Can I put Suboxone in my cheek?
Yes, you can, and the Suboxone label says so. After the first days of treatment, the Suboxone sublingual film prescribing information allows the film to be placed either under the tongue or on the inside of the cheek.
I am Dr. Leeds, and I have treated opioid dependence for over two decades. When I first read that line in the official literature, it surprised me. Nearly every patient is taught that Suboxone goes under the tongue and nowhere else.
Still, under the tongue is the default, and for good reason. Swallowing a Suboxone film or a buprenorphine tablet wastes most of the dose, since buprenorphine is absorbed poorly from the stomach and has to pass through the lining of the mouth to reach the bloodstream in a useful amount.
For years there was a second brand, Bunavail, a buprenorphine and naloxone film made to stick to the inner cheek. Bunavail has been discontinued in the United States, so today the buccal question is about the Suboxone film alone. So, does it make any difference whether the film sits under your tongue or against your cheek? Does one route absorb more of the medication? Or, is this really a question of saliva and comfort rather than potency?
How do you use Suboxone film, according to the label?
The label’s instructions are more flexible than most patients expect. For sublingual use, it says to place one film under the tongue, close to the base, on the left or right side, and to keep it there until it has completely dissolved.
For buccal use, it says to place one film on the inside of the right or left cheek and, again, to leave it there until it is completely dissolved. Either way, the film must be taken whole, never cut, chewed, or swallowed, and it should not be moved once it has been placed.
So, why does the label care which route you use at the start? The answer is the naloxone. During induction, the first days when the dose is being established, the label recommends the sublingual route, because exposure to naloxone is somewhat higher after buccal use, and more naloxone means a higher risk of precipitated withdrawal, or withdrawal set off by the medication itself.
After that, for maintenance, the label states that the film may be taken buccally or sublingually, and that the amount of buprenorphine reaching the body is similar by either route. Yet, a change in route is still a change in your treatment. Talk it over with your buprenorphine doctor before you try it.
Why would Suboxone buccal vs sublingual use be a question at all?
Saliva is the reason. A film dissolves into saliva, and the dissolved buprenorphine is then absorbed across the lining of the mouth, so a person who makes very little saliva may absorb poorly under the tongue.
A dry mouth, known as xerostomia, is common, and many medications make it worse. Some patients also find that a film under the tongue gets in the way of swallowing, or that the taste is harder to bear in that spot than against the cheek.
While there are ways to increase saliva, such as a sip of water beforehand or a bit of citrus, some patients simply do better with the film on the cheek. The film is sticky enough to stay put on the buccal mucosa, or inner cheek lining, for most people.
Tablets are a different story. While a tablet will not stick to the cheek, it may stay in place and absorb if it is tucked into the lower cheek, between the gum and the lining, so buccal use is really a question about the film. Ask your doctor before you experiment.
Is the Suboxone film better than the tablet?
Neither one is better for everyone, and both work. The film usually dissolves faster, it is the only form whose label allows the cheek, and it comes in a sealed pouch that is easy to carry.
Tablets are the older form. The Suboxone brand tablet is no longer made, so the tablets dispensed today are generic buprenorphine and naloxone, and there is also the buprenorphine-only tablet that most people still call Subutex. ZubSolv is a branded buprenorphine and naloxone tablet that many patients find dissolves faster than the generics.
And, generic films and generic tablets are both widely available now, so the price at the pharmacy often decides the matter. Taste is personal, and patients who cannot stand one form often do fine with the other.
In my opinion, the right form is the one that you can take properly, day after day, without dreading it. If you are switching between film and tablet, do it with your doctor rather than on your own, because each product carries its own dosing instructions on its label.
How long does Suboxone take to dissolve?
In my experience, a Suboxone film takes about five to ten minutes to dissolve completely. A tablet usually takes longer, a dry mouth stretches the time for either one, and a larger dose, or two films at once, takes longer than a single small film.
Interestingly, the label does not give a number of minutes. What it does say is that the film must be kept in place until it is completely dissolved, that it should not be chewed, moved, or swallowed, and that you should not eat or drink anything until it is gone.
One pattern I see often is a patient who calls a week after starting, certain that the medication is not working. It turns out that they have been sipping coffee while the film dissolves, or talking through it, or swallowing the film once it turns soft. The medicine was fine. The method was not.
If a film is taking longer than you expect, let it finish rather than chewing what is left. Patience is part of the dose.
How do you get the most out of a sublingual dose?
The label’s own instructions are the place to start. Place one film under the tongue, close to the base, on the left or right side, and if your dose calls for a second film, place it on the opposite side so that the two do not overlap.
A sip of water before the dose, not during it, moistens the mouth and helps the film dissolve. Then keep your mouth closed and do not talk, eat, drink, or smoke for about ten minutes, until the film is gone.
Tablets have one extra wrinkle. Some patients report better results with the tablet in one position under the tongue rather than another, and while this should not matter, it seems to be a matter of personal preference, a point I learned from listening to patients rather than from any label.
Once the film has dissolved, the label asks you to take a sip of water, swish it gently around your teeth and gums, and swallow. Some patients spit out the saliva first and tell me that it eases nausea and headache, and in my experience that helps some people and makes no difference for others.
