Contributor: Dr. Joseph Py, DO FASAM
Patients in medication-assisted treatment (MAT) are prescribed methadone, buprenorphine or buprenorphine with naloxone (Suboxone®, Zubsolv®, etc.), for opioid use disorder or, commonly, opioid addiction. These medications work due to their ability to eliminate withdrawal, decrease craving and normalize brain function.
Similar to other treatments for medical disorders, a person in MAT may need to switch from one medication to another. If you and your doctor decide to switch your medication from methadone to buprenorphine or buprenorphine with naloxone, there is a transition process that will assure a smooth change from one medication to the other. Read on to learn more about the methadone to Suboxone® transition.
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Read on to learn more about the methadone to Suboxone® transition.
Why Do Patients Switch from Methadone to Suboxone?
Methadone continues to be the gold standard of treatment for many individuals treated for opioid addiction, including women who are pregnant. While methadone can often give doctors more options for treating patients with severe opioid use disorder, buprenorphine/naloxone may suit some patients better. A patient may want to transition from methadone to Suboxone® because:
- Some individuals have fewer side effects when they take a buprenorphine medication
- The medication can be taken at home much sooner than methadone
- In some cases, the medication can be prescribed and picked up at a pharmacy
- They have reached a point in their recovery where the degree of structure in methadone treatment is no longer needed
The doctor and patient will work together to decide on the ideal treatment option.
Why Can’t I Just Stop Methadone and Start Buprenorphine with Naloxone?
Suboxone® and similar medications such as Zubsolv® contain buprenorphine, an opioid that acts similarly to morphine, heroin, and other opioids. They also contain naloxone, an opioid antagonist that knocks opioids off of their receptors and therefore causes instant withdrawal symptoms in the individual. The combination of buprenorphine and naloxone makes Suboxone® very different from morphine, heroin, and methadone. This property of buprenorphine makes it necessary to taper down to a low dose or completely off of methadone before taking buprenorphine so that patients don’t experience withdrawal symptoms severe enough to put their recovery at risk.
What Should I Expect as My Methadone Treatment Timeline During the Transition?
If you decide to change from methadone to buprenorphine/naloxone, the time needed before the new medication can be taken depends on the amount of methadone you have been prescribed, how fast your methadone dose can be decreased comfortably and your ability to tolerate some minimal withdrawal.
Addiction Medicine professionals generally recommend lowering the methadone dose to at least 30 mg per day and preferably less than 30mg per day. They suggest a reduction rate no faster than 5 mg a week, or 5-10% per week. You may need more time based on your body chemistry. The less methadone you are on at the time that medication is stopped, the less severe the withdrawal may be.
After the taper, you will need to be abstinent from methadone for up to 72 hours, or be in moderate withdrawal before buprenorphine should be taken. This approach ensures you have the least severe reaction to the switch as possible. Once you reach moderate withdrawal, you can take your first dose of Suboxone®.
Reducing your methadone dose takes patience. No one way to taper is best and your medical provider will work with you closely to determine the approach that is right for you and your recovery.
Learn More About Medication-Assisted Treatment at Health Care Resource Centers
At Health Care Resource Centers (HCRC), our mission is to help patients like you recover from opioid use disorder. If you want to start MAT, change providers or get more information, let us assist. We welcome you to contact our team online to find out more or schedule an appointment.
