Substitute for Suboxone: Alternatives in Opioid Treatment
The main substitutes and alternatives for Suboxone in opioid addiction treatment, including methadone, Subutex, Sublocade, and naltrexone, and how they compare.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
There are several substitutes and alternatives for Suboxone in opioid addiction treatment, and the right one depends on the individual. The main alternatives are methadone, a full opioid agonist taken daily through a clinic, which is very effective, especially for heavier opioid dependence; other buprenorphine medications, such as Subutex (buprenorphine alone, used in pregnancy or naloxone sensitivity) and long-acting buprenorphine injections like Sublocade given monthly; and naltrexone, an opioid blocker available as a monthly injection (Vivitrol), which is not an opioid at all and is suited to people who have already detoxed. Each works differently: Suboxone and Subutex are partial opioid agonists, methadone is a full agonist, and naltrexone is an antagonist that blocks opioids. There is no single best substitute; methadone may suit people who do not do well on buprenorphine, naltrexone suits those who want a non-opioid option after detox, and a different buprenorphine formulation may suit others. The choice should be made with a doctor as part of medication-assisted treatment combined with counselling and support, based on the person’s history, severity, preferences, and circumstances, with the goal of reducing cravings and withdrawal, preventing relapse, and lowering overdose risk.
What can be used as a substitute for Suboxone?
There are several substitutes and alternatives for Suboxone in the treatment of opioid addiction, and the best choice depends on the individual. Suboxone (buprenorphine and naloxone) is one of several effective medications used in medication-assisted treatment (MAT), and when it is not the right fit, for reasons of effectiveness, side effects, circumstances, or preference, there are good alternatives. The main ones are methadone, other buprenorphine medications such as Subutex and long-acting buprenorphine injections like Sublocade, and naltrexone, an opioid blocker that is not an opioid at all. Each works in a different way, and the right substitute is the one that best fits the person’s history, the severity of their dependence, their circumstances, and their goals, chosen together with a doctor.
This article explains the main substitutes and alternatives for Suboxone, how they work, and how they compare, so that a person and their doctor can understand the options. The central message is that there is no single best substitute for everyone: methadone may suit some people, particularly those with heavier dependence or who do not do well on buprenorphine; naltrexone suits those who want a non-opioid option after detoxing; and a different buprenorphine formulation may suit others. What matters most is that any of these medications is used as part of proper treatment with counselling and support, and that the choice is made with a doctor. Changing from Suboxone to an alternative should never be done on your own, as it must be managed carefully to avoid withdrawal and relapse.
Methadone
Methadone is one of the main alternatives to Suboxone and one of the oldest and most studied medications for opioid addiction. Unlike buprenorphine, which is a partial opioid agonist, methadone is a full opioid agonist, meaning it fully activates opioid receptors, which can make it particularly effective for people with heavier or long-standing opioid dependence, or for those who do not get enough relief from buprenorphine. Taken once daily, usually as a liquid dispensed through a specialised clinic, methadone reduces cravings and withdrawal and, like Suboxone, dramatically lowers the risk of relapse and overdose when used as part of treatment.
The trade-offs are that, because methadone is a full opioid agonist without buprenorphine’s ceiling effect, it carries a higher risk of overdose if misused or combined with other sedatives, and it usually requires daily attendance at a clinic, at least at first, which some people find restrictive while others find the structure helpful. For the right person, methadone is a highly effective substitute for Suboxone, and the choice between them depends on the severity of dependence, response to treatment, lifestyle, and medical factors, decided with a doctor. Both are proven, evidence-based options.
| Medication | Type | Notable points |
|---|---|---|
| Suboxone | Partial opioid agonist (with naloxone) | First-line; ceiling effect; misuse deterrent |
| Methadone | Full opioid agonist | Strong for heavy dependence; daily clinic; higher overdose risk |
| Subutex | Partial opioid agonist (no naloxone) | Used in pregnancy or naloxone sensitivity |
| Sublocade | Long-acting buprenorphine injection | Monthly injection; no daily dosing |
| Naltrexone (Vivitrol) | Opioid antagonist (blocker) | Non-opioid; needs full detox first; monthly injection |
Other buprenorphine options: Subutex and Sublocade
If the issue with Suboxone is the naloxone it contains or the form it comes in rather than the buprenorphine itself, another buprenorphine medication may be the answer. Subutex is buprenorphine without naloxone; it has the same therapeutic strength as Suboxone at the same dose and is used in specific situations such as pregnancy, where avoiding naloxone is preferred, or where a person has a sensitivity to naloxone. For most people Suboxone is preferred over Subutex because the naloxone deters misuse, but Subutex is a valid alternative when there is a reason to avoid naloxone.
