Suboxone®, a combination of buprenorphine and naloxone, is a US Food and Drug Administration-approved opioid replacement therapy that works to curb cravings and prevent withdrawal symptoms. It is the most commonly known among the buprenorphine-based medications to address opioid disorder as part of Medication Assisted Treatment (MAT).
Suboxone® treatment can lead those seeking to overcome addiction toward desirable and sustainable outcomes. A large part of this success is knowing how Suboxone® works and how to use it. Is swallowing Suboxone® okay? The short answer is NO. Read on to find out why.
How Suboxone® Works
Suboxone® is presented as a sublingual film that's administered as a single dose and, according to its drug literature, has a recommended dose of 16/4 mg per day for maintenance. Over the course of treatment, a MAT provider may adjust the dosage in decrements or increments to a level that suppresses opioid withdrawal symptoms and is comfortable for the patient.
To take the medication, place the Suboxone® film under the tongue according to the prescribed dose. If more than one film is prescribed, then the second one is still placed sublingually but on the opposite side from the first, carefully positioning them to minimize overlapping. Suboxone® should stay under the tongue until the entire film fully dissolves.
Chewing, moving, and swallowing Suboxone® is not advised because less medication will be absorbed into the bloodstream — meaning it won’t work as well and could result in withdrawal symptoms.
When a patient is taking Suboxone® for the first time, the prescribing clinician will review how to take the medication successfully. The patient will then take their medication as prescribed in the morning, in the evening, or sometimes both.
How to Successfully Start Suboxone®
In order to start Suboxone® therapy, patients must be in moderate opiate withdrawal. MATClinics uses COWS (clinical opiate withdrawal scale) to determine if patients are in moderate withdrawal and able to start their medication. A patient will need to score between 13 and 24 on the COWS to start Suboxone®.
Once the patient is in moderate withdrawal, they cut or break off a 2 mg piece and place it under their tongue. They then let it dissolve for 5 to 10 minutes. Since Suboxone® is only absorbed sublingually, patients are advised not to talk, swallow, or smoke during this process.
After 45 minutes, patients' withdrawal symptoms will likely have improved or worsened. If the withdrawal symptoms have improved, patients may take another 2 mg film. If symptoms become worse, patients should contact their prescribing clinician, as they may have precipitated withdrawal.
Later that day, patients should take another 4 mg (or the rest of the film they previously cut into pieces).
The next day, patients can start taking their prescribed dose.
Tips for While Taking and After Taking Suboxone®
Below is more detailed information for prospective patients on how to take sublingual films:
- Always take your Suboxone® film exactly as prescribed by your doctor.
- Fold along the dotted line and tear downward at the slit to open the film package. You can also use scissors to cut along the arrow if you prefer.
- Before taking Suboxone®, it's a good idea to drink some water to moisten your mouth. This will help the film dissolve more easily.
- Ensure that your hands are dry, and hold the Suboxone® film between two fingers by the outside edges.
- Place one film at a time under your tongue, close to the base. Lean your head slightly forward, and let the film dissolve completely. Suboxone® is absorbed into the bloodstream through the veins under the tongue.
- Develop a daily routine so that it's easier to remember when to take Suboxone®.
- Suboxone® film takes about 5 to 10 minutes (sometimes more) to dissolve completely. After it dissolves, hold the taste in your mouth for at least 20 minutes for it to be most effective.
- Remember: Spitting, chewing, or swallowing Suboxone® is not recommended. There’s also no such thing as a Suboxone® spit trick.
- Talking can also interfere with how well Suboxone® is absorbed. Do not eat, drink, talk or smoke while taking the film.
- You may want to do something else that doesn't require talking while you wait, such as watching TV or reading. Also, let family and friends know you won't be able to talk or answer the phone during this time.
What to Do in Case of Overdosage
Suboxone® is FDA-approved for MAT but it is a controlled substance, which means that only physicians, nurse practitioners and physician assistants can prescribe it and that it should be taken only as ordered. Patients under MAT are carefully monitored and supervised by their prescribing provider. However, in the rare instance that an overdose might occur, here’s what you should do and expect.
Observe for signs of overdose, which can include sedation, hypotension, pinpoint pupils, and respiratory depression. If any of these happen, seek emergency care right away. Doctors will immediately monitor your cardiac and respiratory condition and find ways to re-establish an airway through assisted or mechanically controlled ventilation. Oxygen, vasopressors, IV fluids, and other supportive interventions might be necessary too.
Get Suboxone® Treatment the Safe Way Through MATClinics
MATClinics' science-based approach to dealing with opioid use disorder involves a well-balanced combination of Suboxone® treatment, counseling, and case management. Every patient is assigned a dedicated case manager who will consistently follow up within two days of appointments to ensure that patients are following procedures correctly and are aware of counseling alternatives.
MATClinics has several Suboxone® treatment clinics across Maryland. If you or a loved one is struggling with addiction, we encourage you to begin the healing and recovery process by getting in touch with MATClinics now.