Bupes, and Subs, and Surgery, Oh My

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Imagine bringing a patient to surgery on a naloxone (Narcan®) intravenous continuous infusion that you cannot stop for at least 2-3 days post-operatively.  Envision trying to treat that severe pain with acute opioid therapy (aAOT) but that with each sequential dose escalation, your attempts remain futile because naloxone is blocking the AOT from combining at the site of action, the mu-2 opioid receptors.  Essentially, this is what’s happening when you perform surgery on a buprenorphine (Suboxone®) patient, but with some inherent analgesia activity from the buprenorphine.

Make no mistake; in this case, the adjuvant therapeutic options (regional nerve blocks, IV acetaminophen and ibuprofen, pregabalin, SNRIs, etc.) become the principal analgesic treatments, and AOT becomes the adjuvant – exactly opposite to what we’re all used to. [aAOT examples include morphine, oxycodone, hydrocodone, hydromorphone, fentanyl, and others.]

One of the most misunderstood opioids among clinicians is buprenorphine, and even more especially when combined with naloxone in the branded form of Suboxone®.

If a patient has a scheduled or elective surgery with an active prescription for any buprenorphine product, the approach is not too difficult, but it requires an understanding of pharmacology, rational polypharmacy, but most importantly, common sense.

If the patient arrives on site in an emergency situation with an active prescription for any buprenorphine, the approach is a bit more challenging compared to elective surgery.

But before traveling down this road, let’s first ask; what compelling justification is there for combining buprenorphine with naloxone in the first place?  Answer: NONE!  Consider that buprenorphine is 90-95% bound to mu-1 receptors and has a superior binding affinity compared to naloxone.  Even the manufacturer (Reckitt Benckiser) admits to this, as seen in a 2004 Johns Hopkins University School of Medicine writing entitled “Practical Considerations for the Clinical Use of Buprenorphine“.

How then did Reckitt Benckiser ever convince the FDA that this is a necessary or safer combination compared to buprenorphine alone?  I would sure like to know the answer to that looming question if anybody can enlighten me.  Dr. Hendrée E. Jones shares a diagram that is ironically referenced to the eminent Suboxone manufacturer, Reckitt Benckiser.  It actually illustrates how and why buprenorphine is more tightly bound to the mu-1 receptor compared to naloxone.

In fact, van Vorp and colleagues demonstrated this well showing that although naloxone can reverse burpenorphine, the naloxone dose must be huge and continuous.  But even then, the reversal is short-lived.

You can’t have it both ways folks; either naloxone reverses buprenorphine or buprenorphine blocks naloxone!  Here’s the figure from Jones’ writing with italicized dialogue from his article.

Heroin, Buprenorphine, and Naloxone Effects at the Mu Opioid Receptor

buorenorphine receptor binding

Heroin, buprenorphine, and naloxone (represented above by blue polygons) produce contrasting effects because they interact differently with the brain’s mu opioid receptors (red pentagons).

First, the chemicals differ in how much each stimulates the receptors (represented above by the percentage of receptor “activity zone” each fills). The stronger the stimulation, the more pronounced will be the opioid effects of pain relief, feelings of well-being, respiratory depression, and so on. Heroin, classified as a full receptor agonist (stimulator), nearly fills the activity zone. Buprenorphine, a partial receptor agonist, fills a smaller portion of it. Naloxone does not stimulate the receptor at all.

Second, each chemical binds to the receptors more or less strongly (represented above by the percentage of receptor “affinity zone” it fills). A chemical that forms a tighter bond can push one with a weaker bond off the receptors and take its place. Thus, buprenorphine can push heroin off the receptors, and in doing so replace heroin’s full receptor stimulation with its own partial stimulation.

Buprenorphine also binds more tightly than naloxone. Naloxone can compete with heroin for the receptors. Because naloxone can block heroin and other opioids from stimulating the receptors while not itself stimulating them, it can precipitate opioid withdrawal and is classified as an opioid receptor “antagonist.”

The buprenorphine/naloxone mixture in Suboxone is touted to reduce the possibility of illicit use by injection if an attempt is made to abuse the Suboxone by a parenteral route, presumably because “naloxone antagonizes the opioid effect”.  This justification is flawed.

Let’s think about this for a minute…

Repeat after me…at normal therapeutic doses, naloxone will never see that mu receptor because buprenorphine has a higher binding affinity, a longer half-life, and therefore naloxone is not capable of reversing it.  In fact, to the contrary, it’s more believable that buprenorphine could reverse naloxone.

Now that we’re past that mess, let’s figure out what to do for our surgical patients in a stepwise approach while considering the dialogue outlined above.

Emergency surgery for the patient on buprenorphine comes with challenges for sure.  In a letter to the editor entitled “A new pattern of buprenorphine misuse may complicate perioperative pain control“, Marcucci and colleagues point out just how disastrous this can be.

I ask you to note the following…

  1. Buprenorphine in the form of Suboxone® has a half-life of 24-42 hours.  Following surgery, pure opioids will not be able to displace the buprenorphine for up to 5 days because of the long half-life.
  2. Intuitively, clinicians might keep dosing AOT such as morphine, hydromorphone, or oxycodone in an effort to achieve analgesia, while all the while their efforts prove largely ineffective at normal doses because these drugs need to hover over the site of action until small amounts of buprenorphine leave their binding site.  The patient remains in pain, but moreover the patient is tolerating all these opioids with repeated and escalated doses just fine.
  3. Hours later the buprenorphine begins to dissociate from the mu receptors and now all of the administered pure agonists listed above rush for the receptors.  The worst possible outcome here would be respiratory depression and death.

Certain literature (available upon request) misinterprets previously published recommendations and makes the leap that methadone 30-40mg/day could be used in the acute surgery setting to replace buprenorphine.  Are you kidding me?  The methadone could stay around for quite some time (half-life of 10-60 hours)…just enough time to cause significant toxicity as the buprenorphine wears off.  Others say use hydromorphone by continuous IV infusion.  Are any of these suggestions clinically proven in double blind studies with an outcomes assessment?  Not that I know of.

My [clinically unstudied and unproven] suggestion is to use a highly potent pure opioid with similar lipophilicity that has a short half-life.  It seems reasonable therefore that there could be some competition between fentanyl and buprenorphine.  But the beauty here is that fentanyl has a short half-life and the patient can be supported medically for the short duration while fentanyl is metabolized, should we overshoot the mark while buprenorphine stops lingering on the receptors.

Depending on the complexity of the surgery, another practical approach would be to use buprenorphine intravenously at a starting dose of 0.3mg every 6-8 hours.  Unfortunately, probably 99.9% of U.S. surgeons have little to no experience with IV buprenorphine (but to be fair, neither do pharmacists).  Remember, since buprenorphine is a partial agonist/antagonist, its analgesic properties eventually plateau and no more analgesic benefit will be seen even with escalating doses.

What about scheduled or elective surgery for patient on buprenorphine?

Be smart and wean the patient off buprenorphine and onto a pure opioid beginning 2-4 weeks prior to surgery.  You will make everyone’s life easier; patient and clinicians.

And finally, it is a bad idea to continually dose the ambulatory surgery patient with pure opioids per standard surgical orders immediately post-op if they were on buprenorphine, because pure opioids will not make it to the mu-1 receptors.  Upon hospital discharge, AOT may finally get to the receptors when the patient is home and unsuspecting.  Or, I have seen scenarios where the patient is sent home with oxycodone, hydrocodone, morphine, or others, and told to resume their buprenorphine…and the patient wonders why their pain isn’t controlled.  That is a simple answer; the buprenorphine is blocking the pure opioid agonists from getting to the mu-1 receptors as I clarified earlier.

I encourage clinicians to engage ii studies to validate a stepwise approach to treating surgical patients that have active prescriptions for buprenorphine.  For now however, the bottom line is…USE COMMON SENSE!

PLEASE tell us how you handle these patients if you are a clinician.  For patients, we sure would be interested to learn of your surgical experiences.  Also, tell us if you’ve seen disasters because of the issues outlined above.  All comments are welcome!

Sources:

  1. Alford DP, Compton P, Samet JH. Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy. Ann Intern Med. 2006 January 17; 144(2): 127–134.
  2. Heit HA, Gourlay DL. Buprenorphine New Tricks With an Old Molecule for Pain Management. Clin J Pain February 24; (2): 93-97.
  3. Jones HE. Practical Considerations for the Clinical Use of Buprenorphine. Science & Practice Perspectives. 2004 August; 4-19.
  4. Marcucci C, Fudin J, Thomas P, et al. A new pattern of buprenorphine misuse may complicate perioperative pain control. [Case Reports, Letter]. Anesth Analg 2009 Jun; 108(6):1996-7.
  5. van Dorp E, Yassen A, Sarton E, Romberg R, Olofsen E, Teppema L, Danhof M, Dahan A. Naloxone Reversal of Buprenorphine-induced Respiratory 

    Depression. Anesthesiology 2006; 105:51–7.

     

396 thoughts on “Bupes, and Subs, and Surgery, Oh My

  1. Thanks to my knowledge of Suboxone and other pain medications, the best thing I’ve learned is that I MUST advocate for myself or else if I have elective surgery there is a high chance I will be writhing around in pain like my last surgery because I was so severely underdosed with full mu-opioid agonists. This time around I have to have an ulnar nerve decompression surgery, and immediately I informed my Suboxone doctor of what is going to happen here in about 9 days. I told him that I would be stopping the Suboxone for 3-5 days before the surgery so that I would be in mid-withdrawal by the time I get to the ambulatory surgery center. The surgeon is also aware, and I plan on letting him know the exact course of treatment I had last time and because my previous surgeon severely underdosed my pain management I was in complete agony for at least six days and had no choice but to file a complaint with the hospital…in the end someone felt badly enough that my surgery bill was credited over $5,000 which I found to be more than fair for what happened. This time my neurosurgeon will be prescribing 15mg oxycodone every 4-6 hours for no more than 5 days post-op. By the time the buprenorphine wears off I’ll be able to obtain enough pain relief that I won’t be in agony but I also plan on using a lot of ice packs, my TENS unit, and other modalities of pain relief so that pain pills are the only thing that will prevent me from suffering. Once I run out of the pain medication (or once the 5 days are up) I will have to go 24 hours without any narcotics of any kind so that I can transfer back to buprenorphine and not induce any precipitated withdrawal effects. If I have any spare pain meds left from the surgery they’ll be going immediately in the toilet and any pain after 5 days will have to be controlled by the buprenorphine – since it is a pain reliever but a very weak pain reliever at the dosages I consume and because it’s for opioid replacement therapy. I’m expecting to get a prescription for 20x 15mg oxycodone tablets, changing my pregabalin dosage from 400mg daily to 600mg daily for a few weeks, and I’ll be alternating between acetaminophen and naproxen while on the pain medicine to augment the pain relief effects. I also have someone else handling my prescriptions so that I can be held accountable while still being my own best advocate, and have discussed the entire plan with my RX holder and he agrees that this is the best course for my upcoming surgery.

    I just wanted to lay out my plans for everybody to see and to show that you can be your own advocate, and with letters from your Suboxone doctor and letting your surgeon know that you’re a Suboxone patient and require more pain medicine than others but not in excessive amounts for an extended period of time, they should feel comforted by the fact that you are in full control of your own pain relief and with the help of someone holding your pain medication and giving you your doses at proper intervals, most surgeons shouldn’t have much of a problem prescribing slightly higher than normal amounts of pain medications especially if it’s for a very short period of time. I also make sure the doctor knows that I have a naloxone kit handy just in case anything were to ever happen but also make him aware that because of previous cases I am astutely aware of what it takes for me to achieve enough comfort so that I may not be pain free by a long shot, I can still get just enough comfort that I will be able to tolerate the 5-7 days post-op. Just because I’m a Suboxone patient does not mean I cannot have full opiate agonists post-op but it does mean I may require higher than normal dosages and that 5-7 days of pain medication should be more than enough and with the right kind of help and support there will be multiple people including myself making sure that I take only what I need and no more. I am my best advocate and I recommend to everyone that if they are to have surgery to learn the best practical dosages of narcotics they can have safely and still function while not trying to “get in a high” after surgery because it’s just not going to happen. If you feel like you are sneaky enough to attempt this, it may mean the Suboxone is not doing it’s job well enough to keep you sober and you should seek the help of a therapist, your Suboxone doctor, or an addiction specialist doctor who can make sure you are on the right medication(s) to prevent you from relapsing back to complete addiction.

