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When suboxone is used correctly, the naloxone is destroyed within the liver shortly after uptake from your intestines and contains no therapeutic effect. Buprenorphine may be the active substance; it's absorbed beneath the tongue (and through the entire mouth) but destroyed through the liver if swallowed. There is a formulation of buprenorphine without naloxone called subutex; I have used this formulation once the patient has apparent problems from naloxone, including headaches after dosing with suboxone. I have treated addicts who have had gastric bypass, the location where the first the main intestine is bypassed and the stomach contents empty in a more distal the main small intestine. In such cases the naloxone escapes ?first pass metabolism', the method with normal anatomy where the drug is taken up with the duodenum and transferred straight away to the liver through the portal vein, where it really is quickly and completely destroyed. After gastric bypass naloxone can be adopted by portions of the intestine that are not served from the portal system, causing blood levels of naloxone sufficient to cause brief, relatively mild withdrawal symptoms.

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