Suboxone is a medication approved for the treatment of Opioid Use Disorder (OUD) as part of a comprehensive treatment plan that includes counseling and behavioral therapies. This combination product contains two active ingredients: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist that helps to reduce cravings and withdrawal symptoms by activating opioid receptors in the brain. For the medication to work correctly and safely, its method of administration must be followed precisely. Proper use ensures the therapeutic benefits are maximized while mitigating the risk of side effects.
The Correct Sublingual Administration Process
The unique formulation of Suboxone requires it to be absorbed through the mucous membranes inside the mouth, a route known as sublingual or buccal administration. Before placing the film or tablet, the mouth should be moist, and the patient must avoid eating, drinking, or smoking for at least 15 minutes beforehand. The medication is placed either under the tongue (sublingual) or inside the cheek (buccal), depending on the specific product form.
Once positioned, the patient must keep the mouth still, avoiding talking, chewing, or moving the medication with the tongue. This stillness is necessary to ensure the medication maintains contact with the capillaries for absorption. The film or tablet must be allowed to fully dissolve, which typically takes between five and ten minutes.
It is crucial to wait until the entire dose has completely dissolved before swallowing any remaining saliva. Prematurely swallowing the medication significantly reduces the amount of buprenorphine that enters the bloodstream. This careful process enables the medication to bypass the digestive system, which would otherwise render it largely ineffective.
Why Swallowing is Avoided: Understanding the Formulation
The two components of Suboxone—buprenorphine and naloxone—are designed to be absorbed differently when taken as directed. Buprenorphine is highly bioavailable when absorbed sublingually, with approximately 35% to 55% of the dose entering the bloodstream. This high absorption provides the necessary therapeutic effect for managing OUD.
Naloxone is an opioid antagonist, meaning it blocks the effects of opioids by occupying the same receptors. When taken sublingually, naloxone has very low bioavailability, with less than 10% of the dose being absorbed into the system. This low absorption ensures the naloxone does not interfere with the buprenorphine’s beneficial action.
The naloxone is included specifically to deter misuse of the medication through injection. If the combination product were dissolved and injected, the naloxone would be immediately absorbed in high concentration, precipitating severe withdrawal symptoms. This protective mechanism makes it crucial to avoid any action that would increase naloxone’s systemic absorption.
Swallowing the residual saliva introduces the naloxone into the gastrointestinal tract, where it is more readily absorbed than during sublingual administration. Swallowing the residue increases the systemic naloxone levels. The primary consequence of this increased oral absorption is a greater likelihood of experiencing uncomfortable side effects.
Maximizing Treatment Effectiveness and Safety
The decision of whether to spit or swallow the residual saliva after the medication has completely dissolved impacts treatment outcomes. Swallowing the residue, sometimes referred to as “Suboxone spit,” is strongly discouraged because it provides no additional therapeutic benefit. Once the film is dissolved, the buprenorphine has already been absorbed into the bloodstream.
Any medication remaining in the saliva, primarily naloxone and inactive fillers, can cause side effects if ingested. Swallowing this residue may lead to gastrointestinal distress, including nausea, stomach upset, or headache. By spitting out the excess saliva after the full dissolution time, patients minimize the amount of naloxone and filler that enters the stomach.
If the entire dose is accidentally swallowed before it has fully dissolved, the patient will receive a significantly reduced therapeutic dose of buprenorphine. This is because buprenorphine is largely broken down by the liver when processed through the digestive system, a process called first-pass metabolism. Reduced buprenorphine absorption means the dose is ineffective, potentially leading to the return of opioid cravings or withdrawal symptoms.
Spitting out the residual saliva is a practical step that maximizes the effective absorption of buprenorphine. It also minimizes the risk of uncomfortable side effects from inactive ingredients and the increased oral absorption of naloxone. Adhering to the instructions ensures the medication works as intended for OUD treatment.