Yes, I have changed blog platforms again… hopefully for the last time! I spent the past few days learning to use the self-hosted WordPress platform. After reading the instructions about uploading the program using FTP (no small task for non-techies like me) I went to my GoDaddy hosting account and found that by clicking a couple buttons it automatically installed for me. Since then I have discovered the different WordPress templates available, the widgets, the plug-ins… cool stuff!

But back to Suboxone. One of the questions on today’s keywords was ‘Suboxone vs. Recovery’– I won’t go into that at length now but will direct interested readers to a post where I give some thought to the different things that happen to personality when an addict takes Suboxone vs when an addict goes through traditional step-based treatment. The article is on one of the last pages of that web site.

Another keyword question was ‘Suboxone and Anesthesia’.

As you may know I worked as an anesthesiologist for about ten years before my career was skewered by my opiate addiction.  I still miss the job, but it probably wasn’t good for me… I joke that my arms were getting sore from pushing around that wheelbarrow full of money!  It certainly paid very well, but more than that I loved the feeling of power and control that comes with supporting a patient during surgery, or from totally relieving the pain of a woman in labor.  Anesthesiologists are always heroes in the hospital. 

Some patients don’t know just how important the anesthesiologist is, but the nurses and surgeons certainly do.  I felt like a cowboy, as I raced in from home to secure the airway of a 13-y-o boy who had hung himself and whose neck anatomy was swollen and distorted… or as I ran down the hall to the operating room just ahead of the stretcher carrying a woman whose uterus had ruptured as she labored with her tenth kid.  I still vividly remember standing in the middle of the road at about two AM, after we saved the mom and baveby in that case.  It was snowing, and the city was asleep and very quiet, and as I looked at the dark windows of the house down the street I thought that I was the luckiest man in the world to have such a job.  A few years later the job was gone, and my feelings of power were challenged every day as I came to terms with all of the changes in my life– I was doing physical exams for a fraction of my old salary, the weekly dinner parties came to a halt (in seven years I haven’t been invited to a single one of the houses that I used to go to on a monthly basis), two close friends were dead (one a surgeon who committed suicide and the other Commander Shanower killed at the Pentagon on 9/11), our vacation cottage that the family loved was sold to pay the bills…

I didn’t intend to go down this path.  These thoughts used to be very painful for me, but now I can reflect and almost smile.  I see people in my practice who are facing changes in their lives, and it is nice to know what the situation feels like so that I can understand them.  I can also say with complete certainty that one cannot predict what the future holds, particularly when one’s view is colored by depression or other psychiatric symptoms.  I can also say that if an addict stays clean and works a recovery program, good things will ALWAYS happen.

Anyone interested in my personal story by the way can watch for a book that I am writing called ‘Terminal Uniqueness’.  I am trying to decide if I should post it on Twitter as I go or just wait until I am done.
Suboxone does not interfere with MOST anesthetics.  An anesthesiologist has a number of choices of general anesthetics (regional anesthetics using local anesthetics injected into areas to make things numb are not affected by Suboxone either).  A couple examples– one can do a ‘gas-based’ anesthetic where inhaled agents cause amnesia and anesthesia, or one can do a ‘balanced anesthetic’ using combinations of opiates and other IV medications, perhaps with smaller amounts of a gaseous agent as well.  Suboxone WILL block the opiate portion of this anesthetic, but there are plenty of other agents to use to replace the opiates.

The main problem comes after the surgery in the recovery room, when Suboxone prevents morphine, demerol, and other medication from controlling the surgical pain.  One of my patients had an emergency C-Section shortly after dosing with Suboxone and it was difficult to get her pain under control.  Eventually she was transferred to the ICU for close monitoring as they gave her huge doses of morphine– which eventually controlled her pain.  Some surgeries will be of a nature where injections of local anesthetic can provide considerable pain relief for up to twelve hours.  This is a particularly good option for procedures on the extremities.  Sometimes an epidural can help a great deal with pain control after abdominal procedures, or even chest procedures.  In cases where opiates need to be used, the dose will usually need to be surprisingly high, at levels where nobody will be comfortable unless the patient is continually monitored for respiratory function in a step-up unit like the ICU.

I have helped six or seven Suboxone patients through the surgical process and for the most part they have done well.  Stopping Suboxone for three days prior to surgery will make pain control much easier after the surgery.  Even if sufficient time has elapsed to get rid of the Subxone, though, the person will still have a much higher tolerance than patients not on Suboxone, so I strongly recommend discussion the fact that you are on Suboxone with your surgeon and your anesthesiologist.  If you don’t, they won’t know what is going on, and won’t be able to take the proper steps to help you.

1 Comment

june miller · September 21, 2008 at 10:16 am

hi doc,
i wrote you a while back. for some reason cannot figure out how to write directly so i will post in the comment section.
in any case, i have been on suboxone for the past 10 weeks, was doing fairly well, despite chronic pain issues and trying to find alternative ways of dealing with migraines and fibromyalgia.
a week ago friday i was in a fairly nasty bicycle accident, dislocating y shoulder, my clavicle and tearing my AV ligament in a partial tear. my prescribing doc talked to my orthopedist and she said it was fine for me to use pain medication but would need a much higher dose. so i am taking like 1o dilaudid suppositories a day to just keep the discomfort level down, with no feeling of being high, other than light withdrawals when it wears off during the night.
i am planning to return to suboxone as soon as possible, but on the other hand, am not so great at handling pain. i know once i return, it is pointless to use opiates. btw: i was using as much ibuprophen as i could tolerate but ended up with wicked stomach cramping despite eating with my pills.
this might sound strange, but dilaudid suppositories are the only opiate i have ever been able to tolerate without feeling absolutely bat poop crazy. my addiciton kicked full force in after a medication switch this past spring to opana, having used dilaudid for years as prescribed. i ended up snorting the drug, for some ungodly reason that i rationalized that i needed a stronger route of administration. its just the addict in me that suddenly wanted to be totally high, as opposed to just pain free.
my question is this: my tolerance is obviously high since being on suboxone. will it suddenly drop once its finally out of my system? i am hoping to only be on pain meds for a few more days. i just don’t want to end up being left in pain. i have started PT and out from work on disability, and am trying to both take it easy and at my doc and PT’s advise also use my arm somewhat to keep it from losing my range of motion.
what are your thoughts. i feel ok for the most part, like i said, the opiates are working for pain, but in twice the amount i have ever used when i was actively on opiates. (i was always under doctor’s care, and for a few years, the opiates actually improved my quality of life, being pain free, until i decided to abuse them.
i am currently in out-patient treatment, and my doc there is the one who has prescribed the suboxone. she has spoken with all of my doctors after the accident and made recommendations, though it is fairly difficult to get in touch with her otherwise.

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