20 Comments

  1. sawdeys06

    So, I have been trying this method out for the last 3 days, and here is the thing,
    I have to believe it’s working great, I recently started sub at 16, and now with your method am at 8 and feeling great. However, I have a HUGE amount of saliva that builds in my mouth as soon as I crush the tablet with my teeth. I still try to ‘paint’ the inside of my mouth with the extremely diluted solution for about 10 minutes, and then after a bit, I just swallow.
    So, is this normal? As I said, I am still feeling fine with 8 per day, but it dont get that concentrated solution that you talk about in your article.
    Thanks.

  2. chuck stiefelmeyer

    Actually, all surfaces of the mouth are not created equal. The bio-availability of buccal ( through the cheek) absorption of buprenorphine is around 30%, compared to about 50% sub-lingual ( under tongue). This is due to the relative thin skin and absence of mucous, as well as the presence of several large blood vessels,on the lower surface of the tongue. The manufacturers patient handouts for administration of suboxone (film) contains diagrams showing correct placement on lower surface of tongue ( on top of the visible veins that reside there).

    • Sorry to disagree. The large blood vessels– proper term ‘venules’– are surrounded by multiple layers of connective tissue, and play no significant role in absorption– just as they play no role in exchange of oxygen or carbon dioxide. The veins are like superhighways, without any on or offramps– and the exchange of molecules occurs at street level! Even the capillary beds are less accessible under the tongue; the sublingual salivary glands empty there, causing a constant current that channels beside the tongue and down the throat, out of most peoples’ awareness.
      The little picture by the manufacturer is intended for the same people who need warning labels on cigarette packages.

  3. chuck stiefelmeyer

    So, you are saying that the capillary beds themselves,” street level”, are actually less accessible sublingually than some of the other oral surfaces. I feel like one of those guys who needs to read the directions on a shampoo bottle, and never finishes (wash, rinse,repeat…). I guess I shouldn’t try to argue medicine with a doctor! The films “fit” so well under the tongue, however, I will probably just continue sticking them there for convenience sake, instead of where I WAS putting them(I’d rather not say) before I saw the R-B cartoon. Great site (best of it’s kind) ,and thank you for setting it up, it seems to help a lot of people.

  4. WisdomQuest

    In the USA They can now prescribe Bup in a 2 or 8 MG tab. (It’s also now being used a lot by vets Dr’s on domestic pets because you can’t OD your pet. It’s basically because fido the dog can’t tell you when he’s had too much.)
    The main problem in getting the best absorption is that your mouth fills with saliva and dilutes the compound in your mouth causing you to prematurely swallow it making it inert. If you get you Bup or Suboxone in a form that can be ground up (not films) try this. Get some powered “instant food thickener” (Hormel Thick & Easy is a brand widely available in the USA). This is a white powder that looks like very course sugar or salt. Mix in about 150% of the thickener in volume compared to the ground up medication and mix them throughout. Using a small bowl and a spoon works just fine to grind the two together into a fine powder. Now when you put this powdered mix under your tong it will turn to a gel like consistency, making it easy to keep there for considerable time. This really works!
    Unfortunately most of the other ideas I have read here are questionable at best as they sound good, but don’t work in the real world as you end up swallowing it during the “paint” job. I’ve seen results with this food thickener method where the powdered jel is still in place under the tong after an hour or more; even if the subject took a drink of water or soda. Often you have to move the jel around a bit to get it to dissolve fully. Move it just slightly by grinding it around under your tong.
    Many people are paying $8+ a day for an 8MG tab, this method may allow you to use only 4 MG and stretch out a 30 day supply to a 60 day supply. If you doing H and using Bup (Suboxone) to make it to you next fix STOP IT! Your life is a mess, you have lost control of it. Just go to a doctor and switch over to Bup or Suboxone full time instead. Your life will be all new in 30 days or less, guaranteed! Then you can slowly ween off it, or keep on taking it (Bup) Either way you will then have the opportunity to get control of your life again for only a few dollars a day even if you don’t have insurance. Praise God!
    P.S. I’m not a doctor, use at your own risk, don’t blame it on me, blah blah blah blah blah. 🙂