  2. Dear Readers,
    Hello. I have been prescribed 20mg Suboxone daily, since the fall of 2013 – by the providers at Clean Slate Corporation; this started after 6 months of use of Percocet, prescribed to me by my former Primary.
    During these 7 (SEVEN) years of Suboxone use, I have found that:

    A: I haven’t thought of pain pills in years and years.
    B: Why am I even on Suboxone?
    C. Why am I on Suboxone at 20 mg’s daily, when Suboxone caps out at 16mg?
    D: Did I simply “swap addictions”?
    E: Are these Suboxone clinics simply *legal dope dealers*?
    F: NEVER have any of my “Providers” ever asked me or told me about “weaning off Suboxone”.
    G: During the current Covid Pandemic, Clean Slate Centers are making their customers/clients/health insurance “marks”/”patients” actually come into the clinic to give urines at the clinic, in order to be able to receive their meds. At the same time, the clinic that I go to is completely disgusting and unsanitary. The “secretaries” throw attitude when you go to the window for an appointment (How dare you interrupt their “coffee corner” discussions) and then – when you go in to see the “provider”, the “provider” is speaking to you remotely from home – safe and sound! #ABSOLUTELY_ODIOUS!

    I have 3 (THREE) pre-existing conditions and the last thing I want is to die with a respirator tube down my throat. But in order for me to get my Suboxone, I “have to” show up at the clinic! Why can’t this be done remotely, like a tele-med appointment?
    I have put in a call to the Massachusetts Substance Abuse hotline (not sure what it is called; I don’t have my notes with me) and have filed a grievance over the telephone. But now they (the oversight committee for the place I filed the grievance at) want me to go to the clinic, to pick-up the grievance form. They need a hardcopy form filled out, in order to start their inquiries. [Pardon my French, but the whole thing is pretty fucked-up, in regards to the “clinic” and their ponzi scheme.]
    Fast forward to today: I have kidney stones. In fact, I have a noted history of kidney stones. I do not want to go to the E.R. with my three pre-existing conditions, so I tried to get my Primary to send in some pain meds (percocet) until my appointment next week with my Urologist – unless something open’s up in the Radiology department’s schedule.

    My question is: since being on a high daily dose of Suboxone for SO long and now having an IMMEDIATE need for narcotic pain relief – while *not* wanting to risk Death by going into an Emergency Room: “What” do I do with these 10 mg Percocets in order to get relief from the pain? How do I “override” the Suboxone in my system–where there is an immediate need for narcotic pain killers? Should I take the whole days worth of pills in one dosing?

    I slipped and cut my knee open pretty badly, this past Christmas Eve. And after reading some of the comments, I remember my worries in the emergency room about the Doctor being able to quickly override the Suboxone. I remembered he used an IV injection of Fentanyl.

    Should I phone my Primary tomorrow and tell him I haven’t taken any of the Percocet, and that I need some sort of dose of Morphine or Fentanyl to override the Suboxone, and therefore then be able to get pain relief…And start taking the Percocet?

    All answers are greatly appreciated.
    And thank you for having this blog and conversation.

    -Worried in Worcester

    1. Rona, I’m sorry to hear about all the issues you are facing. I suggest you discuss with your doctor to use intranasal butorphanol for the kidney stones. It may be a safer option for you, will more readily compete for buprenorphine receptor binding, and is quicker acting.

  3. Hello! I am scheduled for a 4 hour long dental procedure in less then six day’s, and I am scratching my head, mind boggled.
    I am having 12 teeth surgically extracted, 6 pulled, bone grafting, and all on six dental implants in both top and bottom arches.
    A month before my surgery I contacted my doctor who prescribes me a daily dose of 8 mg suboxone, and spoke of how I will be getting 4 hours of dental surgery under general anesthesia, and that I am choosing to stop my sub the full 3 day’s recommended before surgery. He agreed that he would call in the proper medication and I should go to his office a week before the procedure.
    I believed He was aware that he would be the responsible doctor to write me opiates to help ween off the subs, and controls my pain level’s after surgery, since this was what we discussed and also since I chose not to tell my dentist that I was taking suboxone because of how embarrassed it would make me. He agreed with me with a yes and a few Ok’s!
    So yesterday, I called my doctor’s office for assistance, , and Because of this unfortunate pandemic, the doctor is not seeing patient’s, but is sending over prescription’s using e-fax to the pharmacies on file!
    It wasn’t until I picked up my prescription when I learned that he prescribed a non narcotic pain medication and nothing at all that I expected!
    I called the office and the secretary explained he doesn’t write pain med’s!! For a moment I was wondering if my doctor had any common sense, let alone a college degree! It defeated the whole purpose and wasted time!
    I am now six day’s until my surgery, and there is no game plan.
    Today was my last daily dosing, and I know I will go into withdrawal without the proper medication, for I have been on a small dose for almost ten year’s.
    Dr. Fudin, Should my prescribing doctor of suboxone have a professional obligation in writing me a opiate to keep my from withdrawal sympton’s, and if he still refuses to do so, who could I turn to to seek help?
    If I know who’s duty this is, it will help me tremendously!! I only have tomorrow to figure this all out!
    Thank you, and stay safe!!
    Pretty Girl

    1. Generally speaking, it would be the dentist’s obligation to order the prescription while collaborating every step of the way with your pain doctor. In my opinion, there is no reason to keep a secret from your doctors, pharmacists, or dentists. I realize you felt as though this was the best avenue, but they are all professionals and they all ned to collaborate for your best care and safety.

      1. Ok so i have been clean 3 years on suboxone 16mg a day.. well i had a 12lb tumor growing in my stomach so they pushed me and pushed me to get this dam thing removed i kept saying no you need a plan to safley get me off n then back on my suboxone i kept telling my sub doctor they dont have a plan im telling you.. well what happend they wouldnt give me pain meds to bring me off the suboxone so like a fool i did it myself bad idea.. then they assure me they have a plan to bring me off the pain meds after surgery to go back to my subs nope he gave me 20 oxycodone but before i left the hospital they stop pain meds for 8hrs and say i need to take my subutex smh i said i can not i will withdrawl smh he sends me home to do this now im stuck with nothing and cant get on my subutex and cant be sick so what do i do use like a fool i want back on my medicine so bad any ideas i tried to take the subutex 12hrs after use and it still through me in withdrawl

  4. Hello. I am having shoulder surgery in about a month. I take 4mg of buprenorphine/naloxone once a day…just wondering what the procedure they will have me do. Will they have me taper off before, and what about post op prescription of opioids, because I obviously will be in pain. Thank you

    1. Zach, I don’t know what pain regimen they will use. More likely than not, they will opt for a nerve block. Although some orthopedic surgeons will not give NSAIDs post-op, others will.

  5. The dose of Suboxone is slowly tapered off as the treatment progresses. It is stabilized to a constant dose of 12-16 mgs for a certain period before it is quit. Suboxone may be accidently or intentionally combined with other drugs. A number of drugs have been known to interact with Suboxone so it is important to consult your doctor before taking it in combination with any other drugs.

    1. Hi. I had total knee replacement at 53, I was not an addict I did not start suboxone until Oct-2019. I had been in an accident and hurt my prosthetic knee two drs said I needed immediate re-replacement, one Dr at Helena Ortho. Said I could try intensive PT. I did for as long as I could manage it. The Suboxone was prescribed for pain, at first it helped about 25-40%, then I started having side effects, constant nausea, sweating, my mouth hurt and I get sores under my tongue. I am having the replacement surfery done again 18 months after the first. I told my Dr that I cannot go into surgery on suboxone. She said I would be fine they could give me fentanyl patches. That doesnt seem reasonable to me, isnt that a terrible response? Please any advice

      1. I’m having emergency spine surgery and a rib removed. I’m also in on subutex for long term pain. He doesn’t seem concerned at all even though he knows I’m scared to death. He said I’ll be in hospital 7 days and have a pain team. But everything I’ve read says he is wrong I need to be off at the least 5 days fir other meds to work even a little. So I’ll have to suffer they the back pain. My surgery is the first.

      2. “…doesn’t seem reasonable to me, isn’t that a terrible response?”

        ???

        Are you concerned because of all you have heard and read about fentanyl overdoses/deaths in the news? The Fentanyl that your doctor will prescribe is legal pharmaceutical Fentanyl, not the illicit fentanyl sold by drug dealers. Because the news media usually just say “fentanyl” in stories about death and addiction and don’t add the word “illicit,” many people think “illicit fentanyl” and Fentanyl prescribed by a doctor are one and the same. (I have to wonder if this is done intentionally…)

        If you are taking Suboxone for pain, and not because of addiction, and if I was in your place, I would thank my lucky stars that during this time of anti-opioid hysteria, I have a surgeon who is willing to prescribe the Fentanyl patch to treat my post-surgical pain!

  6. Hello all and thank you for your time. Very long story short was on bupes decided I didn’t even want to be on them anymore and I’m now down to a quarter of a strip every two to three days the only reason I’m still doing that is because of that night sweats lack of sleep etcetera…
    I’m having to have quite a few teeth extracted and due to insurance or lack of and having to pay for it as why they are extracting many at once but the questions more for after that and the question is
    Last time I just kind of took the medication with the Suboxone but now when I get home how long should I wait from my last dose before taking the prescribed medicine which I assume will be hydrocodone or oxycodone and if it’s not a bother I have another question since buprenorphine is covers The mu1 receptors how long does it take naturally before a hydrocodone or oxycodone would be effective I know nobody has a precise time or anything but considering my lack of buprenorphine intake in the past 6 to 9 months just curious thank you all and have a blessed day

    1. Ronnie, It will vary based on dose. Best thing for extractions is an anti-inflammatory (NSAIDs) over opioids for any patient regardless of whether or not they are on buprenorphine. This of course is dependent on whether or not the patient has any medical problems which preclude use of NSAIDs. My favorite is etodoac because it causes less bleeding and bruising after the procedure.

    2. I know this from experience due to severe tooth abscess… Suboxone does not stop tramadol so have your doctor prescribe you tramadol and keep taking the Suboxone

  7. I just wanted to add something real quick. I had surgery on my hip for a really bad abscess that I had but I had to go under and I had to carry a vaccume bag with me when I left the hospital because it was still draining. They had me stop taking Suboxone (16mg) a day or two before and started giving me 10 mg. Morphine maybe 4 x’s a day. It def was not enough. Although my surgery wasn’t as big of a deal as most, it was still painful and when I got out of the operating room they were pumping me with dilaudid and a nurse starts waving her hand to the nurse helping me ( I was in a recovery room with other patients) to stop! Making a huge deal. I was in tears and In pain from being cut open. I wasn’t really planning to get into all of that – what I wanted to say was that what these Doctors aren’t taking into consideration is that because of the Suboxone- patients on Suboxone already have a tolerance to pain meds. If you’re taking 16mg. A day like I was – a 10 mg morphine is not going to touch it. It was awful and i honestly just wanted to go back on the subs because I knew I would prob Get better pain relief. Remind your doctor of this. They act like your brain is new to opiates when you stop taking Suboxone ( No, or else we wouldn’t withdraw). Idk I just wanted add that because I don’t think it’s taken into consideration at all really atleast not where I was. I had to have someone bring me something ( I didn’t want to do this but the meds they were giving me were not doing a thing).

    The point here: REMIND your doctor that your brain is not opiate naive going into surgery when stopping Suboxone ( prior to surgery) and that you actually have a higher tolerance for opiates. They Really need to consider this when dosing you for pain after.

  8. I have had surgery twice where I was instructed to stop taking buprenorphine 24 hours before surgery. Both times were absolute hell but the last one was the worst. I woke up feeling the worst pain I have ever experienced. They tried giving me fentanyl to no avail. They sent in a “ pain specialist” who was a joke. I take buprenorphine strictly for chronic pain but he kept insisting I was a heroin addict. He did not take my pain seriously. I had surgery at a hospital 7 hours from my home. He did call my pain specialist and got me an appt for 3 days later. He discharged me with 10 5 mg oxycodone for a very invasive pelvic surgery, my 6th one. I suffered horribly until I saw my own pain specialist. I am scheduled for another procedure in 2 months and I am insisting on going off the buprenorphine 2 weeks in advance. I cannot go through that again. I have PTSD over that.

    1. My surgeon said she will not prescribe me anything but Motrin post op. I have endometrial cancer and having a hysterectomy. I feel this is cruel. I have been sober for years. I have never asked for pain meds I don’t expect to get a prescription to take home. But post op Motrin isn’t going to help
      I already have ulcers from taking nsaids for a year straight. So upset and scared

  9. I just had my gallbladder removed on Thursday. I was told to stop taking my 12 my daily dose of suboxone 24 hours prior to surgery. And that I could resume normal suboxne after 24 hours off any prescibed opiates.
    I went off 24 hours in advance. I woke up in major panic and pain. I think my anxiety made things worse. They gave m3 10 my morphine over several different doses. M blood Dr pressure we as extremely high but the doctor said it was high when we he came in. And sent me to be released. They gave me another 10 my oxycodone and a prescription for 10 5mg oxycodone 1 every four hours.. The first few hours the pain was bad but after that it was anxiety thought the roof. Like iwas in detox or something. I don’t know if it was a reaction to the general anesthesia or if it was withdrawal from the suboxone.
    I am at 12 hours since ive had any oxycodone. I’m just curious what your opinion is. So many doctors are oblivious on howmto treat suboxone patients. It is a nightmare.

