Downsides to Methadone

#1 - You have to go to a clinic every day for a long time at the beginning, which I did mention, but I didn't mention the fact that you are surrounded by drug addicts while doing so, and there are usually drug dealers parked outside (especially the lower-class clinics, there are many different "types" of methadone clinics, some for street addicts, some for upper-class addicts, and the latter is far superior.) Buprenorphine doesn't have this problem.
#2 - It is extremely difficult to get off of methadone. You have, in most cases, withdrawals worse than heroin, and lasting over a month (as opposed to a week with heroin.) Buprenorphine has extremely mild withdrawals in most cases, but they are long lasting like methadone, about a month (compared to about a week with short-acting opiates.)
Well, that's really it. I think I mentioned everything else. But these two things are very important. Let me know if I am missing anything.
Finally I want to say that this diary has been misinterpreted that I was suggesting lifelong maintenance. I was not. While that is certainly a possibility, especially with certain individuals, the goal of maintenance treatment is that you will get off of it eventually, and that should be very clear.

Buprenorphine is different than methadone

Buprenorphine is different than methadone, and it's vital. I will get into the legal differences and implications in a minute, but let me get the final bit of basics out of the way. Buprenorphine is a "mixed opiate agonist/antagonist," well, actually, it's better described as a "partial opioid agonist." Describing this is beyond the scope of this diary. Let's just say there are several things about buprenophine that make it very different pharmacologically than methadone, which I will describe:

#1 - It is a much weaker drug. It won't leave you with a sky-high tolerance to opioids.
#2 - Following that, even though it's weaker, it has an antagonist effect - meaning it blocks other opioids from working (i.e. heroin.) - quite well in fact, but not as well as was originally believed
#3 - Following THAT, It seems to fix what heroin broke, and anecdotal evidence clearly implies that you are often more sucessful getting off buprenorphine than methadone.
#4 - Finally, the withdrawals of buprenorphine are mild at best in relative comparison to other opiates, especially methadone. Methadone withdrawals are a month of utter, utter hell.

There are two major downsides to buprenorphine, which I will also list for you.
#1 - As I said, it's, simply put, "weaker." This means that it can't satisfy all addicts - although the specific tolerance and level of addiction of the addict seems to play only a small role in this.
#2 - Due to it's opioid-blocking effects, the transition of getting on to buprenorphine from heroin or other opiates can be quite painful, especially if it's not done properly - and most doctors have no idea what the hell they are doing in this regard.

One final thing to say about buprenorphine - poorly understood, but it seems that it helps greatly with cocaine addicts. Getting into this is beyond the scope of this diary.

Well, I hope that's about it for the technical mumbo-jumbo. I hope you are sticking with it. On to some more relevant stuff.

maintaining your addiction

Maintenance is when you take another opioid instead of heroin, "maintaining" your addiction. At face value, that doesn't sound very productive. But it is, and I will now tell you why. At the current time, there are two maintenance medications: methadone, and buprenorphine[Subutex/Suboxone]. There was a third, LAAM, legally no different than methadone, which worked for a whopping three days, but it was pulled from the market (in the USA) because of lack of interest and the potential for heart attacks it causes (one of the few opiates, if not the only, to have such problems.)

So why is maintenance important, and a very necessary option for heroin and opioid addiction treatment? Why isn't it "trading one addiction for another"? Because depending on the study you are looking at, nevermind anecdotal evidence, your chances of success at long-term abstinence are anywhere from 5-15%. No one knows why this is, at least not yet, but even after the withdrawals are over, "the easy part" according to just about anyone, the hard part begins - long term abstinence. "Willing it" just doesn't seem to work - believe me, I have tried. Your brain seemingly gets rewired to treat heroin like the most basic of your biological needs, lasting anywhere from 6-12 months to the rest of your life. It's like trying to "will" yourself not so sleep, or eat, or fuck. Over the long term.

So that's why it's important, because your chances of abstinence are so low, and people just want to live normal lives (and buprenorphine is a HUGE step towards that goal, as opposed to methadone, I will explain.) The important question many must be asking themselves is what makes it any different than heroin? There is a world of difference between methadone/buprenorphine and heroin/other opiates. The first and foremost is the duration of action and the time to peak effects. They both prevent withdrawals for 24 hours (or more), meaning you will not be constantly running around looking for a fix, and you won't have the ups and downs of heroin - once stablized, you will essentially just feel normal - not high, not low. Your body will adjust to the drug and make itself work as if it wasn't there. Ideally, at least, there are some very unique people out there. The fact that it takes nearly 2 hours to reach peak effects means you just simply don't get high from these drugs - unless you are "niave" to opiates, that is, in which case you wouldn't be going into maintenance. As I said, it let's people live normal lives - people on methadone, undetectable, are lawyers, engineers, even doctors. You would be amazed.