15 Comments

  1. moman

    My experience with surgery while on suboxone was not good. I though it did everything right….took my , meds to the hospital (I had hip surgery, no warning), told all the docs, etc. They put me on a PCA, under-dosed me, and kept giving me suboxone. It took two days before my sub doc intervened and told them to stop the sub. By then, I was two days out from the OR.
    Nothing seemed to work, and being an addict who tried to be honest, I always got less instead of more. The dressing changes were awful, even though they added 80mg oxycontin BID to the MS. When they discharged me, they unplugged the PCA, scripted me 10mg OC BID, plus Norco. It never controlled the pain and I slowly went into withdrawals, until I gave up and restarted my subs on my own.
    My opiate addiction began after an accident left me with 2nd and 3rd degree burns to 15% of my body. I was honest then, and never will forget the first debriding session….with nothing given for pain. I fought em off, and got ONE Darvocet. The next day, they started me on Demerol IM PRN. After a month of that misery, a pain doc finally was called and told me all this stuff was exactly the wrong thing for me. He put me on Brompton’s, and slowly weaned me off. I would never wish this on anyone!

  2. Martie777

    This information is greatly appreciated and vital, but how do we, as patients explain this to our doctors? In my opinion, a Dr. Should not be allowed to prescribe Suboxone unless he/she is on board with a universal protocol to deal with acute or post operative pain.

    • Agreed. There will always be bad doctors, but they become even more of a problem in the absence of good doctors…. so I think we need more doctors willing to do the ‘dirty work’ of treating opioid dependence. If patients had more choices, the bad doctor practices would wither away.

  3. I know I’m 5 years late but this is the most helpful info I’ve found. I’m in the hospital Right Now. Gallbladder removal 18 hours ago. I’ve been on Suboxone 6 years for heroin recovery & chronic pain. (No relapses in that time)
    The pain here is SO bad. I’m getting 4mg of morphine every 6 hours. Think they plan to send me home with Norco. I’ll deal with what I have to for now. The thing I’m TERRIFIED able is getting back on my suboxone routine.
    I got Hydrocodone for a pulled tooth 4 years ago. Waited 12 hours from last Hydro. dose & took a suboxone film & was sent into agonizing precipitated withdrawals.
    Many forums say one must wait 24 hours.
    I’m so scared of detox. I felt I had no choice but to take there opioids (which are only barely taking the edge off – I’m trembling & hurting & can’t sleep after being awake almost 24 hours)
    What do I do? What do I do?
    Please oh please someone out there see this & help me.
    P.S. My sub prescribing doc is gonna be so pissed at me for accepting morphine. I don’t know if she’ll be any help.

    • I sent you an email; not sure if you received it, but I’ll copy it here for other readers:
      Read this: http://suboxonetalkzone.com/post-operative-pain-in-suboxone-patients/
      I just got off the phone with a surgeon, planning pain control for upcoming surgery in one of my patients. That’s what happens in ideal situations. There are two approaches—both described in an NIH consensus paper about the issue. One approach is to stop buprenorphine; the other to keep it going. I do NOT like stopping buprenorphine before surgery for several reasons. First, it takes weeks to leave the system, and even if it does leave the system, you are left going into surgery depressed, dehydrated, and malnourished because of withdrawal. Even if you stop buprenorphine, tolerance remains elevated– so high doses of opioids are needed to provide post-op pain relief.
      So instead, I tell patients to reduce their buprenorphine dose by half, but stay on it EVERY SINGLE DAY. Then I treat post-op pain with a higher dose of agonist than usual. Note that morphine is a WEAK agonist; it does not effectively compete with buprenorphine, even the residual buprenorphine left after stopping the drug for a week. You need a potent agonist like Opana, or oxycodone, or Dilaudid.
      I typically use oxycodone, 15-20 mg every 4 hours. The patient stays on buprenorphine or Suboxone every day. The result is that the person gets pain relief, but does not ‘feel’ the opioid. There is no euphoria, and usually no sedation—but it does relieve pain if the dose is high enough.
      Patients can often control the agonist, as long as they stay on buprenorphine. But to be safe I usually give scripts to cover 2 days, each with a ‘fill after’ date, so that the person never has a large number of pills at home.
      The nice thing about this approach—continuing the buprenorphine or Suboxone every day—is that when you stop the opioid agonist, you can simply go back to your full dose of buprenorphine, with no risk of precipitated withdrawal.
      Feel free to share my email with your doc; understand that no doctor appreciates advice from other doctors though. Good luck!

