Transitioning from Methadone to Suboxone Treatment

Looking for MAT for opioid-use disorder that you can access at home? Here’s what you need to know about transitioning from methadone to Suboxone.

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Methadone and Suboxone FAQs

Methadone and Suboxone (buprenorphine/naloxone) are both FDA-approved medications used to treat opioid use disorder. Both are classified as controlled substances, but in most states methadone is more strictly controlled than Suboxone.

Suboxone contains buprenorphine, a partial opioid agonist. It binds to and partially activates opioid receptors in the brain, reducing withdrawal symptoms and cravings. It has a ceiling effect that stops it from providing the “high” associated with opioids like heroin. Suboxone contains naloxone (known by the brand name Narcan), which is an opioid antagonist meaning it blocks opioid receptors, preventing misuse.

Methadone is a long-lasting, full opioid agonist, which means it fully activates the brain’s opioid receptors. The fact that it metabolizes slowly means that most people who use it don’t experience the highs and lows associated with illicit opioid use.

Suboxone treatment is available via telehealth. Clinicians must be licensed and trained through the DEA to prescribe buprenorphine/naloxone, but they can do so via telehealth after a thorough virtual evaluation. Most states also require drug testing, which can be done virtually. The medication itself is e-prescribed to a local pharmacy. Workit Health offers Suboxone treatment in many states. See the list below to check if we’re in your area. Workit’s telemedicine Suboxone treatment is 100% virtual. 

Traditionally, methadone must be taken at approved clinics, called Opioid Treatment Programs (OTPs), where patients go in every day to receive their dose. Since 2020, some states loosened restrictions to allow people to receive a month’s supply of methadone at a time and to be prescribed via telehealth. But this is not consistent around the country, and it is not yet apparent whether these lighter restrictions will remain or will spread across the nation post-pandemic. Workit Health does not prescribe methadone.

If you want to switch from methadone to buprenorphine, most doctors recommend that you taper down to as low a dose as possible before making the switch—at least 30 milligrams. Experts have noted that some folks may need to taper to an even lower dose. This can be frustrating for people on high doses of methadone because tapering comfortably can take several months to a year (or longer) depending on your dose and on how you tolerate the decrease. But it’s important to be patient with this process. Trying to decrease your dose too quickly will only increase your likelihood of relapse and cause you unnecessary discomfort. Do not attempt to switch from methadone to buprenorphine without medical guidance.

Some patients transition because they do better with Suboxone than methadone. For example, some patients get sleepy from methadone no matter the size of the dose and do better with buprenorphine. Aside from these considerations, the main reason people decide to switch to buprenorphine is convenience.  Buprenorphine medications are subject to fewer restrictions and somewhat less stigma than methadone. Here are some convenience factors to consider with a telehealth Suboxone clinic like Workit’s vs. a traditional OTP:

Telehealth Suboxone treatmentIn-person OTPs (methadone clinics)
Medication is e-prescribed to your local pharmacyTake medication in the clinic daily until you are approved to take home a supply
In-home appointments have less wasted downtime (no waiting rooms)The ability to have a take-home supply at all may be revoked by states post-pandemic
Video appointments are extremely discreet—no one will see you going into a clinic or meetingMethadone clinics are often in inconvenient locations
Avoid germs in waiting rooms or spreading a virusRequires transportation to and from appointments
Save money on transportationClinic wait times can be unpredictable
Spend less time away from work or dependent-care responsibilitiesDoes not require any specific technology
Requires internet connection and compatible device 

It depends on the type of drug test. The standard 5- or 7-panel drug test (like the type an employer might use), doesn’t usually test for buprenorphine or methadone. However, if you’re given a 10- or 12-panel drug test, they may be looking specifically for methadone or Suboxone. Both Suboxone and methadone treatment programs are likely to use these kinds of tests to ensure that you’re taking the medication as prescribed. Read more: Suboxone might show up on a drug test.

What is the difference between Suboxone and methadone?