      1. Thank you for your response. I am doing better now, back on my Suboxone. It’s been a week since the surgery. The only thing now is I haven’t been able to return to my normal sleep/wake up routine. Hopefully over the next week I can get that back as well.
        I have to say I am really grateful I was in a really good place before all this started, I have a great support system also. It’s scary to think about how things might’ve played out if I hadn’t been. After this experience I would suggest to anyone to work towards sustained stability before if at all possible. Im glad that have been stable on Suboxone for over 3 years before I went through this.

          1. I am prescribed 16 mg of Suboxone for pain management. 7 surgeries in 5 years. I was sick of being on vicodin for 7. But I have severe chronic pain and I only take 4mg and downed to 2 mg a week ago. Been on them 10 months. All they do is make me tired. I have never abused opiates, and have to have knee surgery soon. Waiting until I am totally off before having surgery. This drug is more of a nightmare than the pills are. I would start weaning down to as low as you can go before surgery. Even if you get down to 4mg

          2. No. I’m also on subuyex for long term pain management. Well I fractured my spine and have to get wired , cement and a rib removed. The dr knows I’m on subutex and says I’ll be fine. He had to keep me in hospital 7 days bc it’s such a big surgery. He said I’ll have a pain management team and a drip but everything I’ve researched says it won’t work. He didn’t even try to get me off first. Well I have nine days left and I just read that it takes 5 days to get off the receptors enough for anything else to work. So I’m going to have to stop suddenly on my own and feel the pain of my broken back. My regular dr doesn’t want me on opioids at all other than in the hospital bc he doesn’t believe in them for long term . He uses subutex for long term. So my plan is to stop the last 5 days

      2. I have 3 college degrees, BioChem with some work in pharmacology. I found myself having ER gallbladder surgery and taking subutex. From my experience, the added nalox. is just that, it is added and unnecessary. I took very small does of sub with morphine q 4 hours, including a day post-op. Percocet post-op hit me hard but then also went through a ceiling effect. It does appear “changing up” the regular opiate is helpful for pain maintenance.

        My issue is returning back to a “new normal”. I didn’t feel I needed to return to my previous subutex dosage and wanted to be done. My doctor told me to simply quit taking it. I decided to to take at a maintenance dosage (2 mg from 8), but I still have a raging head ache messing with my sinuses after taking the bupe. Is this a precipitous with drawl or just regular withdrawal? I felt better before reintroducing the bupe. Maybe I should have just let it go. My sinuses, head, ears, etc is seriously depressed. It feels like an elephant has sat on my head.

      3. Dr.
        My names is David i have to soon have open heart surgery. I stopped my suboxone of 16mg 5 days ago and was given 10 30mg morphine two a day. I will be out tomorrow as i didnt even take them on the first day. 30mg just dont seem to be taking care of the withdrawal. I have to see the actual surgeon day after tomorrow but my suboxone doctor didnt act like he wanted to even give me these ten im afraid to go back and ask him for more let alone to up the dose after the way he acted last time he might just punch me in the face, joke. This is not something i did to myself i have70 percent blockage in ones side 80 in the other and have to have two stents. My doc didnt even taper my sub dose with an opiate he just had me stop it and gave me the ten morphine 30mg pills i have been honest with everyone involved im the entire process about the suboxone.
        If you were to have a hypothetical patient that had open heart surgery coming up. What would you prescribe your patient to keep withdraw away. I am in no way interested in abusing medicine he gave me the 10 pills last Thursday and i still have two left. Thank you for any hypotheticals you can give as i know you cannot give advice.
        Sincerely
        David

          1. I would rather have withdrawals than take clonidine, it does help with some wd symptoms, but it was the closest to dead I have ever felt. I really felt like it drained the life from me until I stopped taking it.

            Out of all the pharma I have taken and stopped taking, clonidine was the worst. I do not know how anyone can tolerate the feeling it gave me.

            I am not trying to discouarage anyone from using it, just telling you how it made me feel. That is one very small pill that I will avoid at all cost.

          2. JK, Generally it clonidine is well tolerated, however there are always a percentage of people who cannot tolerate certain medications and in whom they should not be used.

      4. This is not really a reply but I’m trying to find answers, anything!! I’m 43 I had a pretty basic surgery last April (bbl) the doctor told me multiple times the surgery would take longest an hour and a half , 5 hours later the surgery was over, they told my ride there were complications. Now during my preop I mentioned multiple times I did not need painkillers because I was on Suboxone , I’m prescribed 2 Suboxone strips daily, and usually only take one., either way i told the nurse, it was on my chart and I was never told to stop taking it before the surgery. When I woke up in recovery, I was in a lot of pain, I figured I’d just triple up on the norco they gave me, but it did nothing, the suboxone worked just fine. After I was able to get bandages off I noticed my chest was black and blue like bad, also I had a popped implant and it hurts to sit and stand up like something happened to my back during the surgery as well I don’t know if the bruising is from chest compressions or if it was from I don’t know. But they will not take responsibility for any of this and they’re saying that they did not do this to my breast but I’m guessing now after reading this article that most likely I was possibly moving around during the surgery is that a possibility because they obviously didn’t take notes that I was on Suboxone the anesthesiologist it was like he didn’t know because I had to go back for a second procedure and the second time he asked are u still taking suboxone? And the surgery was easy, still painful but a lot easier., not 5 hours long. I’m looking to find answers I need to know if this doctor was being negligent and did I almost die because he didn’t read my chart. Could my waking up and moving around during sugery be possible? Is this what left me disfigured. They won’t take any responsibility I’ve already paid well over 20,000 and they keep postponing my breast surgery till after statute runs out I feel. I just want to see if I should file some kind of claim. Anything might help

        1. Carly, This questions and the specifics surrounding it are too complex (and personal) to answer here. If you are considering a litigation, this is something that first needs to be discussed with and attorney. You attorney would then need to retain experts – most likely an expert in buprenorphine pharmacology and therapeutics such as myself or someone with the similar expertise, and a surgeon.

        2. Honestly it sounds to me like the plastic surgeon and his team had no experience in dealing with patients on Suboxone & you might have went into cardiac arrest while in surgery because of a reaction to the anesthesia & your suboxone. So they began chest compressions and/or defibrillation (which commonly will lead to bruising, broken ribs, and yes ruptured implants) YOU SHOULD 10000% HIRE A LAWYER & SUE THEM.

    1. You were taking 12mg of suboxone! If you ever stop taking that mediction at that dose for more then 24 hours your are going to start to w/d (withdrawal) every time you can count on it like the sun rising. I take 2 mg of suboxone 1 x a day and if I don’t take it at least every 24 hours I go into horrible withdrawal.

    2. I had the same experience…except I had to have emergency gallbladder removal and the was no time to wean down or stop. At that time I was taking 2 8mg strips per day. When I woke up in the recovery room I was screaming with pain. The nurses were in a panic because i was crazy in pain. My pain tolerance is low and my tolerance for pain medication is .. well you know.. very very high…it took me at least week to get it under control..ibuprofen helped but not nearly enough and it was killing my stomach..I have ulcers… I was eating the oxycodone like candy and did manage to get 1 more prescription for 20 pills which was gone in several days..i was right back to being strung out on pain pills..I went thru the horror of opioid detox and went right back on suboxone (which I wish now I’d never started back on). That was 6 yrs ago that I had the surgery I’m down to taking 1 4mg strip per day and have been for a year and I still wake up in the morning sweating profusely and hurting all over until I take my strip. I desperately want to get off this mess but all the info I’ve read about coming off suboxone is worse than coming off pain pills and or heroin. And that is a nightmare ride I don’t wish to do again…I’m worried about the longterm effects of suboxone use.. which no one seems to know anything about.

