The forum won't let me include a website URL (because it might be spam), so I am recopying the buprenorphine vs methadone comparison chart. The author is Dr Joseph Andrew Berkowski of ReLACS Health (co-author of the current RLS Guidelines) and he gave permission to share with you all. (AKA "Dr Andy")

The title of this website is: Treatment of Restless Legs Syndrome (RLS) with Methadone Versus Buprenorphine: Who Wins? You can probably google it and read the entire article, if you are interested. The article speaks to his reasoning assigning "stars" to the two drugs and why he thinks buprenorphine is a better drug to prescribe.

I think this is valuable information, but not everyone reacts exactly the same to any particular medication. This is why it is so important to have a doctor who can work with us and tinker, if need be. I never had any improvement from gabapentin or pregabalin, but that is where prescriptions seem to begin and maybe for others these drugs work well.

I can't say buprenorphine is the answer for everyone, but it sure has turned my life around.

You can see from the chart that buprenorphine comes out better than methadone in a number of critical categories. In terms of "risk of death" I believe this speaks to an overdose (such as a grandchild taking unsecured medications). It is, therefore, safer to have buprenorphine around the house than methadone. Although I am careful about where medications are kept, I also have grandchildren and knowing buprenorphine is less likely to cause a lethal overdose is something I appreciate. Also, methadone has more potential to reduce respiration, a potentially serious side effect for some people.

Both drugs can be effective for treating RLS. And, there are ways that methadone beats buprenorphine.

(more stars are better---fewer stars are worse)

For RLS

buprenorphine methadone

risk of death. ***** **
effect on breathing **** *
effectiveness for RLS ***** *****
ease of use ** *****
irregular heart rhythm **** **
cost ** *****
availability & accessibility *** ***
triggers opioid withdrawal ** *****
chemical dependency **** **
constipation *** *
lack of euphoria ***** ***
pronunciation * *****