For people who struggle with taking a daily film or tablet, or who want the convenience and steadiness of a long-acting option, extended-release buprenorphine injections such as Sublocade offer an alternative. Sublocade is a once-monthly injection of buprenorphine given by a healthcare provider, which delivers a steady level of the medication and removes the need for daily dosing, which can support adherence and reduce the risk of missed doses or misuse. These long-acting buprenorphine options provide the same core benefit as Suboxone, relief from cravings and withdrawal through buprenorphine, in a different format, and can be a good substitute for people for whom daily dosing is a barrier. The choice among buprenorphine formulations is made with a doctor based on individual needs.
Naltrexone: a non-opioid alternative
Naltrexone is a quite different kind of alternative to Suboxone, because it is not an opioid at all. It is an opioid antagonist, a blocker, that occupies opioid receptors and prevents opioids from having an effect, so that using opioids while on naltrexone produces no high, which helps remove the incentive to use and supports recovery. It is available as a daily tablet or, more commonly for addiction treatment, as a monthly injection (Vivitrol). Because naltrexone is not an opioid, it causes no opioid dependence and there is no withdrawal from stopping it.
The important difference is that, because naltrexone blocks opioids, a person must be fully detoxed and free of opioids for a period before starting it, otherwise it would precipitate withdrawal; this makes the start-up harder than with Suboxone, which can be started while still dependent. Naltrexone does not relieve cravings in the same direct way buprenorphine does, though the monthly injection helps many people, and it suits those who have already detoxed and want a non-opioid medication to protect against relapse, for example after a period in residential treatment. So naltrexone is a valuable alternative for the right person and situation, particularly someone past the withdrawal stage who prefers a non-opioid approach, and the choice between it and Suboxone depends on where a person is in their recovery and their preferences, decided with a doctor.
Summary
There are several substitutes and alternatives for Suboxone in opioid addiction treatment, and the right one depends on the individual. The main alternatives are methadone, a full opioid agonist taken daily through a clinic, which is very effective, especially for heavier opioid dependence; other buprenorphine medications, such as Subutex (buprenorphine alone, used in pregnancy or naloxone sensitivity) and long-acting buprenorphine injections like Sublocade given monthly; and naltrexone, an opioid blocker available as a monthly injection (Vivitrol), which is not an opioid at all and is suited to people who have already detoxed. Each works differently: Suboxone and Subutex are partial opioid agonists, methadone is a full agonist, and naltrexone is an antagonist that blocks opioids. There is no single best substitute; methadone may suit people who do not do well on buprenorphine, naltrexone suits those who want a non-opioid option after detox, and a different buprenorphine formulation may suit others. The choice should be made with a doctor as part of medication-assisted treatment combined with counselling and support, based on the person’s history, severity, preferences, and circumstances, with the goal of reducing cravings and withdrawal, preventing relapse, and lowering overdose risk.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “When Suboxone is not the right fit, I am glad to say we have good options. For someone with heavy dependence who is not getting enough from buprenorphine, methadone can be the answer. For someone who hates the daily dosing, a monthly buprenorphine injection like Sublocade can change everything. And for someone who has already detoxed and wants nothing to do with opioids, naltrexone fits well. There is no single best substitute, only the best fit for that person. What never changes is that we pair the medication with counselling and support, and we never switch medications without a careful plan.”
Frequently asked questions
What is the best substitute for Suboxone?
There is no single best substitute for Suboxone for everyone; the right alternative depends on the individual. Methadone, a full opioid agonist, may suit people with heavier opioid dependence or who do not get enough relief from buprenorphine. Other buprenorphine options, such as Subutex (used in pregnancy or naloxone sensitivity) or a long-acting injection like Sublocade (no daily dosing), suit people who want buprenorphine in a different form. Naltrexone, a non-opioid blocker given as a monthly injection, suits people who have already detoxed and prefer a non-opioid approach. The best choice is the one that fits the person’s history, the severity of their dependence, their circumstances, and their preferences, made with a doctor as part of medication-assisted treatment with counselling and support. The goal is reduced cravings, prevented relapse, and lower overdose risk.
