After treating patients with Suboxone for over 24 years, I've picked up a ton of inside info. It's an honor when someone chooses me as their doctor. I try to show my thanks by fully respecting my patients and making their treatment super convenient. But honestly, sometimes I space out and forget to share really helpful tricks I've learned. In this post, I want to reveal 5 major Suboxone secrets I often neglect to tell patients. For some folks, these tips are total game-changers. If you're my patient and something here could help you, definitely let me know at your next visit! I aim to keep making things better for you. My goal is to empower you with everything you need to rock your treatment. So keep reading for 5 Suboxone secrets you really should know about!
Secret #1: Memantine Makes Suboxone Treatment Work Better
Suboxone helps treat opioid addiction. But some patients still crave opioids and relapse after stopping Suboxone. Adding memantine may help. This explains why I prescribe it for some patients and not for others.
What is Memantine?
Memantine is a medicine for Alzheimer's disease. It blocks NMDA glutamate receptors in the brain. However, studies show it also helps opioid addiction with buprenorphine.
Here's how:
Buprenorphine cuts cravings and withdrawal.
The neurotransmitter glutamate helps with learning and memory. But too much glutamate in reward pathways increases cravings.
Memantine blocks glutamate at the NMDA receptors. This lowers cravings. It also helps control withdrawal symptoms during buprenorphine tapering.
Research on Memantine and Suboxone
Studies show memantine improves Suboxone treatment:
Memantine reduces cravings.
It helped patient stay in treatment longer.
It reduced opioid withdrawal symptoms.
It is safe.
Memantine reduces opioid relapses while in Medication Assisted Treatment (MAT).
Memantine reduces relapses after Suboxone is tapered off.
Memantine enhances sobriety after Suboxone is tapered off.
How Memantine Helps Suboxone
Researchers believe memantine helps Suboxone treatment in several ways:
It blocks excess glutamate and lessens cravings
It might help damaged opioid receptors recover
It may improve thinking skills and self-control
It eases acute opioid withdrawal
It can reduce opioid tolerance
Who May Benefit from Memantine?
Memantine may help certain subgroups most:
Those with high opioid cravings or withdrawal at baseline
Patients with poor self-control
Individuals wanting to taper off of Suboxone
Younger patients with shorter opioid use histories
I believe it may help fentanyl addicts tolerate Suboxone treatment
But more studies are needed to confirm who will benefit most from memantine.
Secret #2: Taking Suboxone Once per Day is Better Than Multiple Doses per Day
Is there really a difference between taking 24 mg once per day or 8 mg three times per day? Well, apparently there is. Allen et al, "Outcomes associated with once-daily versus multiple-daily dosing of buprenorphine/naloxone for opioid use disorder."
The Study
Scientists looked at 100 people taking buprenorphine/naloxone for opioid use disorder. Fifty people took buprenorphine/naloxone once daily. Fifty people took buprenorphine/naloxone multiple times per day.
They compared:
Negative drug tests
Number of opioid relapses
This was the first study ever on how Suboxone dosing schedules affect addiction treatment. It focused on patients without chronic pain.
Key Findings
The once-daily group had more negative drug tests. Their tests were negative 84% of the time. The multiple-dose group had negative tests 74% of the time. This difference was statistically significant.
The once-daily group had way fewer relapses. They had a total of 43 relapses. The multiple-dose group had 141 relapses. That's over 3 times more!
On average, the once-daily group had 0.68 relapses per person. The multiple-dose group averaged 2.16 relapses per person. This difference was highly significant.
Just 14% of the once-daily group relapsed at all. But 31% of the multiple-dose group relapsed at least once.
They had similar treatment compliance. And the same number of people stayed in treatment.
More people in the multiple-dose group used methamphetamines. But other drug use was similar between groups.
Why Less is More
Why would once-daily Suboxone work better? Researchers had some theories:
Multiple daily doses can reinforce addiction behaviors.
Frequent dosing reminds people they have an addiction.
