Point Retreat offers a medically assisted treatment program that you can ask about.
Frequently Asked Questions
Is Suboxone the same as buprenorphine?
Not exactly. Suboxone is a brand name for a product that combines buprenorphine with naloxone. Other buprenorphine products exist, including tablets and injections.[4]
Which is better, Suboxone or methadone?
Neither is better for everyone. Methadone kept more people in treatment in a large review of trials. Buprenorphine is often easier to access, depending on where you live and your insurance. Both are linked to lower overdose risk while you stay in treatment.[1][2]
Can I get methadone from my regular doctor?
No. In the United States, methadone for opioid use disorder is only available from approved opioid treatment programs.[4]
Can I get buprenorphine by telehealth?
NIDA notes that providers have been able to prescribe buprenorphine by telehealth since the COVID-19 pandemic. Rules can change, so ask a provider what is available to you.[4]
Is taking methadone or Suboxone just trading one addiction for another?
NIDA explains that, taken as prescribed, these medications prevent cravings and withdrawal without the intense high, which makes them less addictive than other opioids. They do cause physical dependence, which is different from addiction.[4]
How long do people stay on these medications?
It varies. Some people stay on medication for a long time and others taper with their prescriber’s guidance. Do not stop on your own.
Are these medications safe during pregnancy?
NIDA states that medications for opioid use disorder are safe and effective during pregnancy and breastfeeding.[4] Decisions still need a clinician’s guidance, and babies can have withdrawal symptoms after exposure, so tell your prescriber early if you are pregnant or planning to be.[5]
References
- Mattick RP, Breen C, Kimber J, Davoli M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2014(2):CD002207. PMID 24500948. Accessed September 2026. pubmed.ncbi.nlm.nih.gov
- Sordo L, Barrio G, Bravo MJ, et al. (2017). Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ, 357:j1550. PMC5421454. Accessed September 2026. pmc.ncbi.nlm.nih.gov
- Larochelle MR, Bernson D, Land T, et al. (2018). Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Annals of Internal Medicine, 169(3):137-145. PMC6387681. Accessed September 2026. pmc.ncbi.nlm.nih.gov
- National Institute on Drug Abuse (NIDA). Medications for Opioid Use Disorder. Accessed September 2026. nida.nih.gov
- MedlinePlus (National Library of Medicine). Methadone: drug information. Accessed September 2026. medlineplus.gov
- MedlinePlus (National Library of Medicine). Buprenorphine sublingual and buccal (opioid dependence): drug information. Accessed September 2026. medlineplus.gov
- Lee JD, Nunes EV, Novo P, et al. (2018). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT). The Lancet, 391(10118):309-318. PMC5806119. Accessed September 2026. pmc.ncbi.nlm.nih.gov
- Substance Abuse and Mental Health Services Administration (SAMHSA). Medications for Opioid Use Disorder, Treatment Improvement Protocol (TIP) 63, updated 2020. Accessed October 2026. library.samhsa.gov
- Substance Abuse and Mental Health Services Administration (SAMHSA). 42 CFR Part 8 Final Rule: Table of Changes. Last updated January 31, 2024. Accessed October 2026. samhsa.gov
Related Reading
- Medically Assisted Treatment Program at Discovery Point Retreat
- Why MAT Nearly Doubles Your Chances of Recovery
- The Vivitrol Shot: How Naltrexone Supports Recovery
- Opioid Addiction Treatment
- How to Tell If Someone Is Abusing Opioids
Resources
- 988 Suicide and Crisis Lifeline: call or text 988
- SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7)
- Emergency: call 911
This article is general education and is not medical advice.
If you or someone you love is struggling with opioids, you do not have to work out the next step alone. Call Discovery Point Retreat at (855) 245-7133 or visit our contact page to talk through your options.