Will buccal administration help to reduce Suboxone side effects?
Probably not. Sweating, headache, constipation, and nausea come from the buprenorphine that is absorbed, and since the label says buprenorphine exposure is similar by either route, moving the film does not change what your body receives.
Some patients blame their headaches on the naloxone. Naloxone is poorly absorbed through the mouth, which is why it does very little when Suboxone is taken properly, but the label notes that a bit more of it is absorbed from the cheek than from under the tongue, so the cheek is the wrong direction if naloxone is your worry.
Consider the saliva instead. If you swallow while the film is dissolving, you swallow buprenorphine that then reaches the stomach, and some patients find that spitting once the film is gone settles an upset stomach. When side effects persist, the more useful conversation is about the dose. Fortunately, a lower dose often takes care of them, and that is a decision for you and your doctor to make together.
Are opioid cravings better controlled with Suboxone buccal vs sublingual use?
Suboxone contains buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, meaning that it activates the opioid receptor only partway, and it holds onto the receptor tightly enough to block other opioids, including fentanyl and heroin. That is how an opioid medication can treat opioid addiction, and patients describe feeling clear-headed and normal, with no sedation, no intoxication, and no cravings.
Should the cheek control cravings any better than under the tongue? There is no reason to expect it, since the buprenorphine exposure is similar by either route. In fact, when a patient reports better craving control with buccal use, it usually turns out that sublingual absorption was poor for that particular person, and the cheek finally delivered a full dose.
I do not have a good explanation for why one patient absorbs well in the cheek and another does not. Everyone’s mouth is different.
Does Suboxone make you high?
In nearly all cases of prescribed use, no. Patients on a stable dose describe feeling normal, as if the opioid problem had been switched off, and that is the whole point of the treatment.
Suboxone does cause physical dependence, and there are withdrawal symptoms if it is stopped suddenly. Physical dependence is not addiction. Dependence is what the body does with any opioid taken daily, while addiction is the compulsive use that the medication is treating, and patients on buprenorphine typically describe the absence of addictive thoughts, not their presence.
Buprenorphine can add to the effects of alcohol and other sedating drugs, and those combinations are dangerous. On its own, at a stable dose, it does not fog the mind, and if it does, that is worth a call to your doctor, because the answer may be a lower dose.
Should patients be concerned about Suboxone bioavailability, or how many milligrams they actually absorb?
It is natural to worry. You depend on this medication, you pay for it, and it is hard not to wonder whether the part that ran down your throat was wasted.
The fact is that the strength printed on the box, 8 mg for example, is the amount of buprenorphine in the film, not the amount that reaches your blood. Only a fraction of any film or tablet is ever absorbed. The medication was designed and dosed with that in mind.
An analogy that might help is watering a plant. You pour a full can on the soil, some of it runs out the bottom of the pot, and nobody gets down on the floor to measure the runoff. You look at the plant. If it is green and growing, the watering is right, and if it wilts, you give it more, and if the leaves yellow, you give it less.
While this is not a perfect analogy, it is how buprenorphine dosing works in practice. The measure of a Suboxone dose is whether withdrawal is gone and cravings are quiet, not how many micrograms crossed the lining of your mouth. Look at the plant, not the watering can.
Is more Suboxone better?
Generally, no. Once withdrawal and cravings are controlled, more buprenorphine does not add more protection, and it may add side effects. In fact, for many patients, less is better over time.
In my experience, patients rarely need more buprenorphine as the months go by, and many find that a dose that was necessary in the first weeks is more than they need a year later.
Of course, dose changes are made together, with the prescriber. A patient who wants to try less should say so, a doctor who believes the dose should come down should say so, and the two should agree on the pace, as tolerated.
There is nothing wrong with asking questions about how to take Suboxone and why your doctor has suggested one way over another. Yet, during the first days, do not move the film to your cheek on your own, because the label’s advice on induction exists to protect you from precipitated withdrawal. If something feels wrong at any point, call your doctor, who wants to hear from you.
What about Sublocade and Brixadi, the buprenorphine shots?
For a patient who cannot make the film or tablet work, there are two long-acting buprenorphine injections. Sublocade is given once a month, and Brixadi, approved by the FDA in May 2023, comes in weekly and monthly forms.
Both are extended-release depots placed under the skin, releasing buprenorphine slowly over the week or the month. There is no absorption question at all, no saliva, no cheek, and no daily dose to remember.
Yet, they are not for everyone. A shot cannot be adjusted the way a daily dose can, and a patient who wants to taper off of buprenorphine later faces a different set of questions with a depot than with a film.
Fortunately, the films and tablets we already have work very well for most people. The question of cheek versus tongue is, in the end, a small one, and it is one for you and your doctor to settle together.
Dr. Leeds treats opioid dependence with buprenorphine films and tablets by telemedicine for new patients throughout Florida, with in-office visits available in Fort Lauderdale. Induction is done at home with phone support, and when fentanyl is involved, a low-dose start is used when needed. Questions about how to take the medication, about dose, and about the long-acting injectables can be worked through in a consultation.
To ask Dr. Leeds about Suboxone treatment or about a question with your own buprenorphine dose, use the contact form.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
