The CMAJ recommends the use of buprenorphine – naloxone, which is sold under the brand name Suboxone, as the first line of treatment whenever feasible to reduce toxicity, morbidity and death. As a second line of treatment, methadone is recommended in individuals that respond poorly to Suboxone, or when Suboxone is not the preferred method of treatment.
There are, however benefits and downfalls to each medication as set out by the CMAJ.
The journal recommends using Suboxone first, and then move to methadone if necessary. Methadone may have better treatment retention when used with high frequency, long term users, but has several safety downfalls compared to Suboxone. According to a study conducted in the United Kingdom, Suboxone was six times safer than methadone.