A steady dose keeps medication levels more stable.
Simple routines improve adherence.
Missed doses increase relapse risk.
Once-daily Suboxone avoids these issues. People feel more normal taking one dose per day. A steady routine prevents ups and downs.
Who Should Use Once-Daily Dosing?
Based on the results, researchers recommended once-daily Suboxone for:
People starting medication-assisted treatment
Patients who keep relapsing on multiple doses
Those who use Suboxone mainly for addiction, not pain
People with busy, unstable schedules
Anyone who wants an easy, normal dosing routine
Of course, individual factors matter most. But try once-daily if you struggle with multiple doses.
The Takeaway
Suboxone once per day had real advantages in this first-of-its-kind study:
Fewer positive drug tests
3X fewer opioid relapses
14% vs 31% relapse rate
No differences in side effects or retention
Dosing only once per day may prevent ups and downs in your buprenorphine blood levels
Secret #3: You May Be On The Wrong Dose
Getting the right dose of Suboxone is crucial. If your dose is too low, you may keep craving opioids or even relapse. But how do you know if your Suboxone dose is right for you? Read Fareed et al "Effect of Buprenorphine Dose on Treatment Outcome."
The Research
Scientists looked at 21 studies on buprenorphine dosing. They compared higher doses (16mg or more per day) to lower doses (under 16mg per day).
They found that higher doses worked better for many patients:
More people completed treatment on the higher dose.
Higher doses meant less illicit opioid use based on urine drug tests.
Staying in treatment longer cut down opioid use.
Why Dose Matters
Researchers gave some reasons the higher dose worked better:
It blocks opioid withdrawal and cravings more fully.
It covers those with heavier addiction histories.
Simple - a higher dose works better for some people.
But there are tradeoffs to weigh with higher doses:
Increased risk of side effects
Higher costs for medication
Potential for misuse and diversion
So proper dosing is a balancing act for each patient.
Signs Your Suboxone Dose May Be Too Low
How can you tell if your Suboxone dose needs adjusting? Here are clues your dose is too low:
You keep craving opioids in the first month of treatment
You use opioids sometimes despite taking Suboxone
Your dose doesn't fully curb withdrawal by the end of the day
Your symptoms return too fast - within 12 hours of your last dose
You struggle with mood swings, sleep issues, or pain
Talk To Your Doctor
If you have signs your dose is too low:
Tell your doctor right away
Be honest about any ongoing opioid use
Discuss the pros and cons of adjusting your dose
With their guidance, you may find a dose that works better.
The goal is to find your optimal dose:
The lowest dose that relieves cravings and withdrawal
The dose that helps you stop using opioids completely
Dose matters - work with your doctor to get it right!
Secret #4: The Suboxone Spit Trick
When taking Suboxone, you put the film or tablet under your tongue. It dissolves into a liquid that gets absorbed. But then some residue is left over mixed with your saliva. You can choose to spit this out. This is called the Suboxone spit trick.
Why People Spit Out Suboxone
After Suboxone dissolves, there's leftover gunk in your mouth. This residue doesn't really help your treatment. Swallowing it may even cause side effects.
That's why some folks spit it out instead of swallowing. There are a few reasons people try this spit trick:
To avoid side effects like constipation or headaches
To get rid of the bad taste left in their mouth
To make sure they only absorb the right dose
The gunk left in your mouth has extra medication in it. If you swallow it, those drugs get absorbed in your gut. This can lead to some unpleasant side effects including:
Constipation - Opioid receptors in your intestines slow things down.
Mood swings - Extra medication throws your hormones off balance.
Low blood pressure - Opioids depress your circulatory system.
Migraines - Changing hormone levels can trigger headaches.
So spitting may prevent these issues by stopping excess absorption.
How To Do the Suboxone Spit Trick
Doing the spit trick is pretty simple:
First let the Suboxone fully dissolve under your tongue.
Wait until it's mostly dissolved - at least 5-10 minutes.
Next, swish the liquid around your mouth.
