Speak to your doctor before making any change to how you take your prescribed medication.
Spit Vs Swallow: Should I Spit Out Suboxone Saliva Or Swallow It?
ZubSolv And Suboxone Saliva: Suboxone Spit or Swallow? Patients who take sublingual medications containing buprenorphine, such as Suboxone sometimes ask about the Suboxone Spit Trick. Interestingly, their concern is legitimate, because they have not been given guidance about what to do after their Suboxone fully dissolves.
Their concern is about the issue of how the medication remaining in their saliva could possibly affect them if they swallow the saliva rather than spitting it out. In most cases, there is little concern over what the patient does after their medication has dissolved under their tongue. Yet, there may be possible Suboxone side effects that might be reduced or eliminated by spitting out the saliva after the buprenorphine and naloxone has completely dissolved.
Buprenorphine is a medication that is FDA-approved to treat opioid dependence. It is the main ingredient in brand-name medications, such as ZubSolv and Suboxone.
These medications are available as sublingual tablets and films. The Suboxone film is a small, flexible rectangular strip that is individually wrapped in foil. ZubZolv is a small, fast-dissolving, minty tablet. Sublingual medication is taken by placing it under the tongue until fully dissolved.
Suboxone treatment is highly effective in preventing opioid withdrawal symptoms as well as preventing opioid and opiate cravings.
When a patient places a Suboxone sublingual film or a Suboxone sublingual tablet under their tongue, it dissolves over a period of a few minutes.A similar medication to Suboxone and ZubSolv is Bunavail. Like Suboxone, Bunavail contains buprenorphine and naloxone. Yet, Bunavail is a buccal film for buccal administration, so it is placed inside the cheek and not under the tongue.
The Suboxone tablet may take a bit longer to dissolve compared to the Subooxne strip. While the directions are clear that patients must not swallow Subutex, Suboxone, or ZubSolv, or similar sublingual medications, the directions are not so clear about what to do after the Suboxone pill or Suboxone strip is dissolved and gone.
Doctors do not typically advise patients about what to do at this point. The healthcare provider may have no information about the topic and, hence, they will choose to not provide guidance.
People often confuse the action of naloxone on the opioid receptor with how buprenorphine itself works on opioid receptors. Both buprenorphine and naloxone are present in Suboxone and ZubSolv. Buprenorphine is an opioid agonist and an opioid antagonist at the same time.
Buprenorphine is effective as a part of medication assisted treatment for treating opiate addiction and preventing relapse which can lead to respiratory depression and overdose. Buprenorphine is itself a mild opioid medication and it does help some patients with chronic pain issues to make their pain more manageable.
The naloxone contained in Suboxone and similar medications is present only as an abuse deterrent. Naloxone does not provide any therapeutic benefits to the patient.
Methadone is another opioid medicine used for treating opioid addiction, though there are no issues with sublingual absorption and what to do about saliva left in the mouth afterwards. This is because methadone is swallowed and not absorbed under the tongue, hence, there is no need to advise patients on what to do after under-the-tongue absorption.
Do the makers of ZubSolv and Suboxone tell patients to spit or swallow?
Interestingly, in the official prescribing information, the directions for use end with the instructions to place the medication under the tongue to fully dissolve. There is no mention of what to do after the medication is dissolved.
Why would there be any question about what to do after the ZubSolv tablet of Suboxone film is dissolved and gone? Many patients who take these medications complain about bad tasting Suboxone saliva remaining in their mouths after the film is dissolved. While ZubSolv saliva is not bad tasting for most patients, they still wonder what to do after the tablet is dissolved, yet the minty taste of ZubSolv stays in the remaining saliva.
When doctors, addiction treatment experts, and pharmaceutical companies do not address the issue, patients turn to online forums to search for answers. They may go to Suboxone discussion threads on Quora. Or, they may look for Facebook groups that discuss medication-assisted treatment with buprenorphine.
What do patients say in the online forums?
While doctors may cringe at the thought of their patients going to online forums to search for answers, these groups are often moderated, and they can be a source for learning about the experiences of other patients. No patient should make a decision solely based on information gleaned from an online discussion group or blog post, but they may bring this information back to their doctor as a way to start a conversation on the topic.
A 21st century doctor should be well-versed in the presence of online forums and patient discussion groups. Rather than immediately attacking the validity of “Dr. Google,” physicians should listen to their patients and consider the information brought to their attention. If the doctor does not have clear answers, they may choose to do further research before discussing the topic with their patients.
When it comes to the discussion about spitting or swallowing remaining saliva after a sublingual buprenorphine drug is dissolved, there are a few main concerns. One issue is the bad taste left behind by the medication. Another is the possibility that the potency and efficacy of the medication will be reduced if the saliva is spit out. A final concern is that side effects, such as constipation and headaches, may be worse if the saliva is swallowed.
Can spitting Suboxone saliva out help to reduce the bad aftertaste?