      • Summer G

        I am having a serious knee surgery this Monday 1/8/18 after 6 surgeries back to back around 10 years actually 14 total I was on Norco 10 325 at a rate of 20 plus per day. I wasn’t trying to get high yadyada. I found an outpatient suboxone doctor and it’s saved my life. I am clean for well over 7 years. I take a level dose of subutex daily to help with pain management. I’m at 8 mgs daily but have been tapering on my own to 2 mgs 4 days to surgery. I’ve kept my surgeon and doctor informed. I’m terrified of withdrawals I already feel poorly and I know I’ll never go back to opioid pills but I know I’m gonna need relief of pain. My surgeon knew nothing about bikes. I had to explain. Help folks. Some actually info to give him and my anesthesia doc. The surgeon has no idea giving me pain pills. I want to minimized those and stay on my subutex.

        • I’m sorry– it may be too late for this. But I have tons of info on my blog, including info that can be given to surgeons (who are welcome to contact me if necessary). You will find them by using this blog’s search function for terms like ‘acute pain’ or ‘post-op pain’ or ‘surgery on suboxone’. Another option is SuboxSearch, where you can search either this blog or my forum for those terms. Check it out– it is very useful!
          It is completely, 100% possible to provide adequate pain control after surgery. Doing so requires ordering doses of medications that uneducated nurses or doctors will resist. Doctors and nurses who are smart-enough to understand buprenorphine (and they all are smart enough) and who have gained a little experience with such care, will have no problem with the pain control. DON’T LET YOUR OWN SURGEON CHICKEN-OUT. If your surgeon says ‘I can’t treat your pain on Suboxone’, tell that person to FIND SOMEONE WHO CAN.
          I am getting tired of the ignorance out there, and how after 14 years, most surgeons STILL have no idea how to manage a patient on buprenorphine.

  4. Hey Dr. Junig, I’ve been an avid reader of this site and even sent you a text about “The Look.” You know, the look we get when we tell an ER doc or nurse that we are on Subs. Well sir, I’ve been giving this a lot of thought and I think I’m going to try to start weaning off of the Subutex through my Sub Dr. There are a lot of reasons for this move. After the horrifying experience I had last Summer with the terrible pain I was in and all the medical “Professionals” would address was the fact that I was on Subutex!! Yeah, no kidding, I tried to be above board and honest, so I told them the truth. Anyway, I’m 58 years old and a raging diabetic along with Arthritis and a few other maladies. OK, now I’m going to be as truthful to you.. These problems I’m having are leading to some pretty painful nights where I’m getting little to no sleep. These Drs. are telling me that the Subutex is as strong as a Percocet 30Mg. OK I’m no Dr. or have any pharmacological schooling, but, if Subutex is only a partial agonist, how can it be as strong as a Perc 30? Anyways back to the honesty part, I hope that once I’m off of the Bupe all together then maybe I can start taking some pain meds at night so I can at least get some sleep. I’ve NEVER had a dirty urine in over 5 years while on Bupe. Went to all of my counselling sessions, always paid in full every month. I was the perfect Bupe patient. (Not Bragging) I did get into heated arguments when they told me I had to use the strips instead of the generic Subutex. And that argument still arises every so often. I just don’t get it, if I had any other disease there would be no problem getting a generic medicine for it. But for this, it’s a HUGE problem. And when I ask why I get double talk. So, with everything I’ve listed here and a few things I didn’t, I think it’s time to start the process of weaning down to eventually be completely off of bupe all together. Please tell me what you think, I really wish I lived near your practice, I would definitely be one of your patients. It just seems like you “Get It” Dr. J. A lot of these other Doc’s don’t. Your patients are very lucky to have you. Please let me know what you think, looking forward to hearing from you.