  5. UPITT

    Dr.,
    Fantastic information and initiative. I also took the path of chemistry academia as my studies (and MCAT scores) suffered while I was abusing fentanyl transdermal patches by using them buccally. It was then that I became incredibly interested in the delivery of lipid soluble molecules through the oral mucosa. I would be hard pressed to find it, but I found a study from an EENT physician association, that listed the thickness of non-absorptive, keratinized tissue in the differing areas of the mouth. The area under the tongue was actually almost 50% less thinly clad in keratinized cells, and thus the most practically accessible mucosal area. Hence higher bupe concentrations, measured by plasma level, as opposed to other areas, especially buccal areas.

    • Interesting! I’m not aware of that study, but that’s an interesting thought. I could see how the lining of the buccal area would be ‘thicker’, given how we tend to bit our cheeks at times and the greater contact with food and other surfaces… I’ll admit that my own addiction, when working as an anesthesiologist, came from the ‘bright idea’ that the lipophilicity of all that fentanyl I threw away each night would allow it’s absorption from the mouth…
      My ideas about buccal absorption in this post come from the 50% bioavailability of Bunavail. But there are other variables at play, primarily less dilution by saliva because of the pouch that hold buprenorphine against the cheek with that product.
      Thanks for the information!

  6. Teetee

    I’ve got a question- I’ve been on suboxone or bunavail for 4 yrs this August. I go every week to be drug tested never missed one appointment never had a positive drug screen with the exception of alcohol showing up one time and that was due to a medication the doctor prescribed for me from my previous visit I have rheumatoid arthritis and severe osteoarthritis i’ve had one hip replaced and I am in need of the other and I have issues with my feet I recently had a horrible upper respiratory infection when I went in to the doctor my pulse ox was 87 he wanted to admit me but I refused instead he gave me a prescription for a prednisone taper an inhaler A Z pack and Loratadine and I was taking Sudafed PE know when I take my Bunavail most of the time I cut up the 2.1 mg patch and take it at different times throughout the day because I feel it helps to control my pain if I take it all at once in the morning then by evening I’m starting to feel bad with all of this being said when I went in for my last drug screen it showed that I had the metabolite of one of the ingredients in my system and not showing anything for the burepenephrine( correct spelling?). I’ve never NOT had it ALL show up. Could it be caused by the decongestants? Could it be caused by the illness itself. I’ve been sitting here wracking my brains out. I’ve had over two hundred weekly drug screens and never had an issue. I’m just at a loss for words because I did take my slip yes I cut it up but no matter what it’s still a dose of 2.1 mgs a day. I’m even wondering if there was a mix up at the lab at this point. Thank you for any answers or explain actions you can give me. There was one other thing that I was doing different while I was sick and that was drinking an 8 oz cup of water with a TBS of apple cider vinager daily in hopes it would help flush the virus out quicker.

    • Teetee

      I started out looking to see if maybe the medications I was taking could affect how I metabolized the medication and then I found this thread and it made me wonder if maybe the % of absorption was affected by the medication I was on because of a decongestant drying you out and I was also wondering if the different ingredients in the patch could be metabolized at different speeds in your body? Just very weird how one ingredient shows up and not the other…

    • Several of those things may have altered the lab results; the acidification of your urine, the dilution by extra water, the effects of steroids… my hope is that you could explain this to your doc, and he/she would then figure out what happened and ignore your recent urine tests. Understand that many things impact the metabolism of buprenorphine, and many other things impact how tests measure the blood levels of buprenorphine… so when you have all of those dynamics going on, urine tests become unreliable.

      • Teetee

        Thank you so much for answering my question. Unfortunately he wasn’t going to bend on this. Funny thing though the nurse told me that there were TWO of the three ingredients in the results of my test! Her exact words were I know you took your medication because I looking at your results and I can see two of the three ingredients that are supposed to be in there! I am really upset because he’s making me come in every single day for 14 days straight for urine screening! He even told me he believes me but the rules are the rules and he won’t bend them for anyone. I think all he’s thinking about are the dollar signs he sees from my insurance company by doing this. I’m looking for a new dr to see because what good is it to be punished over something I couldn’t help and he said he is aware my medications and even just being sick can affect it but the rules are the rules… Now I’m scared to take anything he’d prescribe for me if I were to get sick again and this has caused me so much anxiety that I am now taking my medication about 2-3 hrs before I go in to be drug screened. It just seems very rotten to do to someone who’s had over 200 weekly drug screens come back fine.
        Thanks again for explaining everything for me.

