What is Sublingual Administration?
Sublingual administration is a method of delivering medication where a substance is placed under the tongue to dissolve and be absorbed through the mucous membranes [1.2.1]. This area is rich in tiny blood capillaries, allowing the drug to pass directly into the systemic circulation [1.2.1, 1.2.3]. This route is different from oral administration, where a drug is swallowed and must pass through the gastrointestinal (GI) tract and liver before reaching the bloodstream [1.3.5].
The key advantage of the sublingual route is that it bypasses the "first-pass effect" [1.3.6]. The first-pass effect is a process where the concentration of a drug is significantly reduced after being metabolized by the liver [1.2.2]. By avoiding this, sublingual administration leads to enhanced bioavailability, meaning a higher percentage of the active drug reaches its target, and a more rapid onset of action [1.3.3, 1.8.1]. For example, the onset of action for sublingual administration can be as quick as 3-5 minutes, compared to 30-90 minutes for oral administration [1.8.2].
How Does the Route of Administration Affect Psychoactive Potential?
The potential for a drug to cause a "high" is linked to several factors, including the substance itself, the dosage, and the speed at which it reaches the brain. Because sublingual administration provides a faster onset and greater bioavailability compared to swallowing, it can intensify the effects of a psychoactive substance [1.3.3, 1.3.4].
Many different drugs can be taken sublingually, including cardiovascular medications, steroids, and certain vitamins [1.5.1]. However, this route is also used for psychoactive substances, both legally and illicitly. These can include opioids, benzodiazepines, and cannabinoids like THC [1.5.1, 1.4.3]. The rapid delivery to the bloodstream means the desired euphoric effects can be felt more quickly and intensely, which can increase the potential for abuse [1.4.3, 1.4.6].
Sublingual Use of Specific Substances
Whether sublingual use leads to a high is entirely dependent on the substance in question.
Buprenorphine (Suboxone, Zubsolv)
Buprenorphine is a partial opioid agonist used in medications like Suboxone for the treatment of opioid use disorder [1.6.1]. When taken as prescribed (sublingually), buprenorphine is designed to reduce cravings and withdrawal symptoms without producing the same intense euphoria as full opioid agonists like heroin or morphine [1.4.2, 1.6.5]. It has a "ceiling effect," meaning that after a certain dose, its effects plateau, which is intended to lower its abuse liability [1.6.4].
However, buprenorphine products can be misused [1.6.3]. While getting a euphoric high from sublingual buprenorphine is less likely for individuals with an opioid tolerance, opioid-naïve individuals can experience euphoria and significant respiratory depression [1.7.6, 1.6.5]. Suboxone formulations include naloxone, an opioid antagonist, to deter abuse by injection, as it can precipitate withdrawal symptoms if injected by someone dependent on full opioids [1.4.2, 1.7.3].
Benzodiazepines
Benzodiazepines like alprazolam (Xanax) and clonazepam are sometimes taken sublingually to achieve a faster onset of their sedative and anxiolytic effects [1.5.1, 1.5.2]. This rapid absorption can enhance the drug's psychoactive and euphoric effects, contributing to its abuse potential. This method bypasses the breakdown in the GI tract, leading to a more potent effect from a similar dose compared to oral ingestion.
THC (Cannabis)
Sublingual THC products, such as tinctures, sprays, and dissolvable strips, are popular for both medical and recreational use [1.4.3]. This method offers a faster onset of effects (usually within 15-20 minutes) compared to traditional edibles, which must be digested [1.4.3]. This quicker feedback loop allows users to have more control over their dosage and avoid the uncomfortable intensity that can come from overconsuming edibles [1.4.3, 1.4.4]. For recreational users, sublingual THC provides a discreet and efficient way to achieve a high [1.4.3].
Comparison of Administration Routes
| Feature | Sublingual Administration | Oral Administration (Swallowing) | Intravenous (IV) Administration |
|---|---|---|---|
| Absorption Site | Mucous membranes under the tongue [1.2.1] | Small intestine [1.2.2] | Directly into a vein |
| Onset of Action | Fast (3-5 minutes) [1.8.2] | Slower (30-90 minutes) [1.8.2] | Immediate (30-60 seconds) [1.8.2] |
| Bioavailability | High (avoids first-pass effect) [1.3.3] | Variable (subject to first-pass metabolism) [1.2.2] | 100% |
| Abuse Potential | Can be high depending on substance, due to rapid onset [1.4.3] | Generally lower than sublingual or IV for the same substance | Very high due to immediate and intense effects |
| Examples | Nitroglycerin, Buprenorphine, THC Tinctures [1.2.5] | Most tablets and capsules | Hospital-administered drugs, illicit drugs |
Risks and Considerations
While effective, sublingual administration is not without risks. The primary risk is linked to the drug itself. Misusing potent psychoactive substances sublingually can lead to dangerous side effects, including respiratory depression, overdose, and addiction [1.7.6]. For example, buprenorphine has been associated with life-threatening respiratory depression, especially when combined with other CNS depressants like benzodiazepines or alcohol [1.7.6].
Common side effects associated with sublingual opioid medications can include dizziness, drowsiness, dry mouth, constipation, and nausea [1.7.1]. Additionally, some individuals may experience local irritation or sores in the mouth [1.7.5]. It's crucial to only use medications as prescribed and to avoid eating, drinking, or smoking while the medication is dissolving to ensure proper absorption [1.2.5].
Conclusion
The question "does sublingual get you high?" has a nuanced answer: the administration route itself does not create a high, but it can significantly amplify the speed and intensity of a psychoactive drug's effects. By bypassing the digestive system and liver, sublingual absorption leads to a faster onset and higher bioavailability [1.3.1]. This makes it an effective delivery method for legitimate medical treatments but also a potential route for abuse with substances like opioids, benzodiazepines, and THC. The potential for a high is determined by the pharmacology of the drug being used, not just the method of delivery.
For more information on the risks associated with opioid use, please visit the SAMHSA website. [1.6.5]