  10. Hi Dr. Fudin!
    You asked us to leave a comment if we had an experience of having emergency surgery on Suboxone, and what was used and how did it turn out. So I’d like to share my experience with you, just for your record and for knowledge purposes. I can tell you what happened for me and what it took to knock it off my receptors post op.
    I got clean in 2011- I was taking Roxicodone 30mg several times a day for pain relief and became very dependent on it! Then found out I was pregnant by surprise in November 2010. After about a decade on pain meds. I knew I had to get clean immediately so it took me a few months to get into treatment so I went to detox and was placed on Subutex 8mg daily after I was weaned in detox with it of course. I took the sub all through pregnancy and at 4 mos clean (6 mos preg) I was in a car wreck- two drunk teens hit me and I had to be cut out of the car; rushed to hospital, it put me into labor at 26 weeks and they couldn’t stop it! They said it was my pain causing it and insisted I take narcotics for relief so the contractions would stop. I didn’t want to and was so upset… and I’ll try to make this short for the sake of not making you read a novel lol… but I agreed to take pain meds (morphine) for my baby’s sake. They gave me 4mg IV regular morphine- it did morning for pain- felt like a dose of water. So the doctor said hmm let’s try fentanyl in interval doses and see if that will knock bup off your receptors and provide pain relief. I said okay. (Mind you he was a trauma doctor at a level 1 trauma center and knew nothing about bup but he was willing to learn and he went and googled what medication was best to knock bup off receptors to provide pain relief to bup patients) he came back with the answer of fentanyl is short interval doses. I’m not sure of the exact dose but o know that a nurse came in my room every 15 on the clock and administered me fentanyl in IV. It did not work at first but they kept doing it… the doctor said we would do it until something worked… he told me it wouldn’t hurt me cause it wasn’t a high dose but it was frequent safe doses or something of the sorts. I’m sure you know what he was talking about since you’re a doctor. Anyways, after what I believe was about 2-4 hours I finally felt it.. euphoric effects and all. My contractions stopped immediately and baby was out of distress as was I having pain relief… and man what a relief it was, as it felt like my entire body had been dropped off a cliff from the car wreck hours earlier. Might I add I was admitted at this time and the trauma doctors were continuing my care and seeing me upstairs at this time. They thought it was best for the trauma team to treat me on a floor since I was a trauma patient downstairs and in such dire medical need of care to stop early labor and what was a bad situation. When I felt pain relief, the doctor was ecstatic that his plan had worked. He then stopped the fentanyl and switched to morphine IV 4 mg every 2 hours and then 4 hours and this worked too in full force. Then sent me home 4 days later on hydrocodone 7.5 mg and it worked in full force too. I took the pills for 7 days straight and when they ran out I waited a whole 26 hours in what was withdrawal to me- and then I took my usual dose of subutex and it worked beautifully. The withdrawal was uncomfortable for that whole day or so and I took many hot showers to ease the discomfort, the baby did fine and was kicking normally and showed no signs of any issues or emergency with my pregnancy during those 26 hours, and I sure remember it was 26 hours to the Tee. I’ll never forget it lol. So the rest is history I stayed on my sub and did fine. Took me awhile to get my muscle tone back from the wreck where I didn’t feel like every muscle in my body hurt. Then I decided on my own I was going to ween down to 2mg subutex and even stop subutex for days there at the end of my pregnancy because I was terrified of going through that pain relief nightmare again when I had my scheduled repeat c section. Well it didn’t work out that way… a woman OB doctor saw me in the emergency room and admitted me one night when I came in for cramping and told me to just take my sub and not worry about it because it was best for baby and mother and that I needed to just let the surgeons deal with pain relief when the time come and the risk did not outweigh any benefit. I cried for hours and refused. Then I finally budged and went back on my 8mg dose and went home to continue the last weeks of my pregnancy. I had also tried stopping it not just because I was scared of pain relief post c section but I was terrified my baby would experience withdrawal and it killed my heart to imagine that, so that’s the real reason I tried stopping it , but learned I just had too much pain and couldn’t and it was worse on me and baby to stop it. I have CVID- Primary Lymphedema from a GATA2 deficiency and osteoarthritis and am only in my mid 20s at this time. So you could say I can barely walk without medication or help. That’s why I was on roxicodone to begin with. So sure; I may not be your typical addict but I had true opioid dependence and went through detox and pain just like any addict has to in order to get clean. And I even attended Na and AA meetings, celebrate recovery and now have over 8 years clean. I have been on suboxone that long to manage my chronic illness pain as my joints have crumbled over the years and I’m in my 30s now, and suboxone is the lesser of the two evils and much better than going on pain meds for life. My suboxone doctor team is aware of my condition and they monitor me monthly and sometimes weekly and are very understanding. They have me on 24 mg steady stable dose as that’s what my body needs to function normally without being crippled on the floor somewhere lol. But I still can’t walk a lot of the time and have pain but I just add some Motrin to the mix and it helps. So back to my c section… i was scheduled for surgery but my water broke 1 day before lol…. so I came in; they did a spinal … it was an anesthesiologist id never met before and he claimed he knew all about bup and I could tell he just did not. Shame on him for not listening. He claims he gave me increased doses of fentanyl in my spinal and anesthesia but… it wore off right in the middle of surgery and I felt everything. I felt every cut and it was a true nightmare. They couldn’t put me under until the baby was out so o had to feel all of that in full and then I was knocked out with general anesthesia and woke up in recovery/ my baby was great- she got a 9 on the apgar and got to come home 2 days later with absolutely no sign of withdrawal and she never had any and is 8 years old now and wonderful. Such a blessing huh! Well when I came from surgery back to my room, I was in pain but they put me on a morphine pain pump where I could press a button every 6 mins… well it worked full force, I had great pain relief. I was so confused why it was working like that and so fast since I was on bup and I had taken my last bup dose just like 6 hours earlier. So how was this working!!? I have no idea but it did. Maybe it was an angel watching over me. Or maybe there’s something medical to it…. I think it might be the pain pump method that did it and knocked the sub off the receptors immediately… I truly have no idea but would love to know if you have any idea?!? Well the whole thing of people saying tolerance gets high from bup… it for me… I got soooo sick about 2 hours on the pump and threw up, about to die from passing out and sweating and the morphine was just way too strong and working full effect and working too good. The nurse came in and smiled and told me that’s how morphine effects normal people who have never used drugs or pain meds and that was actually the normal reaction to someone on morphine pain pump and I told her cool but I didn’t care I just wanted the pump OFF and begged her to switch me to something less potent so she said it was time to switch to tablets of Percocet until I went home. So I did. She brought me the usual protocol for every post op c section patient of 10mg of Percocet (two 5mg tablets at once) I took them, they didn’t phase me. I became frustrated and just wanted to be able to get the catheter out and walk and do things so I could get to recovering and go home with my baby and get back to decent health again. I just wanted that outcome/ I had a long heated discussion with nurses and finally with the doctor who just wanted to argue with me and flaunt his knowledge of how he was a doctor and I wasn’t so he knew everything. But he finally was just like “okay, fine, I’ll give you something stronger then okay”. I had to convince him I would need a much higher dose of medicine because of me being on subutex. He wanted to argue that bup was not a blocker that naloxone was and I wasn’t suboxone so I should be fine he said since I was just on subutex which didn’t have suboxone. And I was like omg nooooo…. bup IS the blocker and naloxone only blocks if the medicine is shot up through Iv drug use okay! But he finally just budged and treated me like a human finally, and switched me to oxycodone 7.5 mg and the nurse brought me TWO percocet 7.5mg tablet. I took both of them at once which is what she said the doctor ordered every 4 hours. And guess what it worked like a million bucks and quick! I was up for asking around the maternity ward floor finally and catheter got to come out, I was up caring for my baby and getting some exercise and it felt great. I’ve always known when you have surgery you have to move immediately as soon as you can so that was my goal and this helped me to do it. I stayed on that until I went home. Then the doctor came in to check on me and he was smiling and told me he was very glad it had worked for me and he told me that he was sorry and that I had taught him a lot for the next time he has a patient on subutex and needs pain relief he will now know a bit more of what to do. He told me he was sorry and knew I wasn’t just drug seeking that I legit needed higher doses to have the same effect as smaller doses in normal patients. And he told me going up to 7.5mg from 5mg wasn’t even that bad and was reasonable and wonderful that’s all it took as an increase to work for me. He also told me had called a local suboxone doctor since he saw me last who works on the board with him or something and had a short talk and he even told him the same as I did so he had learned that I was right and he apologized and should have just called that doctor beforehand. And I said and also listen to your patient lol. Then the nurse came in to discharge me and gave me a prescription from the doctor for quantity #45 of Percocet 7.5mg with instruction to take them every 4 hours for pain along with Motrin 800mg. I did that and had pain relief! It was a great experience. I stopped the meds on day 6 and had 3 pills left and was super proud of myself because I went to Walgreens pharmacy and properly disposed of those last 3 pills in their mediation discard machine. And I’m still so proud of myself for that and proud that on day 6 when I woke up and was no longer in unbearable pain having to hold my guts in to walk lol then I was able to mentally say well I don’t need these pills anymore. Gosh that’s such a huge step for people like me, such a huge step! This time I had learned a bit more lol and only waited 12 hours before taking my regular dose of suboxone (going back to my suboxone) and it worked beautifully and the rest is history I was fine. I felt great. So yes I recommend just taking your m de the best you can before surgery and stopping them while receiving pain meds in hospital and at home and then when you stop pain meds I recommend re-inducing back on your maintenance dose of suboxone and continuing your maintenance program. But make sure to wait 12-24 hours as to not trigger acute sudden withdrawal cause you must wait before taking suboxone after you’ve taken opiates! Or at least I did because I try to do things right now and do the right thing by the book. And I have too many health problems to risk any more lol. So I have been on suboxone for 8 years and have been on 24mg of it for most of those years… as they went up on my dose after a year or so due to pain management as well. And my birth control never failed me as I wanted to be off suboxone before conceiving again; but that didn’t happen and I received my blessing of a new baby that is due soon and I’m on 24mg of suboxone as this time it was recommended to stay on suboxone cause new studies show the naloxone is safe for pregnancy so I’ve never weaned or tried during this pregnancy because of the dangers. And I will be having my 3rd c section very very soon and will be going in there on 24mg of suboxone, and will be having general anesthesia this time straight off the bat with no epidural first or anything. And then post operative Iv meds then switch to pain pills and come home on pain pills as that’s my hospitals same protocol for c sections and I’m delivering at the same place as last time. So I will gladly come back here after my surgery and things settle down and I’m home and back online- and will let you know how THAT went with pain management okay! Since it’s a different dose, I’ve now been on it for 8 long years on a steady constant stable dose of it, I won’t be stopping it before surgery since I’m pregnant and it can harm the baby if I did, and I will need that pain relief and the question is how are we (myself and doctors who most I have never met and don’t know yet) going to treat my pain ?!? Well we shall see! Hopefully the same way. I heard the suboxone or the dose won’t make a difference as far as pain relief or withdrawal in the baby (which omg is my main concern) so I believe that and know it’s true and am praying for the best outcome for my child’s well being and also preparing myself for whatever happens and telling myself it’ll be fine either way and to just be strong if something does happen with my baby and NAS. It’s tonight being as sick as I am and also Being in medicarion for it like suboxone, and wanting to bring a baby into this world—- but women do it everyday; we have rare diseases and situations and we stay sooo strong through it and produce life through delivering beautiful babies everyday/ so I tell myself that’s me and I’m amazing for doing this! And I can’t wait to meet my new surprise miracle baby! Such a surprise. I also saw how you said you could collaborate with doctors so if you’d like to give me your info, then I’d more than love to have my team of doctor(s) call you and collaborate with you about treating my pain post op! If you’d like to or be willing to? As I see you say to others you’d gladly do that, I’d love that if you would? If not, then thank you so much for your article and time and for reading and replying in any way you choose to! Many blessings to you and to all those reading this and going through anything tough- hang in there and know they can always treat your pain in an emergency and provide you pain relief no matter how much suboxone you just took lol. So keep the faith and hope and don’t worry or get down about it. Just don’t worry much about it. I’ve experienced it firsthand and know this to be true THEY CAN TREAT YOUR PAIN. Okay?!! They can…so stay positive always!

    1. I have been sober from opiates “pills” for almost 6yrs, give or take a couple days. I’ve been on Suboxone since I placed myself in inpatient treatment and continued in outpatient therapy. My dose is 8mg 2x a day. I just had to undergo surgery this past Friday to have my gallbladder removed and was also instructed to not take my does 12 to 24hrs prior to surgery and start back up 2 to 3 days after. I woke up freaking out and in so much pain and discomfort it was ridiculous to say the least!!! I was prescribed 20 7.5 vicodin for home and not to sound ugly or disrespectful but that was a fu###ng joke!!! I was fine at the hospital bc of medicine I was getting intravenously and when I was released I was fine. Once I got home from the hospital all holey hell broke loose!!! EVERYTHING I was given at the hospital was starting to ware off and I was in excruciating pain like I’ve never felt before!!!!! I was taken vicodin 1 every 4hrs and it weren’t putting a dent on ANY of the pain I was feeling at all!!! I couldn’t move around without help!! I couldn’t get in and out of bed and when I was able to lay in bed it’s like laying to flat felt as if it was pulling in my belly!! I tried just bending my knees to get relief but it still hurt like hell and I could feel my heartbeat everywhere!! Laying in one spot all night was very uncomfortable too!! I’ve never been through this much pain and discomfort ever in my 35yrs of life that I can’t get to ease up where I can at least sleep a little!!! This has been the worst experience I’ve gone through and I really wish I could’ve started different medications a couple weeks ahead of surgery so I’m not wasting time taking medications that aren’t doing anything. This is pure torture and ppl who have never dealt with addiction themselves just don’t understand or get it. I’m not in any way possible trying to get more opiates, higher doses, or anything like that but some Drs. really need to put themselves in our shoes so hopefully they’ll understand how we feel and can figure out a different method for surgery. I’m in the worst pain ever and can’t get any sort of relief, no matter what I try!!! This is day 3 after surgery and I’m not feeling this not one bit!!! Everything hurts so much I’m miserable and tired from no having sleep in my life!!! Heating pads and cold packs are no help either. I started my usual dose of Suboxone tonight just to see if it would help at all and its not. I can handle pain but this laparoscopic gallbladder removal surgery pain is for the birds dude!!! Idk what to do so any kind of advice or comments are welcome plz help!!!

  11. Thank you for making clear that bupe has greater Affinity at binding sites than naloxone. This is not recognized anywhere, not by 99% of physicians prescribing these drugs. I found this out through personal trial an error. It is absolutely possible to inject Suboxone without precipitated withdrawal. Assuming that taking it sublingually would not also precipitate withdrawal. As you also seem to infer, fentanyl is more powerful at binding sites than bupe, So someone on sub maintenance can easily use fentanyl to get high. Also found through personal experience. But thank you for putting out there information that is lacking in the medical community in general, Critical information in the midst of this crisis

  12. I had to get 4 teeth pulled while I was on 16 my of suboxone. I stopped taking it the day of my surgery. They had to shoot me up 6 times to put me under for the pain killer to break through my subxone blocker. And it was successful. I was high as a kite. So yes even though your on subxone they can still break through that blocker with a large amount of pain meds.

    1. I will be having dental surgery in a few hours, my doc told stop taking Suboxone 24 hrs prior,. Giving me oxycodone 10mg. Will this stop pain. The internet has no real answers.

      1. Depending on survey, more often than not, NSAIDs work better than opioids for dental surgery beginning the day prior. I generally use generic etodolac in my patients because you’ll avoid bleeding and bruising. NSAIDs should be discussed with your doctor and you must be assessed for any contraindications due to current medical conditions and potential drug interactions.

  13. I recently had some oral surgery work done and in an unusual amount of pain. Been taking Suboxone for about two years, if that and the dose has been 12mg for the last year of that. The oral surgeon prescribed hydrocodone but he is not familiar with my medical history and I cannot reach my Suboxone dr. I have tapered down to half my regular dose for the past two weeks and took an 8mg dose about 36 hours ago. I am at work and in pain, is it safe to take the hydrocodone at this point or will I experience some kind of sickness or withdrawal from it? I’m not asking permission or medical advice so much as asking if I were to take the medicine for relief, would it result in me getting sick or would it actually help with pain and or dependence?

    1. I just had foot surgery 4/17/19 and currently take 2mg. 1/3 of the strip daily . I was sent home with hydrocone 7.5 and it never has made me sick also on any other procedure I have had, I am on A very small dose of subs that could be why I don’t get sick.

    2. I am not a healthcare professional, so this is my personal non-professional advice only. I’m not sure if you ever got an answer for this or not. But you wouldn’t go into withdrawal taking an opiate when on suboxone. You will however put yourself into withdrawal if you stop your suboxone, treat with the opiates for enough time that sub is out of your system, and then re-start sub’s while the opiate is still on your receptor’s. You must wait at least 13 hour’s after your last opiate to start your suboxone medication or when your in mild withdrawal

  14. I’m in the middle of an anguished situation. Been on bupenorphrine/Subutex for several years. I was scheduled for hip replacement this past Tuesday morning. My Bupemorphrine dr recommended (apparently correctly) to continue use of Bupenorphrine through the procedure. However my Surgeon recommended I ween off before and substitute with Tramadol/Tylenol (which by the way doesn’t work). The preop hospitalist and Anesthesiologist also said the same thing. Yes I told all that my other dr recommended against this, but they replied with ‘he doesn’t deal with surgery patients’. Having said it doesn’t work, I was not able to do this– though I halved my usual 2mg/day dose to 1mg (I can’t break my tablet past quarters which is something that really needs to be rectified [a lower dose]) for at least 4 days.

