The Bupe vs. Methadone Showdown: Which Is More Effective?


The withdrawal symptoms caused by detox from opiate drugs like heroin can be a significant barrier to treatment for many who are considering going to drug rehab. For many patients, the only way that they can face the tremors, sweating, insomnia, agitation, cravings and other opiate withdrawal symptoms is to consider the option of long-term medicated detox using a drug like buprenorphine or methadone. These medications are also opiate drugs and work by binding to the opiate receptors in the brain, allowing the patient to stop taking their drug of choice immediately while experiencing a minimum of withdrawal symptoms.

Why is this effective? Unlike street drugs like heroin, buprenorphine and methadone are consistent in their chemical makeup, thus users don’t risk overdose and other medical problems as long as they take the drugs under the supervision of a medical professional. Over time, the dose can be lowered incrementally until the person is completely drug-free.

But which of the two most popular drugs used to accomplish this task is more effective – buprenorphine or methadone?

Apples and Oranges

One study published in the journal Drug and Alcohol Dependence attempted to evaluate the two drugs based on cost. They found that, in the UK, the cost of methadone was often cheaper than the cost of buprenorphine, a fact that is pretty well-established in the United States as well. But when evaluating cost-effectiveness of a drug, it’s important to take into consideration the context in which it is being used.

For example, buprenorphine can be prescribed by any physician who is certified to write a script for the drug, but methadone must be given out daily in person in a clinic or medical setting that is authorized to provide the medication. Many prefer the freedom that comes with a take-home prescription but find that they are unable to manage the psychological issues that characterize addiction and soon stop taking their medication or relapse.

In other cases, patients can’t incorporate the strict requirements of methadone clinics into their lives and soon get themselves ejected from the program for noncompliance; even though methadone is cheaper than buprenorphine, in these cases, it is not more cost-effective because it didn’t result in a completed detox.

Additionally, not all patients can choose the medication they prefer. For example, those who are taking high doses of heroin when they enter detox will not be able to take buprenorphine right away. Instead, they will need to take a high dose of methadone in order to stabilize physically in recovery and then slowly step down to a lower dose. When their dose is low enough, they may be able to replace methadone with buprenorphine.

Which One Is Right for Your Loved One?

Which medication your loved one uses during opiate detox depends on a number of factors, including:

  • Their drug of choice
  • The dose of their drug of choice
  • Other medications they are taking
  • Their goals for recovery

In some cases, patients opt out of a medicated detox entirely, choosing instead the quicker route to abstinence that may include non-addictive medications to ease their experience of withdrawal symptoms but no addictive medications like buprenorphine or methadone.

Discuss the options available to your loved one in detox and recovery today. Contact us at Axis now.