From my understanding, the narcan in suboxone is in there in order to abstain individuals from using the drug incorrectly, ie. Crushing and inhaling or injecting, but administered correctly, the narcan gets eliminated via the liver. My question is how does inhaling and sublingual administration differ in terms of first pass? I always thought sublingual administration circumvented the first pass effect. I understand the protocol states oral administration and may not be sublingual but I am just curious about the mechanism of action since suboxone is often administered sublingually. Thank you 

Suboxone administered sublingually goes through the same metabolism through the liver as medication taken orally. Due to its almost complete first pass metabolism, it is deemed inactive. However, if snorted or injected, it does not undergo this metabolism and is therefore active. This produces unpleasant symptoms (withdrawal) and deters from suboxone being abused. 

Level of Consciousness,Opioid Toxicity

First Pass Metabolism, Inhalation, Injection, Liver, Opiate Use Disorder, Route, Sublingual, Suboxone, Withdrawal

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