Topic	Heroin	Methadone	Buprenorphine
Onset of action	A few seconds	30 minutes	30 to 40 minutes
Duration of action	4 to 6 hours	24 to 36 hours	About 24-48 hours
Route of administration	Injection, snorting, smoking	Oral	Sublingual
Frequency of administration	Several times a day	Daily or more frequently as needed	Every day or every other day
Effective dose	Ever increasing	Blocking dose, usually 80 to 120 mg	2 to 32 mg
Tolerance	Increasing tolerance	Tolerance is stable	Tolerance is stable
Euphoric effects	Euphoria for up to 2 hours	No euphoria when stabilized	No euphoria when stabilized
Overdose potential	High and increased	Rare – Potential if mixed with other depressants	Very rare
Overall safety	Potentially lethal	Very safe – Possibly associated with rare cardiac irregularities—Treatment choice in pregnancy	Overall good profile--Suboxone injection will cause serious withdrawal symptoms in dependent persons – Not recommended for use in pregnancy or breastfeeding—Caution with liver disease – Currently under study
Withdrawal	Within 3 to 4 hours after last dose	Within 24 hours after last dose	Within 36 to 48 hours after last dose
Craving	Recurring cravings	Eliminated with adequate dose	Craving may not be totally eliminated due to ceiling effect
Pregnancy and nursing	Heroin dependence poses grave risks for mother and fetus	Safe during pregnancy	Not indicated, however study underway
Experience of pain and emotions	Blunted	Normal pain and full range of emotions	Normal pain, but opioid analgesics may not be effective May need to switch to methadone – Full range of emotions
Mood	Constant mood swings	Normal	Normal
Physical reaction time and intellectual functioning	Impaired	Reaction time normal Intellectual functioning unimpaired on stable dose	Reaction time presumed to be normal like methadone. FDA cautions driving and operating heavy machinery in the beginning of treatment
HIV & hepatitis C transmission	High rate with needle use and unprotected sex	Reduced/eliminated	Reduced/eliminated
Immune system for HIV positive persons	Rapid Progression to AIDS	Progression slowed with methadone	Progression presumed same as methadone – Data not available for buprenorphine
Immune/endocrine system functioning	Impaired	Normalized during treatment	Presumed normal during treatment – Data not available
Stress response	Suppressed	Normalized during treatment	Normalized during treatment
Criminal activity	High level	Reduced/eliminated	Reduced/eliminated
Personal relationships	Distributed	Potential for restoration, Improvement with counseling	Potential for restoration, Improvement with counseling
Employment	Deteriorating performance, loss of employment	Full functioning	Full functioning
Community impact	Destructive impact; high crime, high death rate, transmission of disease	Contributes to public health safety, low mortality, increased health	Contributes to public health safety, low mortality, increased health

Data: Substance Abuse & Mental Health Services Administration