For Patients

Sublingual Suboxone: A Guide to Pills & Film

In the midst of an opioid crisis, Suboxone is a medication used as a treatment for addiction to heroin and other opiates. The medication comes in both a sublingual pill and film form. Suboxone contains both buprenorphine and naloxone. Buprenorphine acts as a partial agonist which attaches to the receptors in the brain that are affected by using opioids.

This stops the effects of the drugs. Naloxone is added to buprenorphine to combat opiate withdrawal symptoms. It is also added to lessen the likelihood of Suboxone being broken down and injected. If this is attempted, the user will likely go into immediate opioid withdrawal.

Suboxone is meant to be administered under the supervision of a physician and used as part of a treatment plan that also includes counseling and other behavioral therapy.

The film is available in four dosage strengths and is meant to be taken by placing under the tongue or in the cheek. It has quickly become an essential part in successful recovery by helping people overcome the hurdles that are withdrawal and drug cravings.

How to Take Sublingual Pills & Film

Once your physician decides on the right dosage, the choice of pill or film form of Suboxone is decided. The film can be taken either sublingually or buccal.

If taken sublingually (under the tongue), take the following steps:

  • Hold the film on the outside edges
  • Place the film under the tongue on the left or right side near the base
  • If instructed to take 2 films at a time, place the second film on the opposite side of the first film, avoid the films touching
  • If instructed to take 3 films, do so on either side after the first 2 films have dissolved

If taking the film on the inside of the cheek (buccal administration) do as follows:

  • Hold the film on the outside edges
  • Place the film on the inside of either cheek
  • If instructed to take more than one film at a time, place the second film on the opposite cheek
  • If instructed to take 3 films at a time, place the third film on either cheek after the first 2 have dissolved

While waiting for the film to dissolve do not talk as it may affect how well the medicine is absorbed.

Also, chewing or swallowing the film before it is completely dissolved will cause the medication to not work as well. If a dose of Suboxone is missed, take the medicine as soon as you remember, unless it is close to the time of your next dose. If this is the case, skip the missed dose and continue taking medication as prescribed. Do not take 2 films at once unless instructed to do so. Always check with your doctor if you have any questions about doses.

If you are taking the sublingual pill:

  • Do not crush, chew, or swallow it
  • Place the pill under the tongue and allow to dissolve
  • If instructed to take more than one pill at a time do so by placing each pill under a different part of the tongue
  • Do not eat or drink until the pill is completely dissolved

The pills take 4 minutes to dissolve while the film takes 3 minutes. Many people believe that Suboxone is orange flavored because of the color of the pill and films, but it is actually lemon-lime flavor. The flavoring is added in an attempt to mask the bitter taste of the buprenorphine. Patients typically describe the taste as unpleasant. Drinking water before taking the medication will help with the medicine dissolve quickly.

Why Sublingual Pills & Film Can Be Beneficial 

As opioid addiction became more and more of a problem for people, a solution was created in the form of buprenorphine/naloxone tablets. However, not long after came the problem of diversion and misuse of the tablets, as well as the concerns of the unintended exposure to children. The sublingual films were introduced as a way to address those concerns.

Due to the sometimes-euphoric effects of buprenorphine, typically in people not dependent on opiates, there is a desire for the illicit use of the drug. The lack of access to treatment also creates a demand for diversion. Suboxone often times is administered in an office setting under the supervision of a physician to limit the frequency of misuse of the drug.

The quicker dissolving time of the film is beneficial as it typically dissolves one minute faster than the pill. Another key difference between the film and pills is that a partially dissolved pill can still be removed from the mouth, while the film quickly becomes unable to be removed once administered. According to this study, these are key factors in preventing misuse.

As more Suboxone was prescribed, the number of unintended exposures increased. Exposure to children became the most concerning as the side effects were more severe for them. The accidental exposures eventually led to the sublingual pills being discontinued in 2012 since almost all of the reported exposures were involving the pills, not the film. Each dose of the film comes in an individual child-resistant package.

Two child-resistance trials have been conducted with this packaging, each having high passing rates. Another positive of the film is that each individual film package has its own 10-digit code which allows for better tracking and discouraging diversion.

If a patient is being transitioned from the pill form to the film, there are not many differences. The conversion ratio for up to 4 mg is 1:1. This means the bioavailability is the same and no necessary dosage changes are required. Alternatively, the reported bioavailability of the 8 mg and higher doses of film is higher than that in the tablets. A lower dose may be required when switching from the tablets to the films in these cases.

Other Options for Taking Suboxone

For many years Methadone was the only option for the treatment of opioid addiction. With the introduction of buprenorphine, the access to treatment has been significantly increased.  Unlike Methadone, which can only be distributed in a highly structured clinic, Suboxone is allowed to be dispensed in a physician’s office or other settings.

This makes Suboxone more appealing to those unable to access a methadone clinic or who would prefer to receive treatment elsewhere. Buprenorphine is available in the following ways:

  • Bunavail (buprenorphine and naloxone) buccal film
  • Suboxone (buprenorphine and naloxone) film
  • Zubsolv (buprenorphine and naloxone) sublingual tablets
  • Buprenorphine-containing transmucosal products for opioid dependency

Buprenorphine is also available in an implant. The implant has been created for those who worry about taking their medication every day or possibly losing it. A small implant is placed under your skin in the upper part of your arm. This can be done at your doctor’s office or similar settings by those qualified to do so.

The implant releases buprenorphine into your body for six months. After the six months the implant is removed. A need for another implant will be assessed by you and your doctor. There are many options out there for addiction treatment that can be tailored to you. Reach out and find help today.

 

Sources
[1] A retrospective evaluation of patients switched from buprenorphine (subutex) to the buprenorphine/naloxone combination (suboxone). (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453114/

[2] Graham, R. L. (2014, January). Buprenorphine for opioid dependence: Are there really differences between the formulatons? Retrieved from https://mhc.cpnp.org/doi/full/10.9740/mhc.n186952

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