Thinking of switching between methadone and buprenorphine?
As a medication-assisted treatment (MAT) patient, I am grateful to the many advocates sharing research and facts in order to dispel misconceptions about methadone and buprenorphine. Today, however, I want to offer you something different. I'm sharing my personal experiences with both medicines, which I took at different points in my recovery.
As you're reading this, please remember that different bodies may elicit different reactions to the same chemicals. Just because this was my experience doesn't mean methadone or buprenorphine will be the same for you or others. I am an advocate for both medications.
Methadone was the chemical that kick-started my recovery from heroin addiction. I was prescribed it during early pregnancy so that my growing fetus would not be exposed to the dangerous highs and lows that come along with illicit opioid abuse. I began on 20mg daily, and slowly increased to 60mg. Before getting on methadone, I was constantly detoxing then relapsing, often overdosing in the process. Methadone provided me the stability to begin my recovery journey in earnest.
Because a woman's metabolism changes so drastically during pregnancy, there is some evidence that pregnant women and their babies do better with split dosing of methadone, rather than a single dose in the morning. This was not offered by my clinic, but had it been, it may have reduced some of my symptoms, such as fatigue three hours after dosing.
"Getting High" and Other Side-Effects
Methadone "high:" I felt a slight physical euphoria for the first few days of using methadone. The infamous "legal high." It was neither overwhelming nor debilitating, nor did it last. Four days into treatment, when the long-acting opioid stabilized in my system and the short-acting opiates I'd been abusing were totally flushed out, I was no longer feeling anything from the methadone that could have been classified as pleasurable.
Fatigue: I was extremely fatigued while on methadone. The three-hour mark after dosing was especially bothersome. The fatigue lasted about 45 to 90 minutes each day.
Impaired thinking: I labored to think as clearly as usual, but it was far from the mind-numbing experience of an opiate high. I just felt slightly less sharp than normal.
A need for psycho-social treatment: Like many people who become addicted to opiates, I have a trauma history. Methadone did not provide the emotional numbing of heroin, so some of my worst Post-Traumatic Stress Disorder symptoms flared up while I was on methadone. The methadone isn't to blame for that; I simply didn't have a euphoric chemical masking my PTSD anymore. But my clinic would have been smart to provide counselors whose purpose went beyond evaluating my phasing.
Methadone "high" x 2: After my baby was born, my methadone dose was instantly too high for my suddenly lighter body. This was the only time I felt truly impaired from methadone. It was not a good feeling. I was delirious; hallucinating people who weren't there, "nodding out" constantly, and unable to stay awake, bond with my daughter, or even talk. It was not a euphoric feeling. It had all the lack-of-control of a heroin high, but without the pleasure. Once I tapered down to half my dose at childbirth, I felt normal again.
After I detoxed from methadone, I experienced another traumatic event and relapsed on heroin for about a month. I decided to try buprenorphine, and though I discontinued it for a period, I am now on a stable dose of buprenorphine/naloxone (Suboxone).
Low sex drive: I experienced a noticeable decrease in my sexual desire when I started taking a therapeutic dose of buprenorphine/naloxone. It is significantly harder for me to become aroused or to enjoy sex.
Tiredness: While I don't feel the same overwhelming fatigue that I did with methadone—I don't "nod out"— I often have a feeling of general tiredness throughout the day. I would attribute this to caring for two toddlers, but other people in my peer support group complain of the same.
No euphoria whatsoever: I never experienced a "high" from buprenorphine when taken therapeutically. The induction period was actually very uncomfortable.
Slight decrease in PTSD symptoms: Although I still have a significant need for trauma therapy, I feel less emotionally volatile than I did when I was not on buprenorphine—even during periods of total abstinence. A study done on combat veterans showed that buprenorphine may help with PTSD. This is one reason why I am considering staying on buprenorphine long-term.
Without methadone, I would probably not be sober today. The transition between heroin and methadone was considerably more comfortable than with buprenorphine. Methadone provided me the biological stability that allowed me to have a healthy baby, and to begin my recovery.
For me, buprenorphine/naloxone has ultimately been a better choice. It offers me less side-effects than methadone while helping to manage my drug cravings and correct trauma and drug-use related brain changes. For some, methadone may be a better choice.
If you are struggling to overcome an opioid addiction, you aren't alone. Agonist medication like methadone and buprenorphine can make the process easier. It's important to discuss options with your medical provider, and also keep a close eye on your own reaction to your medication so that you can create a treatment plan that is tailored to you.
Want to know more about medication-assisted treatment?
Workit Clinic provides medication-assisted treatment in Michigan & California
Elizabeth Brico is a freelance writer with an MFA in Writing & Poetics from Naropa University. Her blog, Betty's Battleground, was recently ranked by Feedspot as one of the top 75 PTSD blogs. She is also a regular contributing writer for HealthyPlace's trauma blog. Her work has appeared on Vice, Vox, Stat News, The Fix, and others. When she isn't working, she can usually be found reading, writing, or watching speculative fiction.