    However I’ve been wanting to get off bupenorphrine for a while now anyway, and thought I would just stop post op so needless to say the post op pain remediation was a nightmare and I was prescribed what I was told double the amount of a usual patient (height of 20mg long lasting oxycontin every 12hours and 10mg short acting oxycodone every 4 hours) and a few doses of dilautin. For some reason it was missed that I was taking bupenorphrine before this procedure (at all!) and they found out right before releasing me from the hospital claiming I never told theml (not sure why, I had reported it to everyone as one of my meds and it’s got to be on paper somewhere). Anyway once finding this out sent me home with directions for tramadol/5mg oxycodone every 8 hours/and said to resume my Bupenorphrine. I was already off of Bupenorphrine for 3 days and not sure the effects – plus after all the suffering didn’t want to go back on it. NOW I’m undermedicated at home – the Tramadol still has no effect, and I’m experiencing withdrawal symptoms from the Oxys. I don’t have enough to keep going at 5mg every 4 hours (not sure that would be enough anyway), I only have enough for one every 4.3 hours which might take me to Monday- which is what I’m trying to do—- but still experiencing withdrawal –it’s not enough. .. ..

    I don’t know what to do, and it’s now been a little over 5 days without any Bupenorphrine and am considering going back to Bupenorphrine, BUT I don’t want any precipitated withdrawal to occur either. I’m not sure how to handle this and my surgeon is advising to take the Bupenorphrine — I’m also concerned about my general health post op if I have to wait 18-24hours after my last dose of oxy (which I can’t see happening at this point)… .

    When can I take the Bupenorphrine? Should I take the Bupenorphrine or try and get more oxycodone– if so how much should I be taking of that? I’m lost, hopeless and anguished, and extremely uncomfortable. . .

    thanks for any advice asap. . .
    Me

      1. Thanks for posting my comment Jeff – what I wound up doing is suffering through 14 hours of a very ugly withdrawal, and embarrassed myself in front of my wife who was concerned and scared. Thankfully my Bup Dr responded to my texts all hours of the night to basically validate my plan (and the time needed to not risk precipitated withdrawal). Would you believe my surgeon called me after I reached out to the hospital’s case manager basically asking for the same answer I was looking for on this blog—- and shamed me about this whole situation, denying he ever said to ween off buprenorphine and that I withheld this information from them?? It wasn’t only him but the team at the hospital said to get off of it… Anyway I’m hurt to be accused of doing something like that (why would I mess around with my own well being at the time of surgery) — But if anyone looks at any of the documents I filled out (or assistants had filled out while asking me) the Burprenorphrine will be listed everywhere as I had nothing to hide….

        Anyway I feel the need to paint the picture of this suffering over the course of 14hours for those reading this who don’t know what this can look like. I suggest doctors to take themselves down a few notches in your attitudes towards patients– yes you’re a doctor, but you don’t know everything, and should listen to patient’s as if they might know something —- because they actually just might!..

        I could not stay still for more than a few seconds, and those few seconds seemed like an eternity. With the fidgeting, and restless leg-like syndrome except for everywhere on the body, my face even would crinkle up with an intense grimace— trying to find some kind of peace or relief of the enormous discomfort under my skin all the way to points of moaning and groaning before releasing the flexed muscles by this point, in hopes of something, ANYthing to subside… But no, nothing would. . NOTHING ever would… I would have to get into the shower a total of 8 times to try and overwhelm my senses with hot water running on my face and body until that became a hell, and then would have to attempt to surprise my body with extreme cold, then hot again, and cold again.. . . still never to find any kind of peace. However, if say 20 minutes pass – I might have felt just a little less discomfort – for which I was so grateful for, that I had to cry… and cry I did. Enough in the shower let’s try and lay down again… nope (all the same), let’s try TV- nope, doesn’t work. . . Let’s try music – nope no chance…. back into the fidgeting cycle, back into the shower, back to apologizing to my wife who when looking at me was terrified.. . . If there’s ever a time for suicidal thought folks– this is one of them…. Although I know this will end at some point, I never had the faith I would actually make it going through this shit at hour number 3 of 14!!!!… Pet the cat, no. Stand up and stretch, no. Go outside and walk around, no doesn’t help. Eat something -are you kidding me, can’t eat. I was considering going to the ER, this whole time too. . . F…, it I have to txt my Bup doctor again – -perhaps it might force some time in between him potentially answering. But is he going to on a weekend night at 3am? I was googling ‘how to deal with withdrawal symptoms while waiting in the window of taking buprenorphine– even dialed a random number that popped up of a rehab center just to see if someone can talk to me / kill time. I hung up, but next round of being in the shower I was called back – thank you Michael!.. your voice somewhat calmed me for a bit… in spite of knowing you have an agenda, just being real with me was enough to help. . .. It was about finding these little outlets of killing time, to get by the upset stomach, cringing, moaning, restlessness, anxiety, and by this time diarrhea. . . Umm did I mention I can’t walk yet from major surgery? You know what, writing this is taking me back to this trauma I have to stop. . . . The point is folks, you have to do homework and make sure your different doctors talk—- I know, they don’t want to…, that they know you know and know best— but somehow you need to get them to talk. To finish my story, with the help of my blessed wife, I got through – –took the bupenorphrine 13.7 hours later and upon my last shower, just began to cry on the very very first positive feeling when I knew this was going to be ok…….

        Up for I don’t know how many nights since the surgery, finally I’m feeling better and can focus on healing properly… This info needs to be spread around. I know in spite of being to blame — that everyone involved in treating me will be having some discussion and update of how they will have to handle any future patient who says the word Buprenorphine, Subutex, Suboxone…..

        thank you all for listening and Jeffrey for posting this article- – – you nailed it on the head with what I experienced.. ..

        Now– what is the strategy for getting off Bupenorphrine after I’m healed? It is possible without this kind of suffering?. . . . What else can I supplement to help? How long — what does this look like?

          1. Thank you – – why is it that the doctors still prescribe oxycodone on top of buprenorphrine if the effects are thwarting? I’m in extra pain today, and am being told to take an oxycodone – – -is there any relieving effect I might feel when taken on top of the bupren?

          2. Depending on your buprenorphine dose, there are some unoccupied sites where opioids combine with receptors in the CNS. So, full agonist opioids such as oxycodone could have some benefit.

          1. You’re obviously not a doctor since you can’t even spell whining correctly. Also, don’t post on here with your ignorance. This is for people who genuinely need help a d guidance.

          2. I am having neck surgery on June 12 th I am scared to death I am in one and a half dubs a day have been for the last 8 months I’m sure I am going to have to take pain medicine I really don’t want to can anyone give me any ideas for a plan I’m discussing this with my sub doctor tues just don’t want to be in withdrawal and pain at the same time

          3. Stephe is on point with that!! You’re most definitely not a Dr so please stop commenting, especially when you have nothing of any importance to say. People read this when they need advice, help, have questions or answers for a reason. This random crap is unnecessary so its obvious if you’re not dealing with any situation like the ones being shared please don’t comment.

            Thanks

          4. Your article is spot on. It is indeed the bupe that binds hardest to the receptors and the naloxone is unnecessary. A lot of Drs who prescribe suboxone and subutex only have to take an 8 hour course to be able to prescribe it. I’ve had quite a few disappointing Drs but the Dr I’m with now is a pain and addiction specialist. People with opioid dependency who are on MAT in a lot of cases are more knowledgeable about the workings of bupe and need to be heard. As for the guy commenting about wanting to come off unfortunately a lot of Drs don’t have a decent protocol for it. But there are some very well written taper plans online. The best way IMO would be a slow and steady taper over a rapid taper if you’ve been on MAT for a long period of time. Even jumping off at 2mg can be excruciating. Although it can be hard to get to a lower dose then that as it’s difficult the break a quarter of a pill or strip to get to 1mg. By the end of the taper I would try getting down to the lowest possible dose you can and start skipping days like take 1mg every other day combined with comfort meds like clonodine and gabapentin to help with restless legs and discomfort. Then after the final jump you won’t start to feel the real serious withdrawal symptoms till the third day of your last dose. I believe from there a low dose pain med taper after your last dose of sub could help have some success with getting off it completely but you would have to find a dr who’s compassionate enough and trusting enough to do that for you. Either way a very long slow taper is your best bet coming off suboxone with added colonidine and gabapentin and a low dose of klonopin to help with the sheer terror and panic you feel from intense anxiety during withdrawal. Then getting on an SSRI anti depressant to help with the months of emotional flatlining and depression/anxiety could be very helpful with coming off suboxone as well. It’s scary and takes a long time to heal but it’s not forever. I’m still on subutex and have been for a few years. I’ve also had two years off opiates with no help in the past and had PAWS for the entire first year sweating every night, horrible lower back pain wondering if I’d ever feel pleasure again…. but it did get better until ya know I relapsed and ended up having to get on suboxone after trying to quit cold turkey again and was in pain and withdraw for an entire month it was very scary I didn’t know what else to do but get on suboxone. Suboxone is a lifesaver and I feel mentally in a better place then the previous times I’ve had in recovery. I feel more mentally prepared then ever for coming off of it myself and would like it to slowly taper soon. But with work and responsibilities:finances it almost feels like it could be an impossible feat for those of us that live paycheck to paycheck and can’t take a month or more to just heal when we finally take the final jump off.

        1. Hey guys my name is Rachel I am a 42 year old female. I have been on Suboxone a total of 8 years 8 mg two-a-days. I’m looking at having surgery on Monday. Which is 5 days away. I’ve been honest with all doctors involved. My orthopedic surgeon, the anesthesiologist and my Suboxone doctor. My Suboxone doctor suggest did I go up to three tablets today to deal with the pain. My orthopedic doctor says to taper off my Suboxone in time for surgery. I guess where I’m asking what is a safe taper for this late in the game.

        2. I absolutely feel what you are saying. I think the opiates in the anesthesia and what they gave me put me into worse detox from suboxone. It’s scary that’s for sure. I am on 15 hours right now. I did take some Kratom to helpmdeal with the symptoms and it did. I’ve taken them together before so hopefully it won’t interact. I tried to get my doctors talking and on the same page but they just weren’t having it. I’m going to look into finding a primary care doctor with a background in addition or something. I’m terrified of having any real health issues because they are always so focused on my being an addict and on suboxone and act as if they can’t treat me. It’s very frustrating and scary.

        3. Gary,
          I must say I really enjoyed your post. Everything you said is the truth and then some!! I’ve been on suboxone for 6yrs or so and just went through gallbladder removal surgery Friday and they prescribed 7.5 vicodin. Needless to say they definitely don’t work!! The amount of pain and discomfort I’m dealing with is unreal dude!! Before my surgery the Dr came in to speak with me and said ” you won’t be prescribed any narcotics for pain bc of your situation “. Like wtf is that supposed to mean?!?! The way some Drs look at you, treat you, and judge you when they see Suboxone, Subutex or methadone in your chart is mindblowing!!! They all assume and jump straight into thinking we shoot heroin or something!!! That’s very disrespectful and makes you feel very degraded, like you’re nothing to them. Drs are supposed to be health care providers not judge, jury or executioners!! If they didn’t have your meds in your chart it’s their fault for not devoting their attention on the patient to hear you and put it in your chart. Going through addiction and withdrawal symptoms is fluffing terrible in all kinda ways that’s for dam sure!!! I honestly wish Drs could get it together and understand the use of suboxone ext and what to prescribe before, during, and after surgery. I’m having a very difficult time dealing with the amount of pain I’m in only to get no relief. Your post was very informative also so thanks for posting!!

          Guess I’m gonna have to ride it out and suffer…..

          1. “ like I shot heroine or something”
            So people that did do heroin (like myself), whom go on Suboxone, then get major surgery should just drop dead in pain, but not pill heads eh?
            You’re just as biased as the doctors
            But allow me to help. I started out on pharmaceuticals and then switched to heroin as it was more readily available
            You ready for this shocker
            It’s the same fucking thing! Those pills that you think seperate you from me are heroin, they’re just made in a lab
            Sorry to kick you off your pedestal but they look at you like a heroin junkie, because you ARE one

            There
            Fixed it for ya

  15. Dr Jeffrey Fudin, Thank you for your much needed article regarding surgery and buprenorphine ( “bupes-and-subs-and-surgery-oh-my”, March 29, 2013 ). I’m an Intractable Pain patient due to FBS (failed back syndrome). My FBS has reluctantly resulted in me having 20 years of ‘hands-on’ experience dealing with prescribed Buprenex. I’ve been through the various multiple protocols utilized by a recognized Pain Clinic which ultimately resulted in titrating me up on strong pure opiates (220mg/day M S Contin) to cover my pain beginning in 1994. After 7 years of the E.R. pure opiates I came up with a procedure to switch me over to Buprenex for a ‘trial’ for pain coverage (primarily due to OIC, NBS, & tolerance issues associated with E.R. opiates MS Contin & E.R. OxyContin).