Methadone and Suboxone (buprenorphine/naloxone) are both FDA-approved medications used to treat opioid use disorder. Both are classified as controlled substances, but in most states methadone is more strictly controlled than Suboxone.

Suboxone contains buprenorphine, a partial opioid agonist. It binds to and partially activates opioid receptors in the brain, reducing withdrawal symptoms and cravings. It has a ceiling effect that stops it from providing the “high” associated with opioids like heroin. Suboxone contains naloxone (known by the brand name Narcan), which is an opioid antagonist meaning it blocks opioid receptors, preventing misuse.

Methadone is a long-lasting, full opioid agonist, which means it fully activates the brain’s opioid receptors. The fact that it metabolizes slowly means that most people who use it don’t experience the highs and lows associated with illicit opioid use.

Can I get Suboxone or methadone via telehealth?

Suboxone treatment is available via telehealth. Clinicians must be licensed and trained through the DEA to prescribe buprenorphine/naloxone, but they can do so via telehealth after a thorough virtual evaluation. Most states also require drug testing, which can be done virtually. The medication itself is e-prescribed to a local pharmacy. Workit Health offers Suboxone treatment in many states. See the list below to check if we’re in your area. Workit’s telemedicine Suboxone treatment is 100% virtual.

Traditionally, methadone must be taken at approved clinics, called Opioid Treatment Programs (OTPs), where patients go in every day to receive their dose. Since 2020, some states loosened restrictions to allow people to receive a month’s supply of methadone at a time and to be prescribed via telehealth. But this is not consistent around the country, and it is not yet apparent whether these lighter restrictions will remain or will spread across the nation post-pandemic. Workit Health does not prescribe methadone.

Transitioning from methadone to Suboxone

If you want to switch from methadone to buprenorphine, most doctors recommend that you taper down to as low a dose as possible before making the switch—at least 30 milligrams. Experts have noted that some folks may need to taper to an even lower dose. This can be frustrating for people on high doses of methadone because tapering comfortably can take several months to a year (or longer) depending on your dose and on how you tolerate the decrease. But it’s important to be patient with this process. Trying to decrease your dose too quickly will only increase your likelihood of relapse and cause you unnecessary discomfort. Do not attempt to switch from methadone to buprenorphine without medical guidance.

Why transition from methadone to Suboxone?

Some patients transition because they do better with Suboxone than methadone. For example, some patients get sleepy from methadone no matter the size of the dose and do better with buprenorphine. Aside from these considerations, the main reason people decide to switch to buprenorphine is convenience.  Buprenorphine medications are subject to fewer restrictions and somewhat less stigma than methadone. Here are some convenience factors to consider with a telehealth Suboxone clinic like Workit’s vs. a traditional OTP:

Telehealth Suboxone treatment In-person OTPs (methadone clinics)
Medication is e-prescribed to your local pharmacy Take medication in the clinic daily until you are approved to take home a supply
In-home appointments have less wasted downtime (no waiting rooms) The ability to have a take-home supply at all may be revoked by states post-pandemic
Video appointments are extremely discreet—no one will see you going into a clinic or meeting Methadone clinics are often in inconvenient locations
Avoid germs in waiting rooms or spreading a virus Requires transportation to and from appointments
Save money on transportation Clinic wait times can be unpredictable
Spend less time away from work or dependent-care responsibilities Does not require any specific technology
Requires internet connection and compatible device

Will Suboxone and methadone show up on a drug test?

It depends on the type of drug test. The standard 5- or 7-panel drug test (like the type an employer might use), doesn’t usually test for buprenorphine or methadone. However, if you’re given a 10- or 12-panel drug test, they may be looking specifically for methadone or Suboxone. Both Suboxone and methadone treatment programs are likely to use these kinds of tests to ensure that you’re taking the medication as prescribed. Read more: Suboxone might show up on a drug test.

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03

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You’ll work together with your clinician and care team to develop new daily routines, so you can maintain your new habits for life. If appropriate, your clinician will e-prescribe medication to your local pharmacy.

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