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Should I Spit or Swallow Suboxone?

If residue is left in your mouth from a Suboxone dose, you can either spit it out or swallow it.

Suboxone has helped thousands of people overcome opioid addiction with a simple daily sublingual strip that dissolves under the tongue. If you take this medication, you may find there is a little residue left in your mouth after 15 minutes, after the buprenorphine has dissolved and entered your bloodstream.

You can spit out the residue and rinse your mouth out with water, or swallow it and use a mint or gum to manage any aftertaste. Do not eat, drink, or smoke cigarettes 15 minutes before or after taking Suboxone.

Suboxone: How Should I Take This Medication?

Suboxone is the brand name combination of buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist that minimizes risk of overdose).[1]  Suboxone is one of the most important medications for addiction treatment (MAT). MAT is an approach to treatment that combines counseling and prescription maintenance medicines in achieving abstinence from opioids.

To ensure that buprenorphine enters the bloodstream at a steady pace, Suboxone is manufactured as a sublingual film strip that is placed underneath the tongue until it has dissolved. This usually takes 30 seconds to a few minutes.

Suboxone is usually taken once per day, providing a consistent dose of buprenorphine to reduce cravings and withdrawal symptoms.[2] Although the buprenorphine will quickly dissolve, you may find that some naloxone remains in the mouth.

Do not tear, cut, chew, swallow, touch, move, or otherwise tamper with the film until it has completely dissolved in your mouth.

Spitting vs. Swallowing Suboxone Residue: Which Is Safest?

For best effect, you must wait until the full dose of buprenorphine has dissolved in your mouth. If there is residue remaining in the mouth, many people wonder if they should spit or swallow it since it.

Ultimately, whether you spit or swallow the remaining Suboxone is up to you.[3] If you have waited for about 15 minutes for the full dose of buprenorphine to enter your bloodstream, you should not experience negative effects from either choice, as the bulk of the remaining medication is naloxone, which will not become bioavailable through your digestive system.

You may have personal reasons for either choice, so consider the following:

  • If you swallow the remaining medication to ensure you receive your full buprenorphine dose, know that the dose enters your bloodstream from being absorbed beneath the tongue, so swallowing will make no dosage difference.
  • If you swallow the remaining dose with intentions to get high from it, this method will not work. However, this intention can indicate you have a risk of relapse into addictive behaviors, and you should speak to your physician, counselor, or rehab program leaders.
  • If you do not like the taste of Suboxone, which many people do not, you can spit out the remains of the film strip as long as buprenorphine has been fully absorbed. You can rinse your mouth out with water and spit again. You can also safely eat a mint or chew gum to change the taste in your mouth, but you should not eat or drink anything else after your Suboxone dose for 15 minutes

Tips for Taking Suboxone

If you have been prescribed Suboxone as medication management, it is importantto take this medication as directed. Yourphysician will provide you with specific advice, but in general, followthese steps:[4]

  • Do not take other opioids while you take Suboxone.
  • Avoid drinking alcohol while taking Suboxone.
  • Consider adjusting medications like benzodiazepines while taking Suboxone or stopping them completely.
  • Do not eat, drink, or smoke cigarettes for 15 minutes before and 15 minutes after taking Suboxone.
  • Do not tamper with Suboxone while it is in your mouth or before you take it, as it will not give you the full dose of buprenorphine.

You may experience a dry, sticky, or chalky feeling in your mouth after taking Suboxone. You can take a sip of water and swish it around your mouth before taking the film strip to help offset the taste.

Ensuring your mouth has enough saliva will help the film strip dissolve under your tongue. You can also rinse your mouth out with water after you spit out or swallow the remains of the film strip.

What About a Suboxone Overdose?

If you take Suboxone as prescribed, it is essentially impossible to overdose  on this medication. You are also unlikely to overdose on Suboxone if you tamper with the drug since naloxone should prevent a large dose of buprenorphine from binding with your opioid receptors all at once.

­However, it is possible to overdose if you relapse and abuse other opioids while you take Suboxone. If you notice any signs of relapse or are worried about your risk of relapse, talk to your counselor, physician, or someone at your rehabilitation program. If you or someone you know overdoses on opioids, call 911 for immediate assistance.  

SOURCES

  1. Suboxone. European Medicines Agency (EMA). https://www.ema.europa.eu/en/medicines/human/EPAR/suboxone. July 2020. Accessed January 2022.
  2. Buprenorphine Sublingual and Buccal (Opioid Dependence). Medline Plus. https://medlineplus.gov/druginfo/meds/a605002.html#how. December 2020. Accessed January 2022.
  3. How to Do the Suboxone Spit Trick. Meds Safety. https://medssafety.com/how-to-do-the-suboxone-spit-trick/. Accessed January 2022.
  4. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness (NAMI). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed January 2022.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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