Suboxone is a sublingual film used in the treatment of opioid addiction. The medication should be used as part of a complete treatment plan that includes psychosocial care and counseling. The treatment should be initiated under the direction of a qualified physician or health care provider. Knowing when to take Suboxone varies for each individual patient; however, there are some general guidelines to follow to help facilitate a controlled and effective treatment plan.  

How and When to Start Suboxone

Suboxone is a prescription medication that should be taken when the patient is in opioid withdrawal. Withdrawal symptoms include but are not limited to vomiting, sweating, diarrhea, anxiety, cravings, and cramping. If the patient has other opioids such as hydrocodone, fentanyl, or heroin in their system before taking Suboxone, the medication will initiate an acute precipitated withdrawal which is very uncomfortable for the patient and also poses severe health risks. If you are unsure about your level of withdrawal, refer to the self-directed Subjective Opiate Withdrawal Scale (SOWS) to measure your symptoms. Once your withdrawal symptoms reach a score of 17 or more you can begin taking Suboxone. 

Do not take Suboxone with alcohol, sedatives, tranquilizers, or other medications like benzodiazepine that act on the nervous system. The most effective way to take  Suboxone is when you are feeling sick and feel the urge to use opioids such as heroin, oxycodone, or morphine to prevent further withdrawal. Under no circumstances should Suboxone be administered intravenously. If injected or snorted, Suboxone can cause respiratory failure, loss of consciousness, overdose, and death. 

Suboxone can also make you want to sleep, cause slow reaction retorts and lethargy. Do not drive, operate heavy machinery, or perform what could be classified as a dangerous activity until you know how Suboxone affects you. It is important to monitor the dosage of the medication in the beginning to find the right course of long-term treatment. The recommended dosage is dependent on the individual patient.

The Most Effective Way to Take Suboxone

Suboxone acts sublingually. It is absorbed into the bloodstream in the form of a thin soluble strip. The strip is placed under the tongue where it melts and travels to the brain’s opioid receptors to treat opioid use disorder (OUD). Before taking Suboxone, drink water to moisten your mouth. This will help the medication to easily dissolve. When you remove the strip from its package use two fingers to grasp the outside edges of the film. Make sure your hands are dry and place the film on the underside of the tongue. Do not place the Suboxone strip in the center of the tongue, place it on the right or left side and hold it in place until it sticks firmly. If you have been directed by your healthcare provider to use two Suboxone strips, place one on the left side and one on the right side. Ensure the strips do not touch and keep them in place until they dissolve completely. If you have been prescribed the third strip, wait until the first two have dissolved before applying the third film. Again, this third film should be placed underneath the tongue on either the right or left side.  

Do not open the packaging until right before you plan to use the medication. To open the medication package, fold and tear down along a dotted line. To learn more about Suboxone strips refer to How to Use a Suboxone Strip. 

Taking Suboxone

Suboxone contains buprenorphine (partial opioid agonist) and naloxone (opioid antagonist). The medication works by replacing the effect of full opioid agonists (heroin, oxycodone, fentanyl) in the brain. Buprenorphine itself is an opioid, albeit a partial opioid. This is one of the main reasons why you must be in withdrawal before commencing Suboxone treatment. If the buprenorphine reacts with an opioid already present in your bloodstream it can have life-threatening effects. While buprenorphine stimulates the opioid receptors in the brain, it is only a partial agonist with a tolerance threshold. If the buprenorphine enters the bloodstream while the patient is in withdrawal it imitates the secretion of endorphins and experience of euphoria catalyzed by full opioid agonists. The threshold present in the drug prevents dependency and mitigates tolerance, however, if you suddenly stop taking  Suboxone you may become very ill. If you would like to stop taking Suboxone, it can be done with a medically managed taper. 

If you are allergic to buprenorphine or naloxone do not take Suboxone as it can cause anaphylactic shock. If you are pregnant or become pregnant, alert your health care provider immediately. Do not breastfeed until you speak with your doctor as  Suboxone can pass into breast milk postnatally. Suboxone is not recommended in patients with severe or even moderate hepatic impairment. All patients should be aware that their healthcare provider may monitor their liver function before and during treatment. If Suboxone is not a safe or healthy option for you, you might want to consider alternatives such as Zubsolv or Subutex. See Zubsolv Vs Suboxone: A  Brief Comparison Guide for more. 

Side Effects of Suboxone

Side effects of Suboxone include nausea, vomiting, headache, sweating, numb mouth, drug withdrawal syndrome, constipation, intoxication, lightheadedness,  blurred vision, back pain, sleepiness, dizziness, painful tongue, redness of mouth,  irregular heartbeat, and decrease in sleep. Before taking Suboxone ensure you consult with your healthcare provider. 

The staff at Confidant would be happy to discuss medication-assisted treatment (MAT) with you. Contact us here to schedule your consultation today.