Both methadone and buprenorphine (Subutex) are prescription opioid analgesics recommended to de-addict patients from heroin, an illegal psychoactive (opioid) drug. People who are trying to quit heroin often face its withdrawal symptoms. In order to make things easier, the doctor may recommend these medications as a replacement for the drug addiction. Drug rehabilitation centers often put heroin addicts on either buprenorphine or methadone treatment to reduce the intensity of the withdrawal symptoms. These medications are many times an integral part of drug recovery programs that help control cravings for heroin. The medications act as an effective recovery support, as they allow to mitigate and even prevent withdrawal symptoms. With both the medications being used to get rid of heroin dependence, you may wonder which is better at dealing with those unpleasant withdrawal symptoms. Let's have a look. 24 randomized control trials as a part of 2008 Cochrane systematic review were conducted to evaluate the efficacy of methadone and buprenorphine as an illegal opioid substitute. The study involved participation of around 4,497 subjects, who were randomly assigned to either of the medications as an opioid replacement therapy. The length of time patients continued the treatment, medicine dosage, and ability to curb illicit drug usage during the treatment were some of the factors considered to compare the efficacy of methadone and buprenorphine. The following observations were made from the outcome of the study:

• Evidence showed that during the course of treatment, dosage flexibility with methadone was substantially more effective in keeping the patients engaged to the given treatment.
• Compared to methadone given in low doses, a lesser number of patients remained in the treatment at low or medium doses of buprenorphine. However, low dose methadone was not as effective as medium dose buprenorphine in curbing illegal opiod usage.
• Given in medium doses, methadone had an edge in retaining more patients, and moreover, was better at reducing the use of illegal opioid drugs.

Considering the outcome of clinical trials, one can say that methadone is better than buprenorphine at mitigating drug addiction. A point to note here is that, the clinical trials did not consider any particular opioid dependency for treatment. As far as heroin dependency is concerned, very few studies have been conducted to evaluate the efficacy of buprenorphine and methadone to treat its withdrawal symptoms. In 4 randomized controlled trials, to evaluate the efficacy of these two medications in mitigating heroin withdrawal symptoms, it was observed that buprenorphine was as effective as methadone in alleviating the severity of opioid withdrawal. However, symptoms may disappear at a faster rate with buprenorphine. Also, compared to methadone, patients put on buprenorphine were better at finishing the treatment successfully. This small evidence does suggest that buprenorphine has an advantage as a maintenance drug, as well as in resolving the symptoms early. As far as the abuse potential is considered, oral buprenorphine (partial opioid agonist) has lower chances of abuse, addiction, and even side effects in comparison to a full opioid agonist like methadone. In case of methadone, the potential for abuse is substantially higher. So, in an attempt to get rid of heroin addiction, the usage of methadone could pave the way for yet another addiction. Moreover, buprenorphine displays poor oral bioavailability, making it safer when an accidental overdose occurs. Although serious side effects have been reported with intravenous administration of buprenorphine, when taken orally, it does not produce any adverse side effects. The National Institute of Drug Abuse (NIDA) also considers buprenorphine as a better alternative to effectively manage heroin withdrawal symptoms. In order to further reduce the risk of oral buprenorphin misuse, Suboxone, a combination of buprenorphin and naloxone is recommended. Naloxone, an opioid antagonist added in Suboxone, dissuades patients from misusing the prescribed medication. Despite its safety aspect, the use of buprenorphine hasn't outnumbered to that of methadone in UK, probably because methadone is a better choice at mitigating severe cases of heroin dependence. Buprenorphine is better suited to treat mild to moderate cases of heroin addiction. However, considering the highly addictive nature of methadone, one should reassess their decision and choose one that best works to avoid withdrawal symptoms. Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical professional.