Methadone vs. Suboxone vs. Cold Turkey: What Method of Opiate Addiction Maintenance is Right for Me?

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Opiate withdrawal can make patients feel as if they are dying.  Because heroin and other powerful opiates act directly on pain and pleasure receptors in the brain, coming off these drugs kicks the brain into overdrive.  Pain messages are consistently running through every facet of the neurological system, leaving addicts grappling to find a quick fix to make the pain stop.  It is possible to get clean once and for all.  The methods vary from person to person, but generally patients can decide to use methadone or Suboxone for maintenance or quit cold turkey.

Methadone

Methadone was developed in the 1930’s by two German scientists who were looking to a morphine alternative.  It was used during WWII as a pain relief agent.  In the 60’s, it was discovered as a preventative for withdrawal symptoms while detoxing from heroin.  Methadone can be used to ease short-term withdrawal symptoms like nausea, shaking and sweating.  However, most often, it is used as a long-term maintenance option to prevent relapse on the more illicit option of heroin.

Methadone Use for Short-Term Withdrawal

Some doctors prescribe methadone as a short-term solution to wean patients during opiate withdrawal.  Patients will be prescribed dosages of methadone to ease the withdrawal symptoms. The drug will be immediately tapered with the highest dosage being prescribed during the first day of withdrawal, gradually lessening the dosage over a period of five days to a week.

Methadone Maintenance Schedule

Opiate Addiction Maintenance

Suboxone is taken sublingually once a day or every other day.

Because heroin addicts are at great risk for overdose, HIV and hepatitis C, long-term treatment is often sought.  Doctors often work to prescribed methadone to ease craving and avoid withdrawal.  A maintenance schedule is developed for each patient, averaging between 1 month and 6 months.  There have been patients who continue on a methadone maintenance schedule for up to 2 years.  During this time, counseling is recommended to help patients find alternative methods to coping effectively with the emotional ups and downs of life.

Suboxone

Suboxone is a combination compound of buprenorphine and naloxone.  By binding tightly to the mµ receptors in the brain, Suboxone acts just as more powerful opioids do chemically.  However, buprenorphine does not offer the “high” equated with heroin use.  Further, naloxone prevents other opioids from binding properly to pain receptors.  This means that if a patient slips up and attempts to use an opiate to achieve euphoria, they will be unsuccessful.  This minimizes the risk of overdose for patients attempting to stop using illicit narcotics.

Suboxone Use for Short-Term Withdrawal

Buprenorphine is a longer acting partial agonist.  As a result, it can be prescribed at a high dose on the first day of detox, not at all on the second day and again on the third day.  Doctors work with patients to determine the amount of drug necessary, as well as the length of time to stave off withdrawal symptoms.  For short-term withdrawal, which is often offered out-patient using Suboxone, the taper schedule usually lasts between 3 and 5 days.

Suboxone Maintenance Schedule

Suboxone stimulates and binds tightly to the mµ receptors at lower dosages.  Also, the drug has a ceiling effect, meaning that taking a higher dosage will not increase the “high” feeling.  Thus, approximately 16 mg is generally prescribed for up to 6 months.  The drug is taken sublingually, or under the tongue, once a day or every other day.  It is long lasting and there is very little risk of overdose.  As with methadone maintenance, counseling is recommended to combat the other mental and emotional issues that created the perfect storm leading to addictive behaviors in the first place.

Cold Turkey

Patients withdrawing from opiates with no pharmacological intervention generally report the experience as a negative one.  The way opiates bind to pain receptors creates withdrawal and drug craving coupled with constant firing of pain messages in the brain.  Patients experiencing withdrawal report feeling intense pain and a host of other symptoms.

15 Clear and Unbiased Facts About Opiate Addiction Treatment You MUST Know

Withdrawal Symptoms

Physical symptoms can be harsh, depending upon the length of drug use and dependency.  Symptoms may last between 3 days to 2 weeks.  Generally, symptoms lesson with each passing day. Withdrawal symptoms can include:

  • Pain
  • Headaches
  • Muscle aches
  • Sleeplessness
  • Restless Legs
  • Chills and sweating
  • Abdominal cramps, nausea, vomiting and diarrhea
  • Tremors and Shakes

Benefits and Pitfalls of Going Cold Turkey

The benefit of coming off opioids cold turkey is that once the physical withdrawal is complete, the patient is not dependent upon any other substance.  Mental and emotional freedom can be found in being truly clean.  The downfall is that recovery from opiate addiction is exceedingly difficult.  There is great danger of relapse in early recovery.  Opiate addicts have developed “drug liking” and craving, which can be hard to combat without help and support.

Help and Rehabilitation

Regardless of the path of choice, finding help and support is important.  Methadone, Suboxone or cold turkey detox all work to achieve initial results.  Stopping heroin for a week is possible.  Staying stopped for a lifetime requires a network of help and support.  Addiction is recognized as a disease.  Reaching out to treatment centers, counselors and medical professionals who support the recovery journey is critical for ongoing success. Call our toll-free helpline at 800-584-3274 to get started today.

Resources

Bart, G. (2012). Maintenance medication for opiate addiction:  The foundation of recovery. Journal of Addictive Diseases. 31(3): 207-225. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411273/

Kleber, H. (2007).  Pharmacologic treatments for opioid dependence:  detoxification and maintenance options. Dialogues in Clinical Neuroscience. 9(4): 455-470. Retrieved from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202507/

Kosten, T. & George, T. (2002). The neurobiology of opioid dependence:  Implications for treatment.  Addiction Science & Clinical Practice. 1(1). 13-20. Retrieved from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/

CESAR. Methadone (2016). Center for Substance Abuse Research. Retrieved from: http://www.cesar.umd.edu/cesar/drugs/methadone.asp

NIH. (2013). Viral hepatitis—A very real consequence of substance use. National Institute on Drug Abuse. Retrieved from: https://www.drugabuse.gov/related-topics/viral-hepatitis-very-real-consequence-substance-use

Mitchell, S., Kelly, S., Brown, B., Reisinger, H., et. al. (2009). Incarceration and opioid withdrawal:  The experiences of methadone patients and out-of-treatment heroin users. Journal of Psychoactive Drugs. 41(2): 145-152. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838492/


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