    The ‘Switch’ to Buprenex from the E.R. opiates entailed stopping and then substituting the E.R. opiates with 220mg/day Oxycodone for 3 days. Next, after 3 days of I.R. Oxycodone, completely stop the I.R. Oxycodone for only about 10-11 hours, then injecting 0.3mg of Buprenex once ‘definitive’ withdrawal symptoms occurred. The injected I.M. Buprenex pulled me out of withdrawal in 15 minutes, thus it was only a short time period of opiate withdrawal. I was titrated up to 8 to 10 ampules/day for pain coverage, and have continued with the Buprenex over the past 19 years (switch was conducted Feburary, 2000).

    I have a number of questions and also comments, but will save them for a later time. Two questions for now please:

    1). What is the conversion for parental I.M. Buprenex to Sublingual Subutex (thus, 0.3mg of I.M. Buprenex is equivalent to how many mg’s of Sublingual Subutex?).

    2). Are you familiar with Dr Jeffrey Junigs ‘Procedures for Surgery for Suboxone Patients’? In general Dr Junig advocates reducing or stopping buprenorphine intake before surgery. If a patient cannot stop the buprenorphine at least reduce the Suboxone intake to 2-4mg/day and utilize up to 30mg/4 hours of Oxycodone for post-op pain control. My experiences indicate that post-op pain control could not be achieved when utilizing up to 40mg Oxycodone/4 hours.

    Again, Thank You for your much needed article explaining a number of concepts that medical professionals need to be cognizant of regarding buprenorphine patients and surgical post-op pain control. FYI, I am in agreement with the critically important issues you raise in your 2013 article for buprenorphine patients and post-op pain control. Your level of buprenorphine expertise is evident from the landmark article you present. Regards, and i hope you find time to respond to my questions.

    1. Dan,

      Here are the answers to your questions.

      1). What is the conversion for parental I.M. Buprenex to Sublingual Subutex (thus, 0.3mg of I.M. Buprenex is equivalent to how many mg’s of Sublingual Subutex?).
      There isn’t an exact equivalent. Subutex is about 30% absorbed. Buprenex is 100% absorbed.

      2). Are you familiar with Dr Jeffrey Junigs ‘Procedures for Surgery for Suboxone Patients’? In general Dr Junig advocates reducing or stopping buprenorphine intake before surgery. If a patient cannot stop the buprenorphine at least reduce the Suboxone intake to 2-4mg/day and utilize up to 30mg/4 hours of Oxycodone for post-op pain control. My experiences indicate that post-op pain control could not be achieved when utilizing up to 40mg Oxycodone/4 hours.
      I am not specifically familiar with Dr. Junig’s protocol.

  16. After a spinal injury 5 years ago I was put on Vicodin with was then increased to 15 mg oxycodone. Same story, millionth verse, I became addicted. A couple years ago I also became an alcoholic. I had two falls, the second I fell hard and experienced a traumatic facial injury (bilateral mandible fracture, busted my moth, chipped my teeth, messed up my whole face). So I quit drinking and began using 2 to 6 mg. Of suboxone per day. My pain the past few days has been so intense, to the point that I’ve basically been in bed for three days, so I stopped taking the suboxone which I was on for about one month total and by started to take my oxycodone tablets again instead. I’m not feeling any withdrawal symptoms but I feel extremely depressed, no appetite and no pain relief from the oxycodone. I’ve read through this thread and see a lot of needing to up the dose of a short acting opiate like oxycodone so I’m considering doubling a dose but I’m nervous about doing that. Today is day 3 with no subs. Any advice or guidance would be appreciated.

    1. Sem, You need to get help because you’re going down a slippery slope right back to opioid misuse. Ask your Suboxone prescriber to work with a pain specialist to adjust the Suboxone dose. Stopping Suboxone ad starting oxycodone is the worse thig you could do.

  17. Hi. I’m 32 weeks pregnant and having a scheduled csection in about 6wks. I take Buprenorphine, 4mg a day. My OB has experience with operating on Bupe patients and after expressing my concerns regarding pain management, she really made it seem like no big deal. I know that I’ll be receiving fetanyl in my spinal, and she said I would be prescribed opiates/pain meds after the operation. I am debating lowering my dose some nearing surgery and not dosing for 48 hours prior to my csection, just so I can be a somewhat closer to being pain free. I know being pregnant throws an entire different twist on things because it’s not just me that the meds will affect but the baby. I know they also use opiates to treat NAS in babies. I just fear with my regular doses of buprenorpehnine in my system, pain meds will be ineffective and could potentially put my body through unnecessary stress trying to find which medication will bind and give me pain relief. I would not make any choice, without the supervision of my doctors. My OBGYN said ultimately choosing not to dose would be up to me, she did say she would not want me to go into withdrawal, however. Any insight or advice would be so greatly appreciated. Thank you for this site. It’s great.

    1. Lauren, it sounds like your doctor is experienced with this. Just be honest with the doctor irrespective of what you do, so that the correct decisions can be made by him/her based on what you are really taking.

      1. I take 2-4 MG daily and have sinus surgery next Thursday (8 days from now). Will I have issues feeling the other opiates given to me? Should I stop taking the suboxone in total??

    2. Don’t be on bupe at all before a csec! I had the worst experience just in February. The anesthesiologist, 4 weeks before surgery, told me that THREE days before surgery I would switch to oxycodone. I was on 3.5 mg subutex at this time and needed 80-90 mg oxy to start out of any sign of withdrawal (for baby’s sake) during that 3 day window but of course had zero pain relieve. (Subutex didn’t work at all for the duration of pregnancy for my intercostal neuralgia that flares big time during pregnancy due to a surgery I had when I was 12 for scoliosis.)
      Anyway — fast forward to the csection. NOTHING helped with pain. Fentanyl (3 doses in 45 min) didn’t touch it. Then they moved to morphine — 1 mg every ten minutes and I was losing my mind, at an 8/9 on pain scale and they refused to listen to me. Finally on day 2, after losing my shit with an ob on call, he got me a bolus of 4 mg morphine every hour and then 1 mg every 10 min. But it still hardly touched my pain. It wasn’t until 3 days post op (so 6-7 days after I stopped buorenorphine) that I was able to control enough pain to get out of bed. I was so miserable. I learned that my tolerance was doubled what it had been before starting bupe a year before! So now I need 40-50 mg oxy to achieve pain relief and am on high doses right now and trying to back down but doing so means no pain relief again— and wotha. New baby, I need to not have pain! I am so angry at my pain doc for putting me on bupe in the first place. The only silver lining is that the baby had zero withdrawal effects ( but a friend of mine had been on egregiously high amounts of morphine as she has breast cancer… For her entire pregnancy and her baby girl didn’t have any withdrawl either…) I wish I would’ve read this article a year ago… Because my pain doctor never educated me on the fact that I would never get pain control should I ever be in an accident. I am voice typing this as I am feeding my baby right now so if something does not translate correctly I apologize but please feel free to follow up with any questions.

    3. Hey just wanted to give you some advice based on my experiences having 3 c sections while being on suboxone. The first 2 I had trouble with pain control after the surgery iv meds wore off, and after only stopping suboxone the day before surgery. The 3rd time, I asked to be switched over to Norco for a few days prior to surgery, based on an article I read where it said to do that and it worked – no major problems at all with pain management afterwards. All I did was stop taking suboxone in the afternoon and the next day waited until 10am before taking Norco, 2 days later had surgery and I had no issues with pain meds working well. After I was done with taking pain meds a week later I just stopped in the evening and took the suboxone again the next day around 10/11am and that went fine.

  18. I’ve been on 3/4 8mg suboxone film daily. I am having surgery next Tuesday. My suboxone dr told me to continue taking my suboxone like normal daily and day of surgery. Even if they prescribe hydrocodone, he told me to continue to take both suboxone and hydro, and stop the Hyro as the pain clears up. What’s your thoughts on this? I will be put under with anesthesia. Any issues there?

    1. How did your surgery go?
      My surgeon refuses to operate on my stomach unless I am off Subs for one week minimum.
      I would love to figure out this difference of opinion.

  19. I’m trying to prepare for another round of dental surgery (extractions and implants) in few months or weeks. I’m a healthy, 60 yo man with >10 years on Suboxone. I’m in good shape, exercise regularly, non-smoker no infectious disease. Implants are painful they use a light General (IV Ketamine) for each implant placement. It hurts like all fuck for a 2-4 few days after. After 6.5 hours of oral surgery, my front mouth was stitched up like a football. I needed help getting home.

    Being a Suboxone patient in NYC however, I’m completely ‘on my own for pain management’. No one will do anything beyond advising OTC Tylenol and perhaps Torradol if I’m lucky. I’ve got good doctors and I have faith in them but they steadfastly refuse to do anything for my temporary pain. I’ve been drug free for many years and it has been documented beyond doubt (full chain of custody RIA hair and years of urine toxicology). It really sucked that no physician would take responsibility for a few days of my recovery from oral surgery.

    For my first implant surgery 8 years ago, I tapered my Suboxone dosage down as much as I could while trying to remain functional but should have begun a day earlier (4 not 3). I had ‘acquired’ 8mg dilaudid and 60mg morphine pills. I was told to continue my Suboxone as usual and simply tolerate the pain. I was still feeling the effects of the General all the way home and slept well.

    When I woke up in my own bed the next day, the pain was intense. I began taking my own meds. The naloxone from Subs was still active. I was anxious about how much opiate to take and feared lethality upon naloxone wear-off. I’m not a doctor but I can read. The 2nd day the naloxone wore off and the opiates I had liberally taking put me in a delusional dream-land rather suddenly. If I was not so frightening, it may have been pleasurable. I woke up 36 hours later, my bed sheets wet from my sweat.
    It took me awhile to realize it was 2 days later. I was dehydrated but glad to be alive again.

    The prospect of doing that again is frightening. I’m a decade old now. That no physician or dental surgeon will take responsibility for 1-2 days of pain management is an outrage. I’ve already been cleared for General by my GP/MD. It’s only a matter of weeks before I get a surgery date.

    Now what??

    1. Satch, The naloxone has no effect one way or the other regarding buprenorphine. If there are no contraindications to NSAIDs, I suggest you speak to your doctor about etodolac – it has low risk of bleeding and is a great anti-inflammatory which should work as well or better than opioids if you start them 24 hours prior to surgery. Also, I would inquire about having the procedure in a hospital with a 1-2 days stay where hopefully they will give you opioids if needed.

      1. There have been studies that have shown that Naloxone can have an effect in the Suboxone formulation
        When snorted, it was reported I believe 30% less favorable than a buprenorphine only formula.
        Also there have been studies on low dose naloxone to suppress opiod tolerance.
        So while the company falsely used Naloxone to make a profitable product on an old drug (Bupe. into Suboxone), that doesn’t mean there isn’t more to Naloxone in the formulation than we currently know.
        I would strongly believe that in the next 5-10 years we learn of side effects and interactions we have no “clue” about now.

    2. I was on 1 mg of suboxone and I had 8 implants put in just 3 months ago.The dr sent me home with 10 percocet.Driving home I was really in pain.Anyway I used the percs and felt ok.Presently on .5 of suboxone and weaning down.what a bitch being on this shit!!Thanks Eddie T.

  20. I’m having surgery Tuesday March 19. I’ve been on Suboxone Sublingual Strips for about 8 months, 8mg/2mg day. My last dose was Thursday March 14 at 12pm. My doctor won’t give me anything prior to surgery but started I’d be given a script of 5mg oxycodone every 4-6 hours after surgery. Will the buprenorphine be out of my system with by then for the oxycodone to work at full capacity? Thank you!

      1. I just recently started two days ago on Suboxone. Past two days only took 1 half of an 8mg tablet (4mg) probably a tad less actually bc I’m nervous about taking it. I took last done at 3pm yesterday 21 hrs ago. If I take a Norco today will I go into withdrawal, can it hurt me, will I even feel my pain meds???? I’m so confused.

      2. I’m getting 3 teeth removed in April.. They want to put me under because of my anxiety .. I’ve been on 2mg of suboxone for 6 years. Some days I take 4mg. I’m planning on not taking any suboxone 12 hours prior to surgery . The only pain meds I will be taking after is motion 800, and my daily dose of suboxone. Will I be okay, getting put to sleep?? I’m so scared, with major anxiety.

