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Why would anyone use methadone?

I'm not talking about, why would anyone use methadone instead of cold turkey detox, I'm talking about why would anyone in their right mind use methadone instead of buprenorphine?

Really…I want to know, so if you’ve chosen methadone over buprenorphine or suboxone…why??? Firstly, I should say that I never used either in my battles with opiate type pain pills, but I understand and respect the use of opiate substitution as a valid and respectable choice in a recovery program. But I just don’t get what's better about methadone.

The drug is more easily abused You have to go to a clinic to take it It is very addictive The eventual detox off of methadone is terrible

So why, when buprenorphine has little potential for abuse, and can be prescribed in a month' supply, when it's far less addictive than methadone and when the eventual withdrawal and detox pains are nowhere near as bad as for methadone…why?

I know that there are some problems with finding a doctor capable of prescribing the drug in some parts of the country, and I also know that it is more expensive, but when you consider the cost benefit ration and weigh the options, buprenorphine just seem to me to come up a clear winner. So if any one can answer me this question, I would love to know why so many people still choose methadone.

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Submitted by zenith (not verified) on June 27, 2008 - 6:10pm.

1) Because of the ceiling effect. Bupe is not strong enough for many long term opiate users. It is primarily effective for those who can be maintained on 30-40mg of methadone or less.

2) Because bupe does not work well for everyone. Many people report heightened anxiety while taking it, and it does not control cravings as well as methadone.

3) Methadone has a much longer track record of success than buprenorphine.

Methadone is no more "addictive" than any other opiate and in fact it is less addictive then most. You do not measure the addictiveness of a drug by how long it takes to do a safe taper off of it. Addictiveness is measured by the reinforcing properties of the drug--i.e., the intensity of the high. Methadone delivers a very poor "high" due to the long half life and the fact that it crosses the blood brain barrier very slowly, so there is no "rush" and little euphoria for even the opiate naive user, and for the stable patient there is no high at all.

Withdrawal from methadone is not "harder" than with bupe--it simply takes longer.

I find myself wondering why so many bupe patients and clinicians act as though the two medications are in direct competition with each other, and that it is their duty to "convert" all MMT patients to suboxone. These are tow different medications, aimed at two different patient populations, with some overlap. We need BOTh medications, not these remarks about "why would anyone want to be on methadone!?"

Submitted by Christian Shire on June 28, 2008 - 8:52am.

Thanks for your input Zenith,I've never been on either, so I really did want to get some feedback - (I have been addicted to opiates though.). The feeling I get reading the opiate forums though, is that people are just a whole lot happier with the way Suboxone is working for them and that Methadone seems to entrench into a heavier physical dependency than even illicit drugs.  Have you tried both as a way of comparison?Also, wouldn't a longer period of detox pains constitute a harder withdrawal?Which medication would you reccomend as a starter for a person thinking about opiate replacement therapy?

Submitted by Liz (not verified) on June 28, 2008 - 8:24am.

The main reason for methadone to be chose "over" buprenorphine medications is simple- the ceiling effect. The problem with many of the "new generation" addicts (people who may never have even tried an 'illegal' drug) is that they started with a little...and then increased much more rapidly than the average illicit drug user, quantity-wise.

Suboxone is a revolution unto itself- NO doubt. But there are tens, probably hundreds of thousands of people who it just wouldn't work for. Hopefully one day there will be some type of hybrid- something that works for everyone, is as cheap as methadone, and unlike EITHER of these medications, easy to stop taking.

I believe that in a few years' time, Suboxone will have the same or nearly the same reputation as methadone in terms of "how bad is it to withdraw from?" The people I know who were on the max dose of suboxone (24mg) said it was the worst experience of their lives to come off it. Suboxone is just so NEW, comparatively...and its drawbacks are still coming out, especially the wider the net is cast for its use. No matter what people say about methadone, it is THE singularly MOST researched and tested drug in history. Despite the fact that people abusing and buying it illicitly has increased the number of deaths by hundreds of percent, the number of people HELPED by methadone is about 52 to ONE- meaning that for every one person who dies from methadone (more than 90 % of whom purchased it illegally or otherwise "weren't supposed to" have it) there are 52 people whose lives are SAVED from their addictions. And no matter what these anti-methadone camps say about how methadone is the "#2 killer of the free world" or whatever, the fact remains that we can be *certain* that of those 52 people who are SAVED by methadone vs. each ONE person that is hurt by it, more than one of them would have died from their addiction or related behaviors were it not for getting on methadone.

The "going to the clinic" thing certainly IS a drawback for most, I imagine. But like you say, methadone IS easily abused, and daily monitoring is necessary for most people starting the therapy. However, the clinic system needs to be overhauled in such a way that rewards people better for going longer and longer periods of time with full compliance. These states that don't allow more than three takehomes, EVER- even for people who've been clean for ten years- are just pushing more and more people AWAY from treatment.

