Quick answer: Suboxone (buprenorphine) and methadone both reduce cravings and withdrawal and are linked to large reductions in overdose deaths. Methadone is dispensed daily at licensed clinics; buprenorphine can be prescribed in an office. Vivitrol (extended-release naltrexone) is a monthly shot that blocks opioids but requires being fully off opioids first. The best choice depends on your history, schedule and goals.
How we put this comparison together
East Coast Recovery Center in Cohasset, Massachusetts, offers medication-assisted treatment (MAT) that combines FDA-approved medication with counseling and behavioral therapy. This comparison is based on peer-reviewed research, including a 2017 BMJ review of mortality during and after opioid treatment, and on how each medication is prescribed and regulated in the U.S. Medication decisions should always be made with a prescriber who knows your history.
Opioid use disorder medications at a glance
| Factor | Methadone | Buprenorphine (Suboxone and others) | Extended-release naltrexone (Vivitrol) |
| How it works | Full opioid agonist | Partial opioid agonist | Opioid blocker (antagonist) |
| How it’s taken | Daily liquid or tablet | Daily film or tablet; weekly or monthly injection options | Monthly injection |
| Where you get it | Licensed opioid treatment programs | Doctor’s office or clinic; pharmacy | Doctor’s office or clinic |
| Need to be opioid-free first? | No | Mild withdrawal usually needed before first dose | Yes, typically 7 to 10 days |
| Overdose risk if misused | Higher | Lower, due to ceiling effect | None from the medication itself |
| Best for | Long, heavy opioid use; need for daily structure | Most people; flexibility to keep working | People already off opioids who want no opioid medication |
1. Why medication matters for opioid use disorder
Medication is one of the most effective tools for preventing opioid overdose deaths. A 2017 BMJ systematic review of cohort studies found that staying in methadone or buprenorphine treatment was associated with substantial reductions in all-cause and overdose deaths. Overdose death rates were roughly five times higher out of methadone treatment than in it.
The same review found that the weeks right after stopping treatment carried particularly high risk, which is why stopping medication should always be planned with a prescriber.
2. Methadone: the longest track record
Methadone is a long-acting full opioid agonist that has been used to treat opioid addiction for decades. It prevents withdrawal and reduces cravings. In the U.S., methadone for opioid use disorder can only be dispensed through federally certified opioid treatment programs, usually requiring daily clinic visits at first.
Pros: strong evidence; high retention; good for heavy, long-term opioid use, including fentanyl.
Cons: daily clinic visits; higher overdose risk if combined with other sedatives; the first weeks of treatment carry higher risk.
3. Buprenorphine: flexible and office-based
Buprenorphine, found in Suboxone, Zubsolv, Sublocade and Brixadi, is a partial opioid agonist. It reduces cravings and withdrawal but has a “ceiling effect,” which makes overdose less likely than with full agonists. It can be prescribed in a doctor’s office and filled at a pharmacy, and long-acting injection versions are given weekly or monthly.
Pros: office-based; flexible; lower overdose risk; the BMJ review found mortality stayed stable during buprenorphine induction.
Cons: starting usually requires mild withdrawal first; some people find it less effective than methadone for very heavy fentanyl use.
4. Extended-release naltrexone (Vivitrol): a monthly blocker
Vivitrol is a monthly injection of naltrexone, which blocks the effects of opioids and reduces cravings. It isn’t an opioid, so there’s no risk of dependence on the medication itself. The catch is that you typically need to be fully off opioids for 7 to 10 days before the first shot, or it can trigger sudden withdrawal.
Pros: no opioid; once-a-month dosing; also used for alcohol use disorder.
Cons: the opioid-free period can be hard to complete; tolerance drops, raising overdose risk if someone stops and uses again.
5. Medications for alcohol use disorder
MAT isn’t only for opioids. FDA-approved medications for alcohol use disorder include naltrexone, which reduces cravings and heavy drinking; acamprosate, which helps maintain abstinence; and disulfiram, which causes unpleasant reactions if you drink. They’re underused, and they can be a valuable part of outpatient treatment.
6. Medication works best with counseling and support
Medication treats the physical side of addiction. Therapy addresses the thoughts, habits, relationships and mental health issues behind it. Combining the two, along with peer support, gives the best chance of lasting recovery. At East Coast Recovery, MAT is paired with counseling and behavioral therapies within our day treatment and outpatient programs.
Questions to ask your prescriber
- Which medication fits my history, health and goals?
- How do I start safely, and what will induction feel like?
- How often will I need visits or refills?
- How long should I expect to stay on medication?
- What is the plan if I ever want to stop?
To learn more about medication-assisted treatment at East Coast Recovery, visit our MAT program page or call (617) 390-8349.
FAQ
Which is better, Suboxone or methadone?
Neither is better for everyone. Both are linked to large reductions in overdose deaths. Methadone may suit people with very heavy, long-term opioid use who benefit from daily structure. Buprenorphine offers more flexibility and a lower overdose risk. A prescriber can help you choose based on your history and needs.
Isn’t MAT just replacing one drug with another?
No. Addiction involves compulsive use despite harm. MAT medications are taken as prescribed, at stable doses, to prevent withdrawal and cravings so people can function, work and focus on recovery. Research links methadone and buprenorphine treatment to substantial reductions in overdose deaths.
How long do people stay on MAT?
It varies. Some people take medication for months; many benefit from staying on it for years. There’s no set end date. Stopping should be planned carefully with a prescriber, because the period after leaving treatment carries higher overdose risk.
Can I get Vivitrol right after detox?
Often, yes. Vivitrol typically requires being opioid-free for about 7 to 10 days, so finishing detox can be a good time to start. Starting before you leave detox, or soon after, helps avoid a gap in protection.
Does insurance cover medication-assisted treatment?
Most health plans cover FDA-approved medications for opioid and alcohol use disorder. Coverage details vary by plan. East Coast Recovery is in-network with Blue Cross Blue Shield, Point32Health, TRICARE East and Magellan. Verify your benefits to confirm coverage.