  21. I would greatly appreciate your advice. I have been on Suboxone (Buprenorphine/Naloxone) 8mg × 2 daily for 3 years. We are looking at tapering later this year. As of now, I have breast augmentation surgery this friday (March 15). My surgeon advised me to have my Suboxone doctor oversee my post-operative pain management. My suboxone doctor advised me that all he can do is give me more Suboxone by increasing my dosage of 8mg× 2 to 8mg×3. I told my Suboxone doctor I was uncomfortable with this approach considering my dosage of 16mg/day isn’t even sufficient enough to manage my severe monthly period pains (I have PCOS and Endometriosis). The doctor advised me that there isn’t anything more he can do and taking 24mg/day of Suboxone should suffice as my only post-op pain management. I went to my surgeon with my concerns that 16mg/day doesn’t even manage my severe monthly cycle pain so how could 24mg/day effectively treat my post-operative pain from Sub Muscular placement Breast Augmentation surgery. Unfortunately, He decided he would forgo any post-op pain management, regardless of my increasing anxieties and concerns. My anxiety is increasing each day, so much that I’m considering pulling out of the surgery to find another surgeon. My only issue is my $6,500 would be forfeited if I chose to cancel my surgery. Do you have any advise?

    1. Kayla,

      If there are no medical contraindications, your doctors could prescribe gabapentin just prior to and following surgery. COX-2 specific NSAIDs etodolac, meloxicm, or celecoxib starting prioe to and following surgery should help as well. I doubt that either of your doctors will have a problem prescribing these is there are no medical contraindications. Both of these in combination with your current dose of bupenorphine should be quite beneficial.

      1. I am scheduled to have Spinal Cord Stimulation surgery on May 3rd. I have had 6 back surgeries and I am fused from L3-4 to L5-S1. I was 19 when I got into a car accident and I am now 41. I was on tons of pain medications and this past November I was hospitalized for Menengitis and MRSA Infection. After 48 days in the hospital I got off of the pain meds and was put on 32mg of Suboxone. I am now on 20 mg after 5 months actually starting 16mg tomorrow. I don’t see many people who are on a high dose like I am and I am concerned about the pain I will be in for the first week after the
        surgery. I feel like I am just going to have to deal with the pain because getting down to a low dose or even stopping suboxone at this point would be extremely tough. Atleast that’s what I think. Any suggestions Doctor?

        1. It is possible to treat your pain, but it will be more difficult on Suboxone when you get home. I’d discuss options with your doctors NOW while you still have a couple of weeks.

    2. I’ve been on Suboxone 8mg/2mg once a day for the last 8 months. I’m scheduled to have a surgery in 3 days (This Tuesday). My doctor will be giving me 15mg oxycodone tablets after my surgery. My last dose of Suboxone was on Thursday at 12pm. Will I get the full effects of oxycodone by the time I’m scheduled for surgery?

  22. I am about to go in for a precedure, that will require me to be sedated for 20-30 minuets. I have been on Suboxone for almost 2 years. Will the drug itself have any ill effects on the anesthesia I will have to undergo?

      1. Hi there,
        I was in the hospital for stomach issues ended up on diloted 2mg every 4-6 hours for 3 weeks in December, i was discharged from the hospital cold turkey so i went to a doctor that put my on suboxone 8mg i did it for about 2 weeks and titrated myself off. I’ve had pain issues having to take pain meds a few times a week when i stopped i didn’t feel good, so a few days ago i took half a suboxone, then the next day i cut it in half of a half and yesterday only took a tiny dot of it. I have surgery on the 18th. Will i be okay for anasethia and pain medication by then? I can’t find anyone that can help answer my question and I’m scared, thank you!

        1. Catie, You should NEVER take a drug like this without the guidance of a medical doctor. Using an old medication like this can obviously get you into trouble, as you obviously well know at the moment. I cannot answer your question accurately because I don’t know the dose of Suboxone you used. Generally speaking, if you’re off it for a week before surgery without chronic use, you should be fine.

          1. It was 2mg. That is what the doctor told me to do but his advice was very vague and i couldn’t really understand as I am not really familiar with this whole medication thing, this all started with a long stay in the hospital. I guess the real question is, is since i took 2 mg for 3 days and stopped 8 days before surgery will anesethia be okay? And will i be able to even control the pain with the pills? It is a breast augmentation surgery so i don’t know how painful that usually is after. Thank you for your answers i really really appreciate it!!

          2. Yes, you should be fine for surgery. But just a heads up, breast augmentation has a high incidence of neuroplasticity post-operatively, so it is very important that you stay in close contact with your doctor to treat any surgical pain beyond your hospital stay.

          3. There’s no hospital stay they just do the procedure out here in LA and send me home. I will keep an eye out for that type of pain and stay in communication with him, thank you so much… no one on the internet has taken the time to write about how to get through stuff like this, like you have. It is greatly appreciated dr.

          4. Hi sir, I recently had a tooth pulled and I cannot reach either of my doctors. The pain is pretty rough for some reason and I’m afraid to take the pain medicine given. It is hydrocodone. I usually take 12mg of Suboxone daily but I tapered to just half a dose the past week and took an 8mg dose roughly 36 hours ago. How long do I have to wait before I can take the pain medicine? Again, I can’t reach my oral surgeon or Suboxone doctor for any guidance and it is starting to hurt more and more. I do not want to get sick or have withdrawals either. Thank you in advance.

          5. I cannot give medical advice on here. Generally speaking, anti-inflammatories work better than opioids for dental pain if there are no contraindications. If you can’t reach your doctor, speak with your pharmacist as he/she will have access to ask you questions and will have your medication records.

        2. Cait, I am going in for breast aug surgery next week and have a few questions for you. Your case sounds alot like mine and would love to know how your surgery went. Thanks!

    1. Does your surgeon know your on suboxone? And your Anastasia will go fine. I’ve been through it many times in the past few years

  23. So hip replacement surgery 8 days ago. Have a passed that involved heavy usage of opiates for pain that I became addicted too. Clean and sober for five years plus with the help of suboxone. Was told before surgery to wean down from 16 mg. A day to zero five days before surgery. I did three. Wanted five. Could not make it happen. Anyway went through surgery. Needed alot of post OP meds to control pain. Was sent home with 58 percs that I blew through in 5 days. Overmedicating for the pain or because I’m an addict. Only time I reached for bottle is when I felt craving or withdrawal not the pain . Not that there was no pain it was terrible. The worse part though was dealing with the meds. I finally last night took my last perc and waited for it. Tried to sleep woke up an hour later feeling the withdrawal coming. I was so scared. I promised I’d never put myself in this situation again I was so scared to go to my suboxone. Am I taking to early? Will it make me sicker. I took a small little 2 mg. Piece per my docs reccomendation. In 20 minutes I was resting comfortably no withdrawal at all felt 100 times better than on the percs. Having other hip done next month. I think the key was just taking small amount of buprenorphine. Took another small dose this morning. Percs are long gone and I feel great

    1. After reading this blog (Thank you so much for this important information, Doctor!!!) I have decided to avoid even attempting to achieve pain control with a full opiate agonist after upcoming minor oral surgery (extraction of molar). I don’t have time to taper completely off Suboxone, and I doubt my dentist or sub doc would Rx short acting opioids prior to surgery anyhow, so I would likely be in withdrawal on day of surgery and still achieve no pain relief with low dose hydro or oxy afterwards, anyhow.

      Thanks to this informative blog post and replies, I am going to stay on sub, refuse opiate Rx, and take Tylenol or Ibuprofen plus topical ice packs for post surgical pain. I took Advil for the abscessed tooth a few weeks back and it did the trick OK. I know this will be a little rougher but better than trying to navigate this complex chemical puzzle of pain control on sub. I will post after the procedure to let you know how it went. And all the best to all here, I hope you make it through whatever procedure you are facing without encountering ignorance or contempt from medical “professionals.” I have been on sub for years, and live in fear of needing surgery – it’s the one major drawback of this drug.

    2. Thank you for this comment. I am in a similar situation and was dreading yet yearning to get back on Suboxone after a few days of Percocet.

      I too am now comfortable because your post clarified a concern I had. Wish you speedy recovery.

    3. Thanks much for sharing your experience. Just went through a VERY similar situation one week ago and have been avoiding going back on Suboxone because I just don’t know when…and because I’ve still been in pain, and because I’m an addict and have still had pain pills. I’ve used the pain pills in high doses, and today is exactly one week ago post op. I quit taking Suboxone 2 days before surgery per my doc. Worst advice ever. Should have been me like a week before. I’ve going through 60 percs in a week. Hoping I’m able to take a 2mg dose of Suboxone tonight because as we know 2 1/2 percs (7.5) isn’t going to sustain anything for much time. Again, thanks for sharing. What was your last dose of percs before you took your 2 mg of subs. My doctor said to take Suboxone now and I’ll be fine but I don’t quite trust that statement. He said induction is not necessary if you haven’t been off it more than 1-2 weeks! I’m not so sure about that.

      1. I think doctor’s who prescribe buprenorphine as a means to pain management need to be fully educated on the medication & know the proper window of time needed to take a patient off buprenorphine prior to surgery. I am a buprenorphine patient, but also a patient who is chronically ill, and cannot take NSAIDS at all as back up pain control. I had to have a gastrectomy back in August. I have another big surgery in less than 2 weeks and my prescribing doctor tried to tell me I only needed to be off the buphinorphene 3 days prior to surgery. It’s a good thing I have been down this road before and know better. My body needs atleast 2 weeks off before surgery for any pain medication to work post OP. Had I not known this I would likely end up suffering after this next surgery. I wish my own doctor who prescribes the buphinorphene would better educate himself for all of his patients he prescribes for.
        On a side note: I will not be going back on buprenorphine after this bext surgery this time. I am not ok with constantly having to withdrawl for a new emergency surgery on my gut. Plus this medication is not good for the GI track in which I constantly am having to have surgery on my GI system. I’d rather not put my body through constant withdrawal just to have surgery. I wish my doctor had never suggested buprenorphine in the first place.

  24. I know this is a somewhat old posting with newer comments but I wanted to put in my two cents as well. To give a little back story, because of chronic pain, I used to be on Vicodin and later, Norco. As you would expect, I became addicted and near the end in 2009, I had taken 250 Norco’s (10mg/325mg) that were prescribed within 2 weeks and that was rock bottom.

    After getting help from chemical dependency like many other patients here. We tried Suboxone but the naloxone was making me sick so I was switched to Subutex, 16mg daily since then. About 1-2 years ago, I had to go in for surgery to fix and umbilical hernia. I was worried about the Bupe causing problems and made sure the staff understood this.

    I remember being sedated and later waking up. I do not know for sure if I was out of surgery yet or not because unable to open my eyes or speak but it sounded like I was. Then I noticed a inane and sever pain like my stomach was sliced open. I began to just cry in pain. After what felt like hours of tears (which probably was not that long, just felt that way) and hearing the staff multiple times saying they already gave me pain meds, they finally increased the amount. While I was not fully aware of everything yet and could not function but I knew exactly what was happening but could not speak to tell them. I don’t know how much time passed since I first gained consciousness and was in pain but eventually felt the pain go away and was able to fall back to sleep.

    Later when I finally woke up for real, I was told that they had to give me 3 times the normal amount of pain meds to finally knock the bupe out of the receptors. Up until that that point, I had no idea how well bupe works on blocking opiates since I had never relapsed. It is a rude and crude awakening to just how well it does its job and how unready I myself was for it, even knowing about it before I went in.

    I am at a point here I want to get off of Bupe but I am terrified of withdrawal. If I even miss a single dose because I forgot to take it, I start to feel it and I hate that feeling. I am worried that even if I taper down to a low dose that I will still feel all of those feelings of withdrawal. I fear I will never free myself but at the same time, it was a life saver and I don’t know if I ever want to stop.

  25. Can any one on her help me ? The last post looks like it was 2013. Watching for a comment back so then I can state my problem!

      1. Hi Doc. I went to a new urologist today to discuss my kidney stone. After looking at my (KUB) X-ray, he told me it is stuck in my ureter and we would need to do surgery tomorrow.
        I have been on 8mg of suboxone for 6 months now.
        I did not mention to him that I am on suboxone. Not sure why. My surgery – lithotripsy – is scheduled for tomorrow morning, and I have yet to inform him about the suboxone. I didn’t think it would be that big of an issue until I started reading about it online. Now I’m freaking out. I will tell him as soon as I see him in the morning, and I wonder if he will end up postponing the emergency surgery. (Emergency because he’s afraid I will turn septic since it’s been stuck in my ureter for 2 weeks now).
        Will this effect my anesthesia? I’m sure it will. I hope I can get word to him about this in plenty of tome. I’m not sure when I will see him during pre-op.
        Also, he wrote me a script for hydrocone for postop pain, in which I haven’t gotten filled yet. And I know I won’t feel the hydrocodons, due to recent experience.
        During my first kidney stone attack at ER, I was first given Morphine IV, which took the edge off a bit. And then Dilaudid IV which instantly nipped it in the bud. I was able to feel the “rush” (or “high”) with both narcotic opioids I was given IV. so I guess I need to tell him this.
        I’m afraid he will judge me and not want to prescribe me anything stronger for pain, due to seeing me as nothing more than a dope head, drug seeker.
        Advice please! Thanks. Xo

        1. Tamara, It is dangerous for your doctors not to know, but I also understand your reluctance because of being judged. Your safety is most important here with hopes that your doctors will know how to handle your pain and situation appropriately and compassionately.