But the MAIN reason I would say that people "prefer" (if you can call 'the only choice available to you' a preference) methadone over suboxone is the cost. People who are coming off years-long addictions usually don't have a hefty office visit fee PLUS several hundred dollars a month for the actual medication.

Submitted by Christian Shire on June 28, 2008 - 9:04am.

Hi Liz,

Thanks for your comment

I agree that people should probably be rewarded with larger doses of take-home methadone - in fact I think we'd all be better off if we stopped worrying so much about letting "drugs fall into the wrong" hands...they already fell there.

About the price of Sub - isn't it still cheaper than how much most opiate users were paying to abuse the drugs while using?

Submitted by Liz (not verified) on June 28, 2008 - 10:53am.

Christian-

Congrats...you just made my blood pressure rise about 7,459 points!

I have to tell you, I *hate* when people use that argument- "but they spend three times as much as suboxone costs when they were using..." (or five times or twenty times or whatever)

See, the whole point of replacement therapies or ANY reason (abstinence, meetings, etc) to get someone OFF the train of active addiction is to remove certain things from their life. The most obvious being the chemical itself- remove that. But the SECOND most important thing to remove is "addicted behaviors"- stealing, lying, scamming family/friends...the things that nearly everyone did to get their hands on the amount of money it took to satisfy their addiction to their drug of choice.

If people KEEP getting told "you found the money when you were spending $600 a week on pills off the street...you can FIND the money for suboxone!" then people are eventually going to do those same things to get money and the whole thing will be nullified, probably- because they'll still be engaging in risky behaviors with risky people- remember, the success of suboxone depends on the person's willingness to take it every day, and if they are constantly around the people and behaviors that make using so easy, they will eventually choose to skip "just one dose" of suboxone...and before you know it, the cycle begins afresh.

Sorry, I truly didn't mean to get off on such a tangent! I just HATE when people use that argument- "if you found the money for drugs, you can find the money for treatment". It's SUCH a prevailing point of view among treatment centers/clinics, and I just don't see WHY- it seems so obvious to me that one of the main goals of treatment is to have people STOP engaging in the behaviors that marked their active addiction.

Submitted by Christian Shire on June 28, 2008 - 11:44am.

Oh, no  Liz, I'm sorry - I didn't mean to stress you out!!

Listen, I think that we would both agree that the price of Suboxone should be lowered through subsidies. Why not let addicts have a medication that could help at a price that all would accept, rather than dealing, as a society, with continuing abuse, right?

Unfortunately, this is not yet how the powers that be look at this issue.

What's the price of Suboxone at anyway? I guess it depends on dosage and region and clinic fees etc. Someone just told me they were paying $100 a week for it...but I don't know how typical this is.

But 100$ a week, while not cheap - probably doesn't compell anyone to hustle or steal, does it? Can't most people come up with 15 honest dollars a day to save their life?

This is important - most people don't enter into any kind of drug treatment program lightly, and if the difference between two different medications is a few dollars per day, maybe financial considerations should be secondary to what's going to best get your life back?

But I will say this. You sound like you have more experience with opiate substitution than I do, and you seem to feel that both methadone and Suboxone are valid options as replacement therapy.

So, if someone is reading this and trying to decide which they should choose - what would you tell them? Who is methadone better for, and who is Suboxone better for?

Thanks a lot for the time and energy you've spent. I know that people appreciate it.
 

Submitted by Jenny (not verified) on September 3, 2008 - 3:05am.

Hey everyone. I was just browsing through pages looking for information on the extended side effects of taking methadone, and saw this. (I've been taking methadone at a clinic for almost 2 years now, and while I'm familiar with some of the more immediate side effects, I've recently been experiencing some of the more long term, such as loss of sex drive) Anyway, back to the matter at hand.
At the clinic I go to, you have a choice between methadone and suboxone. Methadone is slightly cheaper, at about $12.50 a day, suboxone being around $17.50 a day. Only a few dollars, but they sure do add up, and speaking as someone who knows how hard it is sometimes to hand over more than a hundred dollars a week just to maintain, the few dollars definitely help. However, I didn't choose methadone because it was cheaper. One of the main factors that made me choose methadone was that suboxone, I knew, was not strong enough to stabilize me. Opiate abusers are not cookie cutter, every one of them is different. They all abuse different drugs, whether it be percocet, lortab, or oxycontin, and they also abuse in different amounts. Some only abuse a few pills a day, while others, myself included, would take up to 25 pills a day, and still not feel satisfied. Because of that, I knew to even come to close being comfortable, or at least maintainable, methadone was the only way for me to go. I'm sure this isn't the case with everyone. I know plenty of people who were abusing drugs as much as I, yet they chose suboxone. It all comes down to personal choice. What you feel will best suit you while you try to piece your life back together.

Good Luck, Hope this was helpful!

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