Are you starting Suboxone (buprenorphine/naloxone) for opioid use disorder or opioid dependence, or is someone you care about looking into medication-assisted treatment? If so, you might have a lot of questions. We answer as many as possible on our All About Suboxone round-up post and our Suboxone FAQ page. But one of the most common questions we hear is also one of the simplest: How do you take Suboxone?
Start with induction
First, it’s important to know that you can’t just pick up some Suboxone or Zubsolv and start taking it without preparation. If you do that too soon after taking another opioid (prescription or illicit), you will trigger precipitated withdrawal, which is especially intense and miserable—normal withdrawal symptoms cranked to 11.
Instead, your provider will work with you to create an induction plan, helping you figure out how long to wait before beginning Suboxone based on the progression of your withdrawal symptoms. I know that sounds silly—that you have to experience some withdrawal to avoid worse withdrawal—but it’s important. Talk to your provider and follow the guide they discuss with you.
Take Suboxone sublingually
Suboxone (buprenorphine/naloxone) will not work if you don’t take it correctly, which means sublingually (under the tongue). Buprenorphine is absorbed very well through the mouth but poorly through the stomach. So if you swallow it, it won’t have much, if any, effect. And because it contains naloxone as a safeguard, if you try to snort it or inject it, the naloxone will block the effect and send you into precipitated withdrawal, which we’ve already said is a terrible experience. Here’s the recommended way to take it sublingually:
- Place the film (if you’re using Suboxone or a generic version of it) or tablet (if you’re using Zubsolv or a generic version of it) under your tongue, close your mouth, and wait for it to completely dissolve. This can take up to 15-20 minutes. DO NOT SWALLOW THE MEDICATION, as it will not work as well.
- After it has fully dissolved, swish your mouth with a little water and swallow it.
- Some people dislike the taste of buprenorphine/naloxone medications. If your meds tastes bad to you, wait at least 15 minutes (ideally 30) after it fully dissolves before eating or drinking something to get the taste out of your mouth. We have some suggestions for getting rid of the taste on this post.
- Wait at least an hour after fully dissolving your medication before brushing your teeth. This waiting time will help to protect your teeth from damage.
Talk to your provider if your dose needs to be adjusted
Your provider wants you to be on the most effective dose, so don’t hesitate to talk to them if you think your dosage isn’t right. They may suggest:
- Changing the time of day you take your meds. Sometimes the same dosage will work better if it is just taken at a different time of day.
- Splitting strips into smaller, more frequent doses. For some people, taking the same amount but in smaller increments can make it more effective or can reduce side effects.
- Changing your dose. Your provider may adjust your prescription to get you on the best maintenance dose. I strongly suggest NOT experimenting with changing your dose on your own. Increasing it without your provider’s agreement makes you much more likely to run out of medication before your next refill, and decreasing it on your own makes you more likely to experience withdrawal symptoms. If you work with your provider on any dosage changes, they can help you find the dosage that is best for you.
The Don’ts
I prefer to stay positive rather than saying ‘no’ all the time, but it’s worth collecting the things to avoid in one convenient spot:
- Don’t begin Suboxone for the first time without waiting long enough for induction—it will send you into withdrawal.
- Don’t swallow your Suboxone instead of dissolving it under your tongue—it won’t work.
- Don’t snort or inject your Suboxone—it will send you into withdrawal.
- Don’t eat or drink while the Suboxone is dissolving under your tongue—wait 15-30 minutes after it fully dissolves.
- Don’t brush your teeth immediately after taking Suboxone—wait at least an hour.
- Don’t change your dose without your provider’s support.