    • Thanks for the nice comments. Yes, I remember our earlier communication, and I understand the look and attitudes that you describe. Buprenorphine does have potent opioid effects comparable to 30 mg of oxycodone, but your doc is missing the tolerance issue, which removes almost all of the opioid effect of buprenorphine after a few weeks on the medication. Tolerance takes longer to develop, and develops less completely, when people take a drug like oxycodone that leaves the body within a few hours. In contrast, buprenorphine’s ceiling effect allows for constant opioid activation across the entire dosing period.
      I’ve written posts over the years about the unfortunate status of people with chronic pain. There are a couple aspects to the chronic pain debate where the figureheads from the medical side– the medical societies and organizations that often provide soundbites about medical politics, or groups like “Physicians for ‘Responsible’ Opioid Prescribing” that encourage politicians to remove doctor autonomy- are either not being honest, or are not putting on their ‘thinking caps’ before speaking about the issue. For example…
      Doctors often distinguish between acute pain and chronic pain. If a doctor says that acute pain, such as major surgery or a broken femur, doesn’t need treatment with opioids, anyone listening will consider that doctor to be an insensitive fool. We know from mountains of studies that untreated postop pain leads to increased stress responses and increased morbidity and mortality. The need for opioids in such situations is obvious, and withholding them would not be humane. At the same time, doctors often say that opioids are NEVER indicated for chronic pain– as if there is a qualitative difference between the experience of pain in one case vs. the other. But what if the pain experienced by some people with chronic pain is WORSE than the pain experienced by patients after surgery? There is no evidence at all that chronic pain is less severe. Maybe, since it goes on so long (and patients with chronic pain are treated in the way that you described, made to feel like criminals for seeking pain relief), the suffering is greater! The dichotomy between acute and chronic pain is artificial, and created ONLY so that doctors can feel better about denying pain medication to chronic pain patients.
      Also, the same experts would say that opioids don’t help, and possibly make chronic pain worse. But there are ways to treat chronic pain with opioids that DO work. I’ve tried to raise awareness of those approaches over the years, presenting one approach at ASAM, but there is little hope for the methods to go mainstream given the current atmosphere. I even shared one of them with one of the founders of PROP a few years ago, and he dismissed it without trying to understand the neurochemistry behind the approach. The approaches rely on combinations of agonists and partial agonists, such as buprenorphine and oxycodone, where buprenorphine prevents the maximal stimulation of the mu receptor by agonists, but allows enough stimulation to provide analgesia… without tolerance formation, euphoria, or addictive ‘pull’.
      I thought I discovered that approach, but found while researching the combination that others have described the phenomenon for many years. The approach involves combinations of generic medications, so I don’t see much motivation for pharmaceutical companies to get involved- but one would think that more doctors out there would have empathy for the millions of people struggling with chronic pain.
      I’ll get off the soapbox for the night. But I understand your frustration. I hope you’ll use SuboxForum during your taper, as there are always people there working toward that same goal- and the support is helpful during those sleepless nights. I’ll likely see you there!

    • Hi Dr. Junig, Well, it’s been a little over a year since I started my taper and I’ve gone from 24mgs. to 8. I know I still have a ways to go but the SuboxForum helps me so much!! No matter what questions I have all I have to do is go to the forum and sure enough someone has already asked and you have answered it. You should consider opening a satellite office here in Pittsburgh. I’d be your first patient!! Thanks again for all of your hard work!!

  5. Corey D

    Hi there, I have been doing so much research today since I’m having an oral procedure in 2 days. I’m on 4 mg of Subutex, although I’ve been taking 8 mg the past 3 days hoping it’d cut the acute pain I’ve been having the entire weekend. I went to my dentist this morning, and they have to extract 2 teeth. They’re going to sedate me, although not with an IV. They said they will give me Xanax & Halcion to put me under, then remove the teeth. I’m worried that those 2 medications might be dangerous having been on Subutex for 2 years.
    The only other medication I’m on is 20mg of Vyvanse for ADHD, but I don’t forsee that being problematic. I’m desperately hoping that although this is an older post, someone out there can respond within the next 48 hours. If not, I’m thinking about calling and cancelling my sedation and just baring with the fear, anxiety & pain being awake while the cut open my gums to take the teeth out (one is broken with almost nothing above the gum line). The dentist knows I’m on Subutex, but I get the feeling he doesn’t really even know much about it at all. I called my Sub doctor, and they just said “if your dentist thinks it’s fine, it’s fine.” But I don’t really feel good about that answer either. Do you have any experience with these medications being used to sedate someone while on Subutex/Suboxone? Thank you sooooo sooo so much in advance!

    • Hopefully you saw my answer at http://www.suboxforum.com — those medications are ‘benzodiazepines’ that can worsen respiratory depression caused by opioids. But you are tolerant to those effects from buprenorphine, so the risk in your case is very low, assuming they don’t give huge doses of those two drugs. I’m not sure why they would use both Halcion (triazolam) and alprazolam; they have identical actions, but different half-lives.

  6. Thank you for your article! I am a 59 year old woman with chronic pain. I recently began a suboxene program for my pain. I was on rather high doses of oxycodone for years. The suboxene has relieved my pain almost entirely! I need back surgery, but am putting it off for now . I do have side affects however. I cannot taste food, feel eye drops rolling down my face or even feel my bowels move. It is wonderful to not be in pain though! I’ve had great concern about being put under for some reason. Your article has validated my fears! I’m hoping to resume life with no medication after surgical pain. Suboxene really does work for pain in some people , I’m living proof! I only took the oxycodone that I was prescribed by my physician by the way .. he did me no favors. Thanks again. ..♥

  7. Lana-jo

    Hi in desperate need of advice I’m on buprenorphine 1.4 ml I booked and paid for a breast augmentation to the cost of £6,350 I disclosed my medical records as requested today Monday 22nd Oct I had a phone call at 3.45 to tell me my surgery scheduled for tomorrow the 23rd was cancelled also there saying the small print states I may not get my money back please help

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