Buprenorphine or Subutex is a long-acting, partial opioid agonist used to treat those with opioid use disorder or opioid dependency. It does provide mild pain relief, so it was once used as a pain reliever. Although some will say that buprenorphine does not cause a euphoric state if it is taken properly, it can cause a slight euphoria.
How Does Buprenorphine Work?
Buprenorphine does have a ceiling effect, so once you get to a certain dose, usually 24mg, taking more of the drug will not increase the high you experience. Buprenorphine is used in medication-assisted treatment (MAT) because it both prevents withdrawal symptoms from occurring and also significantly reduces cravings. 
What is Methadone?
Methadone is a synthetic full opioid agonist commonly used to treat moderate to severe pain. It is a very long-acting medication and is effective for some in treating chronic pain conditions and for those with opioid use disorder or opioid dependency. Methadone is used in medication-assisted treatment (MAT) because it reduces cravings and helps prevent withdrawal symptoms. However, methadone differs from buprenorphine because it does not have a ceiling effect. Increasing a person’s dose can produce a euphoric state which also makes the drug easier to abuse.
More About Mixing Buprenorphine and Methadone
Mixing buprenorphine and methadone is never commended; it is dangerous. Taking both of these together can cause a rare but life-threatening cardiac arrhythmia or irregular heart rhythm. Drug interactions involving methadone and buprenorphine published by the National Institute of Health says:
A combination of agonists and partial agonists can also result in opioid withdrawal. Methadone should generally not be combined with the partial agonists’ buprenorphine, pentazocine, nalbuphine, or butorphanol. Patients on buprenorphine who are also taking opioid agonists for pain may experience incomplete pain relief. (NIH)
As stated by the NIH, mixing buprenorphine and methadone can also cause very unpleasant opioid withdrawal symptoms. Precipitated withdrawal occurs when someone takes buprenorphine before they have fully detoxed from any full agonist like methadone or other opioid medications. Some of the symptoms of precipitated withdrawal can include:
- Watery eyes
- Runny nose
- Diarrhea
- Intense sweating
- Goosebumps
- Chills
- Tremors
- Anxiety
- Restlessness
- Body aches
- Headaches
- Loss of appetite
Precipitated withdrawal is a terrible experience. The symptoms are usually a lot more severe and intense than regular opioid withdrawal symptoms. Precipitated withdrawal symptoms can occur in as little as one to two hours after taking the buprenorphine and could last for a day before symptoms subside. In some cases, an individual may be taking methadone for opioid dependence and want to switch over to buprenorphine treatment. Switching medications should always be done under the direction of a doctor that specializes in addiction. To avoid precipitated withdrawal symptoms, a person needs to be off of the methadone and in full opioid withdrawal before starting treatment with buprenorphine. Both methadone and buprenorphine are effective in treating those with opioid use disorder, however, they should never be taken together. Mixing any medications without being under the care of a physician is dangerous and can prove to be fatal. If you are having trouble with opioid abuse, please seek professional help.
Treatment for Opioid Addiction
If you or someone you love is struggling with opioid addiction, our addiction specialists are available around the clock to assist you. Evoke Wellness at Miramar offers cutting-edge addiction treatment. We are South Florida’s premier medical detox and residential treatment facility. We will help you rebuild your life and get on the road to long-lasting recovery from opioid dependence, including buprenorphine and methadone, some of the most painful and difficult synthetic opioids to come off successfully.