Then simply spit it all out into the sink.
Rinse your mouth with water to get rid of the taste.
It may take some practice to get the timing right. But once you got it, the trick is easy.
The key is waiting until it's fully dissolved. That way all the medication has been absorbed.
Spitting earlier could waste some of your dose. But spitting later poses no issues.
No Clear Guidelines
The prescribing info for Suboxone doesn't say whether to spit or swallow. Doctors don't always recommend one way or the other.
That's because there's no research proving this trick actually works. The evidence is anecdotal - just people sharing stories online.
But many patients swear by it. They report fewer side effects and a better experience.
So while unproven, it's reasonable to try the spit trick yourself. Pay attention to how you feel.
See if you notice any differences in side effects or with the medication's effects.
Give It a Try
While unproven, many people firmly believe the Suboxone spit trick works for them. If you swallow your saliva now, consider giving it a try:
Wait 5-10 mins until fully dissolved
Swish liquid around and spit out
Rinse mouth so no bad taste lingers
See if you feel any different in terms of side effects or drug effects. If not, no harm done.
But you might just find spitting makes your treatment go a little more smoothly.
Secret #5: Protect Your Teeth on Suboxone
Suboxone can cause dental problems like tooth decay and loss. But you can take steps to defend your teeth. Protecting your smile while on Suboxone is totally doable.
The Warning Signs
The FDA shared over 300 reports of dental issues with Suboxone tablets and films. These dissolve in your mouth to get absorbed.
The problems included:
Cavities and tooth decay - Even rampant decay ruining many teeth
Gum disease and tooth infections - Which can spread and get serious
Loss of fillings - Filling can fall out if the underlying tooth is damaged
Tooth fractures and loss - In severe cases, teeth may need extraction
These issues arose even in folks with no prior dental problems.
Why It Happens
When Suboxone tablets or film dissolve, the drug levels in your mouth spike.
This likely changes the pH balance and invites bacteria growth. It also dries out your mouth.
These changes make teeth more vulnerable to decay and infection. Left unchecked, it damages tooth structures.
Protect Your Smile
You can take simple steps to defend your teeth on Suboxone:
Brush gently twice per day and floss once daily.
But wait one hour after taking Suboxone to brush. This gives your mouth time to normalize.
After the medicine dissolves, rinse mouth with water to clear it out.
Stay hydrated and chew sugar-free gum to produce more saliva.
See your dentist ASAP after starting Suboxone for a checkup. Get exams every 6 months.
Inform your dentist about all meds you take, including Suboxone and dosage.
Follow any personalized dental hygiene plan they recommend. This may include fluoride treatments or antimicrobial rinses.
Switch to once per day Suboxone dosing. This reduces the amount of exposure your teeth has to the medication and the potential damages.
Don't Delay Treatment
If you notice any dental problems like pain or swelling:
Tell your doctor and dentist right away. Don't put off getting it checked out.
Prompt treatment can often fix issues before they escalate.
But waiting risks more decay, infection, tooth fractures, and potential tooth loss.
Stay on top of your dental health. Prevention and early action are key.
The Benefits Outweigh the Risks
Suboxone can cause dental issues, but offers major benefits for treating opioid addiction.
For most people, the benefits clearly outweigh the risks. With proper precautions, you can further minimize any risks to your teeth.
Good dental hygiene plus prompt treatment protects your smile. Don't let fear over dental issues stop you from receiving this important medication.
Talk to your doctor about any concerns. And take measures to safeguard your oral health while on Suboxone treatment.
I am Here to Help
I lead a team with decades of experience, a commitment to providing you with comfort, care, and respect as you navigate this challenging time in your life. We also make treatment super convenient with hours of operation that extend from 0800 AM to 0900 PM, 7 days a week through scheduled appointments, accept most insurances, making addiction treatment accessible to practically all who call 918-518-1636. We are conveniently located in Tulsa, Oklahoma and The Woodlands, TX. We are waiting for your call.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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