Some Suboxone patients complain that Suboxone films leave a bad taste in their mouths, sometimes for hours after taking the medication. In some cases, people have reported that spitting out the Suboxone saliva helps to reduce the aftertaste. Other people have reported that the bad taste can be addressed by having a mint or drinking a cup of coffee or tea afterwards.
Will swallowing ZubSolv Saliva or Suboxone saliva help to make the medication more effective?
Generally, patients have not reported feeling as if their buprenorphine medication was more effective with swallowing over spitting. Regardless, the thought process involved in swallowing the saliva may not be healthy in terms of treating opioid addiction.
Drug users in active addiction tend to not want to waste any available drug. If there is some residual powder remaining from a drug, such as heroin or fentanyl, the user will likely wipe it onto a finger and lick it off, even though they are aware that the small amount of drug will not likely add to the drug high they are trying to maintain.
This behavior is similar to the common hunt through the carpet and under the table or bed, looking for any extra drug that might have fallen and gotten lost. Active addiction involves some common behaviors that patients in recovery from addiction should make an effort to avoid.
Swallowing saliva because it has a medicine taste, hoping to get an extra kick from the drug, is probably not healthy behavior. The manufacturers of buprenorphine medications make it clear that administration of the tablet or film is complete when the medication is fully dissolved. If they wanted patients to attempt to get extra micrograms of buprenorphine by swallowing the remaining saliva, they would have included that in the instructions.
Can spitting out ZubSolv or Suboxone help to reduce medication side effects?
While there does not seem to be any documentation or studies regarding this issue, it may be the most compelling question of all. Some patients do have significant side effects, making it difficult to tolerate buprenorphine. They may have severe headaches, insomnia, or even serious constipation. Doctors may choose to reduce the patient’s dose of buprenorphine, or even stop it altogether. Or, they may add a medication to address the side effect.
When it comes to constipation, there is a medication named Movantik that blocks opioid receptors in the gut. Movantik can help reduce constipation caused by opioids, including buprenorphine.
While medication for constipation can help, wouldn’t it be nice if there was a solution to reduce Suboxone constipation and ZubSolv constipation without the need for another prescription or OTC drug? Throughout online forums and discussion groups, there are complaints about “Suboxone poop” and how it makes it difficult to continue with medication-assisted treatment.
Interestingly, many people in online forums have stated that spitting out the saliva remaining after the sublingual medication is fully dissolved does help with constipation and other side effects. If this does work, it is an issue that should be carefully studied by addiction treatment experts and properly documented. Imagine how useful it would be to confirm such a simple solution to addressing medication side effects!
So, should I spit or swallow my Suboxone saliva or my ZubSolv saliva?
As stated above, the manufacturers of sublingual buprenorphine medications make it clear that taking the medication involves placing it under the tongue and allowing it to fully dissolve. There are no further instructions regarding the saliva left in the mouth after the pill or strip is dissolved and gone.
Therefore, spitting out the saliva or swallowing it should be an individual decision. My opinion is that spitting out the saliva is the best option if possible.
Spitting it out may reduce medication side effects. The reduction of buprenorphine induced constipation makes sense since spitting out the saliva may keep excess buprenorphine away from intestinal opioid receptors.
Also, the amount of medication to be absorbed has been calibrated by manufacturers such that everything that the patient is expected to get into their system will get in by allowing the tablet of film to dissolve under the tongue. There is no need to attempt to get every last bit by swallowing the saliva. And, swallowing saliva with a few micrograms of buprenorphine is not going to make any difference, since the drug is minimally active when swallowed.
And, spitting out the saliva may help to reduce the aftertaste associated with Suboxone and other buprenorphine drugs. While a bad aftertaste may not seem like a big deal, when someone has to take medication on a daily basis, it can become a significant issue to deal with hours of a bad taste in your mouth.
Speak to your doctor before changing anything about your medical treatment.
If you are reading this and considering making a change to how you take your medication, it is important that you first speak to your doctor. You should never make a change to anything regarding your medical treatment regimen without discussing the change with your doctor and getting their approval.
You might be surprised that your doctor will find the topic interesting and want to do further research to learn more about what the best practice might be. While doctors are often overwhelmed with patient scheduling and they sometimes have little time to discuss involved topics, I believe that this topic, as it relates to swallowing residual buprenorphine after Suboxone has dissolved and how it may have an effect on gut opioid receptors will interest your doctor.
Even if you see a Suboxone telemedicine doctor, you should ask about “The Suboxone Spit Trick,” or better simply ask if you should spit out the saliva or is it fine to just swallow it after your prescribed buprenorphine and naloxone medication has fully dissolved under your tongue. If you are having side effects, such as Suboxone constipation or Suboxone headache, ask your doctor if these side effects could be related to swallowing the saliva remaining after your medication has dissolved.
Of course, if you see a concierge telemedicine Suboxone doctor, then you can be fully assured that your doctor will take the time to listen and discuss the topic with you at length. If you are interested in learning more about the benefits of having a doctor who is always available for discussion at any time, please contact us here for more information about concierge medicine online and in-person.