Buccal Vs Sublingual: Can I Put Suboxone In My Cheek? Which Is The Best Way To Take Buprenorphine?

Buccal Vs Sublingual: Can I Put Suboxone In My Cheek? Which Is The Best Way To Take Buprenorphine?

Suboxone Sublingual Administration Vs Buccal Administration

If your doctor has prescribed a Suboxone film or Suboxone tablet, then they have certainly instructed you on how to take the sublingual tablet or sublingual film. You simply place the medication under your tongue and wait for it to dissolve.

What happens if you swallow Subutex or Suboxone? Swallowing Suboxone or similar medications renders the medication ineffective.

A Suboxone pill or film will not work if swallowed. Swallowing Suboxone strips will lead to very low absorption of the medication.

If you know how to properly take Suboxone, then you understand that the best absorption typically occurs sublingually, or under the tongue.

Yet, there is another brand of buprenorphine/naloxone named Bunavail, similar to Suboxone in regard to ingredients, but different in that it is placed on the inner cheek. Is Bunavail the same as Suboxone otherwise?

Bunavail is formulated with a special adhesive property to stay in place when attached to the buccal mucosa. As a buccal film, it is intended to be used in this manner.

Yet, while Suboxone is not designed for buccal administration, some people do use it this way. Buccal vs Sublingual: which works best with Suboxone?

How to use Suboxone film.

In the Suboxone package insert, approved by the FDA, there is information on what to do and not do when taking a Suboxone sublingual tablet or Suboxone sublingual film. For example, they are very clear that the medication must not be cut in half or in pieces.

Yet, the instructions for buccal vs. sublingual administration are more flexible. The literature states that Suboxone, and similarly, Subutex or ZubSolv, should be placed under the tongue at the beginning of treatment.

Then, they state, that the patient can decide later on if they want to place Suboxone under the tongue or in the cheek. When I saw this, I was surprised that the official Suboxone literature allowed for this flexibility.

Of course, my position on this topic is that a patient who is receiving buprenorphine treatment should always discuss these issues with their doctor. If a patient is considering trying to take their prescribed Suboxone film by placing it on their cheek, rather than under the tongue, they should discuss it with their doctor first to see if there will be any issues.

Why would Suboxone buccal vs sublingual use be a question at all?

Possibly, if a person produces too little saliva, a condition known a xerostomia, Suboxone may not absorb well under the tongue. While there are ways to increase saliva production, such as drinking citrus juice, some patients may be interested in trying buccal administration of Suboxone.

While this may seem obvious, I should mention that buccal Suboxone administration will only work with the Suboxone film and not as well with the Suboxone, ZubSolv, or Subutex tablets.

Bunavail is a film made to stick to the inner cheek. The Suboxone film may also stick adequately for some patients. Tablets will not stick, though possibly, they will stay in place and absorb if placed in the lower inner cheek, between buccal mucosa and the gums.

So, while it is best to use Suboxone films in the way they were intended to be used, under the tongue, saliva issues may lead a patient to seek alternatives. Speak to your doctor about the possibility of buccal vs sublingual use of Suboxone.

Will buccal administration help to reduce Suboxone side effects?

Does Suboxone make you sweat, or do you get Suboxone headaches or Suboxone constipation? You may wonder if buccal administration will help you to avoid Suboxone sickness.

Unfortunately, placing Suboxone in a different part of the mouth will probably not help at all with Suboxone side effects. Yet, since there is little harm in trying, you might want to discuss the possibility of buccal Suboxone with your doctor if you have side effects.

Also, consider the possibility that you are swallowing Suboxone saliva during sublingual administration or afterwards. Some patients state that spitting out the saliva after their Suboxone has been absorbed helps to reduce side effects, such as upset stomach, constipation, and headache.

Are opioid cravings better controlled with Suboxone buccal vs sublingual use?

Suboxone contains both buprenorphine, an opioid agonist and opioid antagonist, as well as naloxone, a pure opioid antagonist. Since the naloxone sublingual bioavailability is very low, when Suboxone is taken properly, naloxone does not have any significant effect on the patient.

Some patients claim they get headaches as a result of the naloxone in Suboxone. Naloxone side effects are unlikely, but still possible, because a small amount is still absorbed, even sublingually.

Buprenorphine is a unique opioid drug that is highly effective in preventing opioid overdose in patients with fentanyl or heroin addiction. How can an opioid medicine treat drug addiction?

