Buprenorphine and Methadone: What are the differences?

Shawn Kilgarlin

September 14, 2023

Buprenorphine and Methadone: What are the differences?

The opioid epidemic has been a growing public health crisis for decades, affecting millions of individuals and families worldwide. To combat this crisis, various medications have been developed to treat opioid addiction, with two of the most commonly used options being bupropion and methadone. While both effectively reduce opioid cravings and withdrawal symptoms, they have distinct differences that make one more suitable than the other in certain situations. This article will explore the contrasts between buprenorphine and methadone to help individuals and healthcare professionals make informed decisions about addiction treatment.

Understanding Opioid Addiction

Before delving into the differences between bupropion and methadone, it’s crucial to have a basic understanding of opioid addiction. Opioids, including prescription painkillers like oxycodone and illegal drugs like heroin, are highly addictive substances that bind to brain receptors, leading to euphoria and pain relief. Prolonged use of opioids can result in physical dependence, making it challenging for individuals to quit without experiencing severe withdrawal symptoms.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) is an evidence-based approach for managing opioid addiction. It involves using medications with counseling and therapy to address addiction’s physical and psychological aspects. Buprenorphine and methadone are two of the most widely prescribed medicines in MAT programs, and they operate through similar mechanisms but with notable differences.

Chemical Composition and Mechanism of Action

Buprenorphine: Buprenorphine is a partial opioid agonist, which binds to opioid receptors in the brain but only partially activates them. This partial activation reduces cravings and withdrawal symptoms without producing the intense euphoria associated with full opioid agonists like heroin. Buprenorphine’s effect reaches a ceiling, meaning that increasing the dose beyond a certain point does not intensify its effects, reducing the risk of overdose.

Methadone: Methadone, on the other hand, is a full opioid agonist. It binds to opioid receptors and activates them fully, similar to other opioids like heroin or oxycodone. However, methadone has a longer half-life, which means it stays in the body for an extended period, relieving cravings and withdrawal symptoms for up to 24 to 36 hours with a single dose.


Buprenorphine: Buprenorphine is typically administered as sublingual tablets or films, placed under the tongue and allowed to dissolve. It is also available as a monthly injection called Sublocade.

Methadone: Methadone is dispensed in liquid form and must be taken under the supervision of a healthcare provider at a licensed Methadone clinic. This daily visit requirement can be burdensome for some patients, but monitoring and adjusting the dosage is essential.

Regulation and accessibility

Buprenorphine: Buprenorphine is subject to less stringent regulations compared to methadone. Qualified healthcare providers, including some primary care physicians, can obtain a waiver to prescribe Buprenorphine in an office-based setting. This makes buprenorphine more accessible to patients in various healthcare settings.

Methadone: Methadone can only be dispensed through federally regulated opioid treatment programs (OTPs). Patients need to visit these clinics daily for their doses initially, and as they progress in their treatment, take-home privileges may be granted. The strict regulations are in place due to the higher risk of overdosing on methadone.

Efficacy and safety

Buprenorphine: Buprenorphine is generally considered safer regarding overdose risk compared to methadone. Since it has a ceiling effect, taking more of the medication does not lead to a significant increase in respiratory depression. However, it can still be diverted or misused if not taken as prescribed.

Methadone: Methadone has a higher risk of overdose, especially during the initial stages of treatment when patients are closely monitored for dosage adjustments. It can cause respiratory depression and potentially fatal outcomes if taken in excessive amounts or in combination with other depressants, such as benzodiazepines.

Treatment Duration

Buprenorphine: Buprenorphine treatment can vary in duration, ranging from a few months to several years, or even lifelong maintenance, depending on the patient’s needs and goals. Some individuals may be able to taper off Buprenorphine successfully, while others may require long-term care.

Methadone: Methadone treatment often involves a more extended maintenance phase, and some individuals may remain on Methadone for an indefinite period. The decision to taper off methadone should be made carefully, and patients should be closely monitored.

Buprenorphine and methadone are both valuable tools in the battle against opioid addiction, and their differences make them suitable for different individuals and situations. Buprenorphine’s flexibility, accessibility, and lower risk of overdose make it an appealing choice for many patients, especially those highly motivated to recover. Methadone, on the other hand, can be a more effective option for individuals with a long history of opioid addiction or those who have not responded well to other treatments.

Ultimately, the choice between Buprenorphine and Methadone should be made individually, considering the patient’s medical history, treatment goals, and level of support. When used as part of a comprehensive MAT program, both medications can significantly improve the chances of successful recovery from opioid addiction. Healthcare providers and patients need to work together to determine the most appropriate drug and treatment plan to address each person’s unique needs on the path to recovery.