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Abstract
Background. Although there is evidence that buprenorphine is more effective than placebo in suppressing heroin use, and is a recommended treatment for opioid dependence, methadone remains the dominant maintenance treatment. However, this may have adverse consequences in increased dependence liability and greater withdrawal effects. Rationale. The study assessed the experiences of clients in Lanarkshire who had experienced both substances to report on the strengths and weaknesses of each. Method. Two phases of opportunistic data were collected – open narrative accounts of those successfully detoxifying from Suboxone (a buprenorphine/naloxone combination) and structured interviews with clients comparing Suboxone and methadone. Results. Consistently, clients reported more clarity of thinking while on Suboxone. However, this was not always perceived positively as increased clarity necessitated more psychosocial therapeutic support than was needed on methadone. Suboxone was associated with increased confidence and lower stigma than methadone. Concerns were expressed about the antagonistic effect of Suboxone, with several reports of “use on top”. Conclusion. Participants made clear distinctions between methadone and Suboxone, with the strongest difference being increased clarity of thinking on Suboxone. Suboxone has significant potential for staged use within a “recovery journey” but only if prescribed within an appropriate package of psychosocial care.