    • I suppose that theoretically, nicotine may change the blood flow through surface vessels and alter absorption in that way… but I cannot imagine that ever being a significant effect. I’m wondering of nicotine does anything to the enzymes that metabolize buprenorphine…. but I don’t know of any effect of nicotine on cytochrome CYP 3A4, which is the major enzyme in most people for that role.

  7. HI Dr. I’m new to finding this group, but old using Buprenorphine 8mg x 3 daily since 2007.just recently I decided I would detox off using a pain management Dr It didn’t work out for me I gave up after 9 days..I Lost 14lbs in that amount of time and my husband called the Dr. On a Sunday evening and was told to bring me in before the office opened .so we arrived went in to see him the Dr, looked at me then my husband and said I recommend she continues the Buprenorphine again and regain her weight and health. The main reason I wanted off because I felt my generic buprenorphine was not working anyways so..I found your posts on obsorbtion maybe I have been doing something wrong or have they really stopped after all this time??.I used to way back 2007 take all at once since they weren’t working maybe I should spread them out. This last weekend I’m following your advice and doing them all in the morning. I also used to wake. Rinse for my toothbrush as fast as I can for my 1st dose….because I feel like they are not working or getting me around the clock..so I do not understand the chewing part crushing between your front teeth. I NEVER HEARD THIS BEFORE. can somebody please explain this very slowly I have read this post over and over and still don’t understand how to do this..do you mean take the buprenorphine crumble it up into peices very small chunks then let dissolve??? I’m very, very confused thank you

    • Hi! It has been a while since your question, but hopefully you’re still out there. Understand that ten years ago, when this blog was young, I was more of a… perfectionist? about everything. I had many new patients, and new patients tend to have more problems with buprenorphine than patients on the medication a long time. So I’m a little surprised that you’re having this much trouble at 11 years. I don’t mean to be insulting– I’m just wondering why things go so complicated now, after attempting to taper off the medication.
      The chewing part was just referring to the fact that the medication is doing NOTHING when it is in solid form, in a tablet. So when dosing, you can help the tablet dissolve by crushing it in your teeth and mixing it with saliva. The goal is to dissolve the buprenorphine in saliva, and then have the buprenorphine diffuse into the tissue lining the oral cavity, and into the capillaries. That process is aided by helping it dissolve, by having a high concentration of buprenorphine in your saliva (by starting with a dry mouth), and by increasing the time for the process to occur.
      But honest– a typical 8 or 16 mg daily dose is a LOT of buprenorphine. If a person starts focusing on how he/she feels all day long, that person will have memories of prior withdrawal experiences, and those memories will trigger anxiety and fear about the dose not being sufficient. There is a huge mental component to all of this.
      I typically recommend dosing twice per day because that second dose seems to reassure people that it isn’t wearing off. But the FDA recommendation is to dose once per day. Both work, and both have advantages and disadvantages. For me, recommending that people dose twice per day has resulted in fewer people running out of medication early. When people take the whole dose once in the morning, they often think they need more later– and then they take extra and run out early. Then I have to worry… either because my patient is sick, or because I will get in trouble for being too ‘loose’ with the medication.
      Feel free to write again; I check in every few weeks.

