Methadone vs. Buprenorphine for addiction…

Methadone detox 6

There has been much controversy for decades over the treatment of opioid addiction.  Methadone has been the mainstay, along with detox, rehab counseling and perhaps outpatient behavioral modification.  Methadone has its advantages, such as low cost, and it quite effectively suppresses cravings for heroin and other opioids.  The problems with methadone are numerous however, such as the need to show at the clinic daily for sometimes megadoses of liquid methadone.  This is a problematic area.  Even in profound addicts, methadone is so powerful that the clients become somnolent and then are released to drive themselves home, or wherever.  Methadone is indeed a powerful agonist just like heroin, oxycodone, morphine, fentanyl, etc.  So such psychic effects should not be unexpected, even though the somewhat slower onset of action of methadone mitigates this side effect a bit.  Other very significant side effects involve pregnant methadone users, who deliver babies highly dependent on the opioid and must be routinely treated with weaning doses of an IV opioid in the neonatal intensive care nurseries, often for weeks or months at tremendous taxpayer expense.  Finally, methadone is most usually considered simply a replacement therapy for heroin, etc.  It is not viewed except, under rare circumstances, as a stepping stone to finally being opioid free.

Suboxone has been touted as a worthwhile alternative to methadone.  It is a weak partial agonist with a threshold effect.  While methadone and other potent opioids can be taken to a point of severe respiratory depression and fairly rapid death, Suboxone cannot, unless the patient consumes with multiple other concurrent drugs such as alcohol, benzos, and other sedatives, even these cases are unusual.  The relative safety of Suboxone allows for the writing of a prescription that frees the patient up from daily visits to the Suboxone center.  Also, it appears to be just as effective in craving suppression as methadone, but without the somnolence and adverse effect on neonates born to addict mothers.  Time spent in neonatal intensive inpatient care is minimal in comparison to methadone users during gestation – saving taxpayer monies.  Naturally, the drug model of treating opioid addiction in isolation does not succeed forever, except in unusual circumstances, unless combined with appropriate psychotherapy; this can take the form of group therapies, IOPs, solo CBT, etc.

There is little doubt that Suboxone treatment of opioid addiction will supplant methadone treatment eventually.  The long term financial future of methadone clinics is therefore very murky at best.

About Dr. Michael J. O'Connell, New Hampshire
Dr. Michael J. O'Connell of Barrington, New Hampshire, has forged a distinguished career spanning over three decades, as entrepreneur, physician, businessman, philanthropist and healthcare consultant. As former owner, administrator and CEO of a 225+ employee multi-specialty medical practice, Dr. O'Connell has dedicated his entire professional life to helping patients with family medicine and especially those experiencing chronic pain and all aspects of addiction. Since selling his family of healthcare businesses, he has never once contemplated retirement despite his rich and fulfilling journey, but instead has turned his focus to consulting in an industry starved for courage and creativity. Having weathered many political, technological and legal challenges, there is hardly a storm he has not confronted, a tempest he has not quelled, an urgent need he has not met. While the talking heads and self-proclaimed experts in the field have assumed the conventions and standards of the times, Dr. O'Connell does not believe in merely reflecting the herd mentality, but rather in leading the charge. Eschewing political correctness, Dr. O'Connell says and does what needs saying and doing, and not what the mindless masses expect. In addition to the continual education afforded by his variegated life experiences, Dr O'Connell earned his BS in Biochemistry at the University of NH in 1975, his Medical Degree from Dartmouth College in 1981, interned at Walter Reed Medical Center in 1982, Residency/Fellowship at UCSF in1986, and finished his Masters in Healthcare Administration at UNH in 1995. Dr. O’Connell enjoys many outdoor activities, including rock climbing, snowboarding, hiking, and golf. Through the decades Dr. O'Connell has supported many non-profit charities to include the St. Charles Home in Rochester NH, the Tri City VNA and Hospice, Hyder House, and Cocheco Valley Humane Society. To the latter organization alone Dr. O'Connell has donated over $180,000 and pledged another $250,000 in the “Bring-Us-Home” campaign for a new building. His “Matching Donations Christmas drive” has generated over $175,000 in charitable giving from the community. In addition Dr. O'Connell has participated in many dozens of other volunteer and donation efforts locally as well as in Africa and the Dominican Republic. For a listing of how I gave back to the community during my career and continue to do see:

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