Methadone or Subutex?

Question by Gilla B: Methadone or Subutex?
Which one is easier to detox from? I have heard horror stories about both of them. People say that sub is just as hard to get off of as the methadone. Most Dr’s say Sub is easier.. I am just curious. My son is on Subutex. Thanks!

Best answer:

Answer by AJ
Hi,
Methadone is terribly difficult to withdraw from. You would need someone to reduce the dosage very slowly (say 5mg per week for higher doses and 2mg per week when you get to the lower doses). So if say you were on 40mg of Methadone for a couple of months, you can imagine how long the taper process itself will take.

Subutex on the hand is a very strange molecule. Some people have no withdrawals at all when stopping, but a great number of people do notice withdrawals. The withdrawals from Subutex can last up to 15-20 days for the physical and acute symptoms. However the withdrawals are much milder than any other opioids.

Ideally one should use Subutex for 2-3 weeks and taper off of them. But there are many reasons for which you may want to use it long-term. It is an excellent medication for weaning off of opioids. The withdrawals can be difficult yes, but nowhere near the difficulty of stopping Methadone. Hope this helps. Feel free to drop me a line if you need.

PS: There are a great number of questions asked in this category as well as the Pain Management category, pertaining to Methadone Maintenance. I urge you to read some of the answers given. Also, certain forums like http://www.bluelight.ru contain a wealth of information for people wanting to know more about any kind of opioid.

EDIT:
There is a lot of confusion concerning Subutex, due to it being a partial agonist. Even pharmacologists have trouble dealing with the concept of a partial agonist. (A drug that binds to a receptor, but only activates it partially).

The reason why Subutex can make it difficult to stop is because it has a very long dissociation rate from the receptor (ie. it binds to the opiate receptor, only activates it partially, but sticks to it for a very long time and very slowly dissociates (removes itself) from the receptor.) In some people, this makes it easier to withdraw since the effects of the drug very slowly reduce. But in my experience, this can only make it tougher to quit since the withdrawals start much later, and tend to last for a longer time, and it is usually the longevity of withdrawals that can break a person, not so much the intensity.

Subutex being a partial agonist has *nothing* to do with how easy or difficult the process it. Being a partial agonist only gives it it’s good safety profile. It may not be a “full-on opiate”, but it still is an opiate (opioid is the correct term).

Answer by CrazyTraci
Either can be difficult to detox from but the reason that many people have an easier time with Subutex is that it works by being what’s called a “partial agonist” to the opioid receptors in the brain. What that means is, it helps the body think that there is actual drug in the receptor, but it’s not a true “full-on-opiate”

I hope this helps!

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