Version July 2025
| Feature | Buprenorphine* | Methadone¶ |
| Treatment retention[1-3] | Appears lower | Appears higher |
| AccessibilityΔ | Can be prescribed in private offices | Requires licensed OTP |
| Suppression of nonprescribed opioid use[4] | Appears comparable | Appears comparable |
| For patients with a high level of physical dependence | May be preferable | |
| For patients with fentanyl use | May be preferable | |
| Drug-drug interactions | Potentially lower | |
| Overdose-related mortality from the treatment medication[5] | Likely lower | Likely higher |
| All-cause mortality[2] | Appears comparable | Appears comparable |
| Induction difficulty | Risk for precipitated withdrawal when initiating | Need for slow titration to avoid potential iatrogenic overdose |
| Availability of wraparound services | May be available | Counseling availability required in OTP settings in the United States; other services may be available |
| Cardiac conduction effects | No evidence of cardiac conduction effects | May cause QTc prolongation if other risk factors and/or very high doses used |
OTP: opioid treatment program; QTc: heart-rate corrected QT interval.
* Comparisons are relative to effects with use of methadone.
¶ Comparisons are relative to effects with use of buprenorphine.
Δ Pertains to access in the United States. Regulatory, economic, and legal factors differentially affect accessibility in countries outside the United States.