      • Thank you Dr. Junig, for writing me back..I’m going to try your advice..like I said ive been on buprenorphine since 2007 and since about a year ago it seems that maybe it has stopped working for me..that’s why I decided to jump and detox. That was the only reason..I’m still having trouble and now tomorrow I’m trying your advice..i have been totally lost and in and out of dr offices the past 3 months atleast trying to figure what’s goong on..nobody has any info for me .I just thought it had stopped all together and maybe I will have to try methadone..now most people to go from buprenorphine to methadone. It works sometimes the other way around….or has the buprenorphine stopped? For me after all this time. Thank you

        • I have NOT had any cases where the actions of buprenorphine changed – where it didn’t last as long, or where it didn’t have the same receptor effect. But I HAVE had patients whose addictions were too complicated for buprenorphine treatment. For example, I have had patients who were stable on buprenorphine but then they started using crack or methamphetamine. In those cases I recommend methadone programs, because they are much more intensive. Patients see nurses each morning when they dose; they are drug tested very frequently; they are required to see counselors…. so it wasn’t the buprenorphine that stopped working, but rather their addictions required a higher level of care.
          I have had methadone patients change to buprenorphine, and that’s what I think would be the best approach to treating opioid addiction going forward; start with methadone for a year or two in order to establish abstinence from illicit drugs, then transfer over to buprenorphine for longer-term maintenance. The problem is that it can be a tough transition from methadone to buprenorphine. One must taper down to 40 mg methadone, and then be off methadone for a least a few days before starting buprenorphine to avoid precipitated withdrawal.
          Good luck– just remember that there is a huge psychological component to how a person feels while on opioids. Keeping yourself busy and distracted can be very helpful.

  8. Well thank you Dr.Junig, I believe you might have just answered all my questions. I’m starting my notice good results again with my Buprenorphine. I’m finding out through other blogs that it’s the inactive ingredients that might be messing around with how I have been feeling .the Pharmacy’s in my area carry 2 generic buprenorphine here its either from actavis the orange half moon.or the sun pharma..I found the brand from Hikma 54 411 that agree with most..but for some reason the grocery/pharmacy charged me almost 3 x my co- pay. I dont get that part..I just found out a new generic is out by Rhodes Rb 8mg..everyone is raving about it …its been out since oct..2017, but I’m not having any luck findings it so far. Its fairly cheap for pharmacies to get but…if I can find it maybe it will help.. … I gave some thought to what you said about the old memories triggering my mental memories with the old addition and the withdrawals that follow…THE MORAL OF THIS IS ABSOLUTELY THE THOUGHTS OF WITHDRAWAL PLAYING IN MY MIND…I HAVE NOTICED IF I KEEP MYSELF BUSY THE THOUGHTS ARE COMPLETELY GONE AND ALL IN ALL MY BUPRENORPHINE IS ACTUALLY WORKING….THANK YOU, THANK YOU SO MUCH FOR YOUR THOUGHTS.. … in my 11 years of using buprenorphine I never once touched another drug out there .my mind has never gone back for some reason…now I do have a sister on methadone and she told me she has the opposite of me….believe me I did not want to go that route of methadone the thought was absolutely terrifying to me…so I’m very happy I found this site. Even tho I’m not new to buprenorphine I find good honesty in this blog of yours…

  9. FX

    I’m curious regarding many aspects of buprenorphine. Will you (attempt) clarify on a couple of these aspects that have me perplexed, please? If only 30% of buprenorphine is absorbed, sublingually and assuming max absorption/bioavailability, than would that only equate to only 2.4mg per 8mg tablet/film? Isn’t the ceiling effect between 4mg – 8mg, depending on numerous, individual factors, with 6mg being the average? Therefore, when one is attempting to ensure they’re reaching their ceiling effect, wouldn’t they need to take 16mg – 24mg of buprenorphine (4.8mg – 7.2mg max absorption/bioavailability – 30%) to secure the 97% of mu receptors are being occupied? I’m just confused, obviously, and want to better educate myself on the ceiling effect. The only other plausible reasoning I can think of is when we speak of the ceiling effect, we’re speaking of the medication itself (e.g. 8/2 or 4/1 meeting the ceiling effect) and not the amount absorbed (30% max) which only brings in many other questions… Essentially, am I wrong when I say the ceiling effect is not being achieved when taking an 8mg/2mg film/tablet due to the poor absorption/ bioavailability as only 2.4mg of actual buprenorphine (max) is being obtained? Thank you for your time and supportive information you have made available to the suboxone/subutex community.

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