Is Injectable Buprenorphine a Better Alternative?

123peace wonders about alternatives to methadone, such as probuphine implants. Dominique Simon-Levine consulted with a physician working in medication-assisted treatment (MAT), and shares his response below.

"Do you have any information in regards to probuphine implant versus methadone?

Is this implant just as good???? as methadone?

I understand that one implant lasts up to 6 months. I’ve read about this on the internet, however, toooooooo much to absorb and nothing is really clear cut."
 

Hello 123peace:

We asked a doc who works in medication-assisted treatment (MAT) to answer your question. Here is what he said:

“The comparisons between Methadone and Buprenorphine when buprenorphine was newer to the scene showed outcomes that were about the same. A couple trials had methadone performing a little better. The Buprenorphine implant performed as well as the sublingual/transmucosal daily Buprenorphine. However, it is only indicated for people who have been stable on standard Buprenorphine transmucosal (under the tongue) at 8mg per day or less, which is a lower than average dose. The implant lasts 6 months, and can be repeated once (in the other arm). Insurance coverage varies, and specific training is needed for health practitioners in order to provide the implant. Given these limitations, few people have received the implant compared to transmucosal Buprenorphine such as Suboxone, or Methadone. Now, a monthly injectable form of Buprenorphine was recently approved by the FDA, and is an option for folks on a range of doses of the transmucosal buprenorphine, and given this and a simpler means to administer (injection under the skin), it will likely be utilized considerably more.”

Here is a blog post by another experienced MAT doc who we trust: https://web.archive.org/web/20201112021325/https://janaburson.wordpress.com/2010/08/23/which-is-better-suboxone-or-methadone/

Keep in mind that Suboxone is a combination drug made up of Buprenorphine (an opiate) and Naloxone (an opiate blocker) while Methadone is just an opiate. Suboxone, administered in any form, is available at a doctor’s office, while Methadone is only available through specialized clinics. Methadone is dispensed daily, with the approval of take-homes of a daily dose when the patient has tested opioid-free for a certain length of time.

With the injectable form of Suboxone, patients need only visit a doctor’s office monthly, then eventually every six months. This makes it a lot more convenient. The injectable is very new. How doctors will help maintain their patients’ accountability is likely to differ by provider. While the injectable will deter the problem of people selling their Suboxone, the lower frequency of visits makes it harder to follow a patient’s accountability through urine tests and required therapy visits.