{"id":284,"date":"2023-11-15T21:45:41","date_gmt":"2023-11-15T21:45:41","guid":{"rendered":"https:\/\/stagingserver3.com\/morseclinic\/?p=284"},"modified":"2023-11-15T21:45:41","modified_gmt":"2023-11-15T21:45:41","slug":"how-to-choose-between-methadone-and-buprenorphine","status":"publish","type":"post","link":"https:\/\/stagingserver3.com\/morseclinic\/how-to-choose-between-methadone-and-buprenorphine\/","title":{"rendered":"How to choose between Methadone and Buprenorphine?"},"content":{"rendered":"
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First of all, congratulations on deciding on maintenance therapy to begin with! \u00a0The medical evidence for any form of maintenance therapy for opioid addiction is very strong. \u00a0The success rates for methadone are about 60-70% and buprenorphine are 70-80%. \u00a0Which one to choose is an excellent question. \u00a0Glad you are weighing your options.<\/p>\n

Methadone is a long-acting mu opioid analog. \u00a0Buprenorphine is a partial mu opioid agonist with a high receptor affinity and occupancy – 93% at 16 mg a day (also the Morse Clinics maximum dose) (Greenwald, et al. 2003). \u00a0Both create a blockade or attenuated effect of the use of additional opioids with buprenorphine having greater blockade. \u00a0They stop you from getting high. \u00a0Buprenorphine has a favorable safety profile due to a ceiling effect (you cannot overdose on buprenorphine alone \u2013 unlike methadone). \u00a0Buprenorphine has lower street value and lower abuse potential \u2013 folks who suffer with opioid addiction cannot get high on opioids while on buprenorphine.<\/p>\n

At the Morse Clinics, methadone is dispensed by our nurses in the form of a cherry-flavored, red liquid that is swallowed every morning. \u00a0Because we use the liquid, we can dose down the exact milligram. \u00a0There is no limit to the dose of methadone but we do check blood levels at 120 mg and every 30 mg thereafter to insure safety. \u00a0Buprenorphine is dosed in 2 mg or 8 mg tablets \u2013 dosing options are limited to 1, 2, 4, 8, 12 or 16 mg taken sublingually and absorbed within about 5 minutes. \u00a0An advantage of buprenorphine is that you do not need a gut to absorb it. \u00a0If you have the flu or a GI bug that causes you to vomit, you cannot vomit up your buprenorphine. \u00a0You can vomit up methadone. \u00a0For our patients who have extensive GI surgeries, gastric bypasses, IBS, or Crohn\u2019s Disease, buprenorphine may be more effective.<\/p>\n

It is not unusual for folks to get addicted to opioids due to pain conditions. \u00a0Methadone is usually more effective treating pain than buprenorphine.<\/p>\n

To get started, if you are actively using, methadone is easier on you. \u00a0Buprenorphine can cause precipitated withdrawal. \u00a0Buprenorphine displaces full opioid agonists (because of its higher receptor affinity and lower level of receptor activation). \u00a0Its severity varies. \u00a0Common features include sweating, cramps, diarrhea, nausea, anxiety, cravings, yawning, and restlessness \u2013 typical but immediate opioid withdrawal symptoms that you are probably used to. When does precipitated withdrawal occur? \u00a0Usually about 30 minutes after the first dose and peaks at 90-180 minutes after the first dose. \u00a0Minor symptoms may last 2-3 days and may persist with continued heroin\/opioid use.<\/p>\n

Let\u2019s talk about cost. \u00a0If you have Medicaid, your treatment at any Morse Clinic is free for methadone. \u00a0It may be free for buprenorphine as well \u2013 if you your MCO is Sandhills or Cardinal Innovations (at the time of this writing). \u00a0If you do not have Medicaid, the cost of methadone is $80 per week and Buprenorphine is $120 per week \u2013 regardless of the dose. \u00a0The difference in cost makes some of our patients choose methadone over buprenorphine. \u00a0The reason is simply that we buy both in bulk. \u00a0Our profit margin is usually less for buprenorphine then methadone.<\/p>\n

Which is easier to come off of? \u00a0First of all, we recommend at least a year clean, sober and stable (same job, living situation, relationship) before starting a gradual taper down. \u00a0Many of our patients choose to remain on their maintenance medication indefinitely. \u00a0Addiction is a chronic disease and most chronic diseases require chronic medications. \u00a0Because you can lower 1 mg a time of methadone liquid, a methadone taper can be easier and more gradual. \u00a0Because buprenorphine is only a partial agonist, an abrupt detoxification off buprenorphine is easier than methadone. \u00a0So if there is a possibility that you maybe going to jail or prison, I would suggest buprenorphine over methadone.<\/p>\n

Did that help or get you more confused? \u00a0Please come into a Morse Clinic and talk to one of our doctors. \u00a0You will be glad you did!<\/p>\n

Thanks,
\nEric D. Morse, M.D.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

First of all, congratulations on deciding on maintenance therapy to begin with! \u00a0The medical evidence for any form of maintenance therapy for opioid addiction is very strong. \u00a0The success rates…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":{"0":"post-284","1":"post","2":"type-post","3":"status-publish","4":"format-standard","6":"category-blog"},"_links":{"self":[{"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/posts\/284","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/comments?post=284"}],"version-history":[{"count":1,"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/posts\/284\/revisions"}],"predecessor-version":[{"id":285,"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/posts\/284\/revisions\/285"}],"wp:attachment":[{"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/media?parent=284"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/categories?post=284"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stagingserver3.com\/morseclinic\/wp-json\/wp\/v2\/tags?post=284"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}