Methadone or Buprenorphine to Cure Addiction?

Methadone and Buprenorphine are both manmade, opiate-based medications prescribed around the world both as painkillers and as long-term cures for opioid addiction therapy. Both drugs act as a substitution therapy for people with opiate addictions, relieving the symptoms of withdrawal, while decreasing the risk of mortality and giving users a sense of euphoria similar to, though markedly diminished from, the feeling of a heroin-induced high.

Though methadone has been in widespread use to stem addiction since the mid-1980s, its misuse has marred its history as an effective tool to combat addiction. In 2009, 30 percent of prescription pain killer deaths involved the drug. According to the Centers for Disease Control and Prevention (CDC), methadone’s increased use as a painkiller has led to its rampant abuse in a nonmedical setting and the high rates of overdose. However, methadone is only part of a larger national trend in skyrocketing painkiller sales.

Between 1990 and 2008, deaths from drug overdoses more than tripled in the U.S., most of them caused by prescription drugs. According to the CDC, opioid medication sales in the U.S. have increased 300 percent since 1999. In 2008, 36,000 Americans died from drug overdoses, and 14,800 of those deaths were caused by opioid painkillers, surpassing deaths from cocaine and heroin two-fold. According to data collected by the CDC, methadone was involved in one out of every three prescription painkiller overdoses in 2009.

Methadone is a full opioid agonist, meaning it engages the same receptors as heroin and buprenorphine and provides euphoria and a temporary cure for pain, but it can also be linked to addiction. Though overdose is less likely with methadone use than with heroin use, the painkiller still accounts for a large number of deaths nationwide. Buprenorphine by comparison boasts reduced mortality rates, as well as decreased likelihood of abuse, according to the National Institutes of Health (NIH).

Both methadone and buprenorphine are opioid drugs synthetically derived from opium, unlike opiates such as heroin, derived from naturally occurring morphine in the poppy plant. Buprenorphine, however, is a partial opioid agonist, which makes it less potent and less lethal. Buprenorphine causes fewer of the feelings of euphoria than methadone by engaging the mu receptors to a lesser degree, but it still provides relief from withdrawal symptoms with a significantly decreased likelihood of misuse and overdose. The drug also has a “ceiling effect,” meaning that, at a point, increased doses will not increase the effects, and it reduces the effects of opioid use with time, reports the NIH.

Antagonist opioid drugs completely block the opiate receptors instead of engaging them, keeping addicts from feeling the effects of opiates, but they tend to report lower efficacy rates than partial or full agonists, largely because they provide no pain relief, euphoria, or reprieve from the painful symptoms of withdrawal. Despite its many benefits, warns the NIH, buprenorphine can still cause overdose, especially when used with alcohol, benzodiazepines or other opioids.

Methadone is also prescribed and administered differently, and is often more cost-effective, making it a better option for curing individuals with a more severe addiction, says Dr. Peter Friedman, a buprenorphine expert at Brown University. Methadone is prescribed and administered through clinics in highly-structured addiction programs. The dosage can be monitored and altered to best fit the patient, and since methadone does not have a ceiling effect, much higher doses can be given to combat the most severe opiate addictions. Buprenorphine, on the other hand, can be prescribed and administered in an office by physicians who fit the criteria provided by the Drug Abuse Treatment Act of 2000, which Friedman believes is more appropriate for those with a less severe addiction. Methadone also tends to be less expensive, according to the NIH, though there is not yet enough data to suggest a significant difference in cost.

By Sree Aatmaa Khalsa


The Washington Post

National Institutes of Health

Centers for Disease Control and Prevention

Centers for Disease Control and Prevention

Photo by westpark – Flickr License

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