Buprenorphine is only a partial agonist, meaning that its opioid effects are very mild. As an opioid receptor blocker, it is highly effective in maintaining its effect on receptors and blocking other opioids.

Patients describe taking Suboxone as allowing them to think clearly and function normally, without any feeling of sedation or intoxication. While Suboxone does cause physical dependence, and there are Suboxone withdrawal symptoms if the patient stops taking the medication, patients describe the treatment as feeling normal, without addictive thoughts.

Does Suboxone make you high?

In nearly all cases of prescribed use, Suboxone does not make patients high at all. How does Suboxone make you feel? For many patients, it makes them feel normal, as if they did not have an opioid addiction.

While Suboxone can be a CNS depressant, especially when combined with other CNS depressants, it typically does not cause brain fog or other CNS symptoms. When patients experience side effects, the doctor may suggest lowering the dose.

Suboxone, because of the buprenorphine ingredient, is highly effective at preventing opioid cravings. It is about as effective as methadone, yet without the side effects and dangers of overdose.

Will buccal vs sublingual administration make a difference in preventing opioid cravings? There will likely be no difference, though some patients have reported differences in buprenorphine absorption with buccal vs. sublingual use.

Any difference in absorption is most likely related to the specific patient’s issue with sublingual vs buccal absorption. If a patient has difficulties with sublingual absorption, and buccal works better for them, then, of course, it will seem to them that buccal administration has better absorption.

Should patients be concerned about Suboxone bioavailability or buprenorphine bioavailability?

Being overly concerned about getting every last milligram or microgram of a drug is an aspect of addictive thinking. People in active addiction have been known to spend hours, searching through the carpet on their floor, looking for drug powder or residue.

As part of addiction recovery, it is best to avoid overthinking issues of medication absorption. If the Suboxone doctor prescribes Suboxone to be placed under the tongue, and it is working, there should not be any concern about how many milligrams are actually being absorbed.

I have seen in the literature that sublingual absorption is around 1/3 of the medication. So, if a patient takes Suboxone 8 mg, they may absorb around 2.5 mg. This should not be a concern at all, because it is made to work this way.

The manufacturer documents how many milligrams are in the Suboxone pill or strip, not how many milligrams end up in a patient’s blood stream. Hence, patients should mainly be concerned with how well their treatment is working with respect to not having opioid withdrawal symptoms and not having opioid cravings.

When it comes to Suboxone, generally, more is not better. In fact, for many patients, over time, less is better.

When you are starting Suboxone, follow your doctor’s instructions.

There is nothing wrong with asking questions about how to take Suboxone and why your doctor has instructed you to take it in a certain way. You should feel comfortable asking questions.

Yet, after it has been established during your Suboxone telemedicine visit or in-person visit how you are going to take your medication, you should stick with the plan. If you feel that there is a problem, reach out to your doctor.

You should be able to reach your Suboxone doctor at any time if you have questions or concerns. While your doctor will instruct you on the best way to take buprenorphine, if you believe that your treatment is not ideal for any reason, make a phone call to speak to your doctor right away.

Suboxone buccal vs sublingual administration: in conclusion.

While the official literature does discuss buccal use of Suboxone films, the films are not designed for buccal use in the way that Bunavail was designed. For most patients, the ideal way to take Suboxone will be Sublingually, or under the tongue.

In the future, they may improve the formulations of sublingual and buccal medications. Sublingual medications do have limitations, but it is possible to make improvements.

For example, there was a buprenorphine wafer that was patented and may be in development. The Suboxone wafer is described as dissolving under the tongue in seconds rather than minutes.

ZubSolv is a brand of buprenorphine/naloxone that is known to dissolve very fast. It is a tablet that, according to the literature, dissolves in just under three minutes.
Additionally, there is the Suboxone shot, Sublocade.

And soon, there will be another buprenorphine shot, Brixadi. These monthly injectable buprenorphine products are injected under the skin and last for an entire month.

With these long-lasting injectables, there is no issue of buccal vs sublingual absorption. The patient does not have to worry at all about taking medication on a daily basis.

In the meantime, fortunately, we have medications that have a very high success rate in treating opioid addiction and opioid dependence. While they are not perfect, they do work very well for many people who want to overcome opioid addiction and begin on a path of addiction recovery.