Which Program Should I Choose?
Opiate addiction is a medical illness in which the chemistry of the brain endorphine system has been altered by opiate drug abuse. The most proven effective treatments involve medications that normalize the endorphin system. The two approved medications are methadone and buprenorphine (Subutex/Suboxone).

Because the brain chemistry changes usually result from months or years of addiction, treatment usually requires long term medication management. What is ‘long term’? At least a few months. Failure rates for short ‘detox’ treatments (no matter what they are, residential, or medication) are in the 90-95% range. Study after study has shown this. For this reason, we also offer a 180 day ‘detox’ program that allows much more time to establish recovery before a withdrawal is attempted. The emphasis on medications does not mean that counseling and support groups are not important! They are important, but they rarely work without an initial medication management of the medical illness.

However, a short term treatment has the advantage of giving a patient an exposure to treatment medications and to see if they are one of the few who can use short term medication successfully as a first step in a recovery program. Most patients will choose to graduate to some longer period of maintenance treatment.

What medication should I choose?
Subutex/Suboxone and methadone are different medications. While both are effective, some patients may do better with one. For example, a long term 10-20 year heroin addict may respond better to methadone. Those with shorter term pill addictions may be more satisfied with Subutex. Methadone is a more treatment intensive program requiring daily attendance, for at least the first 90 days, to receive the medicine from the clinic. This program provides more psychological support in addition to closer medical monitoring. Subutex is a much more flexible program in which the physician can write a prescription which the patient takes to any pharmacy. Physician visits are frequent during initial stabilization and gradually reduce to once a month. An evening support group is also an important component of the Subutex program.

What is the difference between the medications?
Methadone is a full opiate agonist. It turns the brain’s opiate receptor on full.  Think of a dimmer switch that you can turn on full or ½ way on.  Then buprenorphine (Subutex/Suboxone) turns the switch on ½ way. This makes buprenorphine a safer medication in an overdose situation. Therefore the FDA allows this medicine to be given by prescription. Methadone is more dangerous in an overdose situation and it is very tightly regulated in terms of allowing take home doses. However, both medications are equally safe when used as prescribed!

A major difference is cost.
Subutex is an expensive medication, although some insurances will cover it. Methadone is a less expensive program because the medication is not expensive. The cost for the actual on-going treatment services, i.e. counseling and physician visits, are fairly similar. 

In summary, you can choose either short term (21 day) or medium term (180 day) detox programs using methadone. Subutex can be used either short or long term because the program does not differentiate and can be tailored to patient wishes. And methadone also can be used for as long as needed.

Is one or the other harder to withdraw from?
Unfortunately no. It is important that brain recovery must occur. The endorphin system must come back to normal. It does not matter which medicine one uses to help someone to stabilize and then taper from. It is the physical recovery of the brain that matters. This will occur best with full recovery from all drugs of abuse, a healthy lifestyle, good diet, and exercise.