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Switching from Methadone to Suboxone

A person dissatisfied with Suboxone treatment can easily switch over to methadone, but methadone users cannot as easily switch to Suboxone.

Why Is It Difficult to Switch from Methadone to Suboxone?

There are 2 primary reasons why it can be tough to switch from methadone to Suboxone:

1. Methadone is a full opiate agonist and so it’s a lot stronger than Suboxone

Methadone is a very strong, full agonist opiate medication and Suboxone is a partial opiate agonist medication. Taking additional doses of Suboxone provides additional relief from withdrawal symptoms until this dosage ceiling is reached – and after that, taking more Suboxone has little extra effect.

People on moderate to high daily doses of methadone are receiving opiate receptor activation at a level that is above what Suboxone can provide, at any dosage. If someone switches from a moderate to high daily dosage of methadone to a high daily dose of Suboxone, they will experience a dramatic decrease in opiate receptor activation – which will result in opiate withdrawal symptoms.

Because of this, people wanting to switch from Methadone to Suboxone are advised to reduce their daily methadone dosage down to 30 mg a day for at least a week prior to switching (the switch can occur at higher daily doses, in some cases). 1

2. Methadone has a long half-life, and so stays in the body for a relatively long time

You must be experiencing significant opiate withdrawal symptoms before you take your first dosage of Suboxone. Methadone is a long lasting medication that stays in the body for a long time and so you must wait at least 36 hours (or longer) before taking your first Suboxone pill. Because withdrawal symptoms can emerge slowly, this can be an uncomfortable wait.2

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