Is methadone better than Suboxone?
Neither is simply better; they suit different people. Methadone is a full opioid agonist that fully activates opioid receptors, which can make it more effective for people with heavier or long-standing opioid dependence or who do not do well on buprenorphine, but because it lacks buprenorphine’s ceiling effect it carries a higher overdose risk if misused or combined with sedatives, and it usually requires daily attendance at a clinic. Suboxone is a partial opioid agonist with a ceiling effect that makes it safer against overdose, contains naloxone to deter misuse, and can often be prescribed for use at home. Both are proven, effective, evidence-based treatments. Which is better for a given person depends on the severity of dependence, response to treatment, lifestyle, and medical factors, decided with a doctor.
Can you switch from Suboxone to naltrexone?
Yes, but it must be done carefully under medical supervision, because naltrexone is an opioid blocker and you must be fully detoxed and free of opioids, including buprenorphine, for a period before starting it; otherwise it would precipitate withdrawal. This means switching from Suboxone to naltrexone involves first tapering off and clearing the buprenorphine, which is the harder part, before starting naltrexone, often as a monthly injection (Vivitrol). Naltrexone suits people who have completed this detox step and want a non-opioid medication to protect against relapse, for example after residential treatment. Because of the detox requirement and withdrawal risk, this switch should only ever be planned and managed by a doctor, never attempted on your own. Done properly, naltrexone is a valuable non-opioid alternative for the right person.
What are the long-acting alternatives to daily Suboxone?
The main long-acting alternatives to daily Suboxone are extended-release buprenorphine injections, such as Sublocade, a once-monthly injection of buprenorphine given by a healthcare provider that delivers a steady level of medication and removes the need for daily dosing. For people on naltrexone rather than buprenorphine, the monthly naltrexone injection (Vivitrol) is also a long-acting option, though it is a non-opioid blocker and requires full detox first. These long-acting options can support adherence, reduce the burden of daily dosing, and lower the risk of missed doses or misuse, which makes them helpful for people for whom taking a daily film or tablet is a barrier. The choice of a long-acting option is made with a doctor based on the person’s needs, and it provides the same core treatment benefit in a more convenient format.
Why might someone need a substitute for Suboxone?
Someone might need a substitute for Suboxone for several reasons: it may not relieve their cravings and withdrawal adequately, particularly with heavier dependence, in which case methadone may work better; they may have troublesome side effects; they may be pregnant or sensitive to naloxone, making Subutex preferable; they may struggle with daily dosing and benefit from a long-acting injection like Sublocade; or they may have already detoxed and prefer a non-opioid approach with naltrexone. Personal circumstances, preferences, and access also play a part. In each case the point is that effective alternatives exist, so if Suboxone is not the right fit, treatment does not have to stop; it can be adjusted. The choice of substitute should be made with a doctor as part of ongoing treatment, with the switch carefully managed to avoid withdrawal and relapse.
Should you change from Suboxone to another medication on your own?
No. You should never switch or stop Suboxone on your own. Changing from Suboxone to another medication must be planned and managed by a doctor, because doing it wrong can trigger withdrawal and increase the risk of relapse and overdose. For example, switching to naltrexone requires a full detox first to avoid precipitated withdrawal, and changing between agonist medications needs careful dose management. Stopping Suboxone abruptly removes its protection against opioid use, which is dangerous. So if you feel Suboxone is not working for you or want to try an alternative, the right step is to talk to your prescriber, who can assess the options, choose a suitable substitute, and manage the change safely. Effective alternatives are available, and accessing them safely means doing so with medical guidance, not alone.
Sources
Substance Abuse and Mental Health Services Administration (SAMHSA). Medications for Substance Use Disorders. https://www.samhsa.gov/medications-substance-use-disorders
National Institute on Drug Abuse (NIDA). Medications to Treat Opioid Use Disorder. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction
Food and Drug Administration (FDA). Information about Medication-Assisted Treatment (MAT). https://www.fda.gov/drugs
National Library of Medicine (MedlinePlus). Methadone; Buprenorphine; Naltrexone. https://medlineplus.gov/
American Society of Addiction Medicine (ASAM). National Practice Guideline for the Treatment of Opioid Use Disorder. https://www.asam.org/
World Health Organization (WHO). Opioid Overdose. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
Substitute for Suboxone — key entities and related terms
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