  26. Very interesting thread!
    In the six years that I have been on Suboxone maintenance therapy I have encountered most of the issues discussed above. In my understanding, naloxone is combined with bupe in the sublingual in order to discourage IV abuse via the potential for precipitated withdrawal (PW): when taken orally, bupe is absorbed in the mouth while the naloxone is swallowed, acting on different mu receptors, the brain and the stomach respectively. If injected, both the bupe and the naloxone would compete for mu receptors primarily in the brain and cause PW. I have reached this conclusion through a 6yr patchwork of reading and talking to people. This understanding is probably oversimplistic and probably not technically correct, but in my experience NOBODY UNDERSTANDS THIS. This article was the most on-point discussion on the topic that I’ve come across — Thank you!
    About a year ago I was involved in a car accident that had me rushed to the hospital for a spleen embolism; I was hospitalized for three days total, one night in the ICU. At that time is was taking 4mg Suboxone sublingually/day. The spleen procedure was arthroscopic and I was awake throughout. Anesthesia was a combination of fast acting opiate and benzo. Anyway, I had no issue with pain and consulted witht he doctors on my bupe maintenance situation. Relative to many stories presented above, I was treated well. They discontinued the bupe and had me on 5mg Oxycodone Hydrochloride every 4hrs. While in the hospital this was a sufficient dose: I was comfortable and slept well the whole three nights and four days I was hospitalized.
    Once home, I stayed on the 5mg/4hrs and discontinued the bupe. Having abused opiates in the past, this was an interesting situation for me. he accident had been so unexpected and the options so limited I didn’t feel like I had a choice. Plus, that small a dose didn’t get me “high” especially since I had been on bupe maintenance prior to the accident. In fact, after the first day home, I had a tough day with pain and general discomfort (4 broken ribs as well?). Later in the day, I decided to double up on the Oxy and all my problems were solved! On top of not addressing my pain, the 5mg/4-6hrs had me in opiate withdrawal! So on a 10mg dose I was set, although I ran out of my Rx early. By then I was convinved that I could taper off Suboxone with these micro doses of Oxy! I had been struggling to get below 2mg/day for a long time, never finding a good time to completely go off with work and school etc. There’s never a good time to taper off in life. With Oxy I probably could have, but of course my Dr. thought I was exhibiting drug-seeking behavior (fine) and I went back on Bupe with a heavy heart. The good thing is that I went back on at 2mg with no withdrawal. I had cut my dose in half with two weeks on small dose Oxy! Oh joy!
    In my experience tapering Bupe, getting lower than 2mg/day can be done with relative ease if you drop your dose by 1/4mg using the 2mg strips. Granted, I haven’t done it myself, but by no fault of the proposed system. The key is not relapsing on fast-acting opiates. The progression: with time, my body needs more bupe after shorter relapses as I get older. And it’s harder to stabilize on bupe as time goes on.
    It gets A LOT harder. I used to be able to get back on a relatively low dose 6hrs after a fast acting and feel strong and stable. Now, a transition has me in bed for 24hrs at least with moderate withdrawal symptoms although I’m able to get back on bupe 6-12hrs after opiate without experiencing PW. The process is so uncomfortable that its a big problem actually: I need a three day time slot of little to no stress to be able to transition back onto Suboxone. It isn’t as easy as it used to be.
    That being said, in response to the people above who don’t seem to be experiencing blocking effects. THANK YOU, me neither. I’ve felt the effects of opiates after taking 13mg of Suboxone! This would have been unheard of for me when I first started on bupe maintenance. What I’ve noticed is that if I feel like I’m experiencing any level of withdrawal, no matter how much bupe I’ve taken that day, a fast acting opiate will take effect and make me feel better. This is both a good and a bad thing as you might imagine: I can stave off withdrawal need be, but dosing does little to guard against relapse for me.

    Anyway, there’s my two cents. Very interesting tread! Thank you all for contributing. A strong and helpful community is essential for people dealing with Suboxone maintenance. We’re getting there!

    1. I just had to have reconstructive facial surgery Jan 15, 2019 using a rib graft. It’s been one week and the last week has been hell. I told them I was on suboxone and they told me to discontinue subs 48 hrs before. After surgery I was received dilaudid every 4 hours and 20 mg of oxy every 4 hours. The pain medication did not work until I was on day 5 with no suboxone. I literally had one dose where my pain level dropped to a 7 after all those opiates and they decided to cut my pain meds. They cut me down to 5 mg of oxy every 6 hours. I had a splint on my face from having a nose and cheek reconstruction and I was sneez.ing from the withdrawals. Not to mention it was so painful because every yawn and sneeze was killing my ribs from them removing the cartilage. I cried and told them I was in Ed and the doctor told me to take suboxone. I cried even more because it was only a couple hours after a dilauded and oxy dose. He argued that there was no such thing as precipitated withdrawal and told me that I’m less likely to withdraw if I take an opiate then a suboxone because I’m getting more opiates! Finally they let me take 15 mg of oxy to keep my withdrawals just bad enough and above the sneezing point. I have had restless legs and anxiety for days in the hospital. Last night they cut me off the 15 mg of oxy and gave me nothing but pepto bismol to help. They did not even let me take my own prescribed clonidine because after taking it, they checked my blood pressure in my sleep and it was low. So I was sneezing and yawning with a splint attached to my face and everything being stitched together feeling like it’s breaking apart. This morning I got back on subs and I will never ever get surgery on suboxone. The surgeon made a plan to keep me comfortable after surgery with my sub provider and I don’t know who’s fault that was. PLEASE TRY TO GET OFF SUBS BEFORE SURGERY. The hospital treats you like a junkie and has no sympathy what’s so ever. This happened at RI hospital if anyone happens to be going there for a surgery.

      1. Going thru same thing.Been on 16 mg of sub daily for past year. Just had car wreck an emergency surgery. My last bup dose was tues. have been on 2mg iv morphine an 10 mg Roxie every two hrs. Wasn’t sick but released today with only 5 mg Roxie every 4 hr.Withdrawl started sitting in once home. Coughing an with a 8 in incision on my stomach. Hating life right now.

        1. Damn that sucks. Dude I’ve been off subs now for 5 full days, today is starting my 6th day off. I just took a perc 15. I feel nothing. What a waste. I’m getting so frustrated. Restless legs are killing me and I don’t want to go to subs ever again.

  27. As a chronic pain patient whose been on Subutex (Buprenorphine( for 15 years, THANK YOU! It is so difficult to find ANY doctor, even & especially those who consider themselves “addiction specialists/pain specialists” who truly understand this drug. I have been in the hospital 8 times this year due to doctors not understanding why my pain isn’t under control. It’s scary being admitted & feeling like I know more than the doctors do about my Rx & my body. It’s very clear that none of them understand it, nor do they even WANT to understand it. Sadly, I had my gall bladder removed in October & this presented a new set of issues. Thank you, sir! You are most definitely doing God’s work!!

    1. I just had surgery to get my gallbladder removed this past Friday and I’m in the absolute worst pain I have ever been in in my entire life right now!!! I’ve been on suboxone for 6yrs and take 2 8mg strips a day. I was told not to take my dose the day of my surgery and could start again 2 to 3 days after surgery. Before surgery the Dr came in to speak with me and said,”you wont be prescribed any narcotics bc of your situation”. Like wtf dude?!?! What’s that supposed to mean?!?! Oh its bc when a Dr sees somebody’s on suboxone, subutex or methadone in their chart, they automatically assume you’re a junkie weither you were or not! It’s very disrespectful and degrading and that’s bullshit. Drs should be more aware of patients on suboxone etc. and be prepared for the proper treatment of pain medication before, during and after surgery. Taking prescribed narcotics for surgery is a waste of time having buprenorphine in your system. Going through all the pain and discomfort from surgery is bout as bad as withdrawals.

  28. Thank you! Finally, someone caring enough to address these serious issues relating to ‘Suboxone and surgery’ with the pharmacological plus physiological knowledge to back it up. I genuinly thank you and hope that your knowledge can be passed around to the myriad uneducated doctors, nurses and medical personnel in hospital and emergency settings nationwide. I have been prescribed Buprenorphine for almost 5 years now. I strongly feel it should NOT be used as a maintenance drug. I want to cease its use but have such a hard time weaning off. I will hopefully be done with it by Feb. 2019, but I find myself saying the same thing every couple of months. It is by NO means a panacea, but it is touted as such. For me, it greatly affects my quality of life in a negative aspect. Regardless of my plight, I REALLY just wanted to re-emphasize what you have already established: IF YOU HAVE SCHEDULED SURGERY — DO YOURSELF A MEGA-FAVOR AND STOP TAKING SUB OR BUPE FOR AT LEAST 2 WEEKS PRIOR. I say that earnestly and with my own anecdotal evidence to back it up. Post-surgery, my nurses and doctors kept trying to flush my sysyem with opiate upon opiate ad nauseam a few years back with NO affect whatsoever. Most of these doctors have no clue. YOU must do your OWN homework, send a copy of this brilliant article to your surgeon, his/her anesthesiologist crew, all your doctors, etc. I cannot stress enough how much aggravation you will save yourself if you do. THANK YOU – THANK YOU – THANK YOU!!!!!

      1. It depends on what does you were taking, but even if opioids work, their effect will be somewhat limited for up to a week. NSAIDs work as good or better for this type of pain, and if there are no medical contraindications, I generally recommend etodolac because it has less risk of bleeding ad there will be less bruising. Also, ice it. Often times, SNRIs such as duloxetine are helpful to help avoid development of long-term chronic pain.

    1. Hello,thanks .My daughter is taking Suboxone. She is in surgery now, long recovery with lots of pain. Her sub.dr.told her to NOT stop dosing until the morning of surgery,she weaned down.dr.who is a prescriber has no clue. Surgeon knew more about it than her addiction doc.her addiction doc basically set her up for pain post op.Something needs to be done to educate these Dr.,rather than stating office policy.whew got that off my chest. People beware of staying on Suboxone prior to surgery,do your homework.

      1. I just had surgery to get my gallbladder removed and I’ve been on suboxone for 6yrs and they prescribed me 7.5 vicodin that ain’t working at all. I was told to stop my dose the day of my surgery and start again 2 to 3 days after. I’m in the worst pain I’ve ever experienced in my life!!!! Everything hurts to the point of tears!!! Comfort definitely ain’t in my life right now and neither is sleep!!! I’m so frustrated and miserable!! Can’t do shit for myself and that makes me feel helpless and a burden. I really really wish somebody told me to stop my dose or cut back a week prior to surgery bc this shit is for the dam birds!!! Drs need to get it together and put a different gameplan together for those of us in treatment that are having surgery.

  29. I just have to say…you, dear Dr, are AMAZING! Thank you for spending so much time and energy educating all of us who are willing to listen. I’m sure I speak for more than just myself when I say I appreciate you so very much. Happy Holidays!

      1. Hello. I’ve been off Subutex for 6 days. For a surgery. Is it save to take Vicodin or will it put me back into withdrawals

        1. You’d only risk withdrawal if you are taking opiates and you take suboxone too early, not the other way around. If you’ve been off for six days you should be able to feel the effects of any opiate you use. Thanks to Dr. Fudin for taking the time to write such a great article. Broaching a subject that may be taboo with general physicians and surgeons takes some gusto and it’s appreciated. It’s sad that the doctors and pharmaceutical giants who caused the opiate crisis are turning their backs on the peons that made them who they are in the first place.

          1. I think it feeds their egos. The gusto, Gaul and condescension of telling said peon “no” makes them feel superior and they get to pat themselves on the back and tell themselves that they didnt feed an addiction, that they themselves started for millions of us.
            Plus most of them probably think we are getting what we deserve by leaving us in post op pain

            Regardless of the fact that they ain’t stopping shit and frankly,I just started Suboxone and if I’m ever put in this situation, I’m getting what I need for pain control off the street. And I know I’m not alone. So in essence they are intensifying this epidemic as I know plenty of people whom were forced down that road leading to harder opiates such as heroin, tainted bags causing ods, and starting the ritual again. Which could have been avoided if the Doctor perscribed appropriate pain relief to begin with.
            So Id tell them to shove their crappy Vicodin up their ass. Lol the day I need a doc for pain control is the day hell freezes over. Most doctors today are dumb as shit and only know what pharmaceutical companies ALLOW them to learn

            Funny how they need an 8 hour class to perscribe bupe but them oxy scripts fly out of their offices creating us addicts to begin with

      2. Will a vivitrol shot work the same as Suboxone with surgery. Broken foot and have to have surgery. My next shot is 2/14 and surgery is scheduled for the next day

        1. Vivitrol will be worse than Suboxone for certain. The active ingredient, naltrexone, is the only drug that has a higher binding affinity to the mu opioid receptor than buprenorphine. That said, depending on the type of surgery, you very well may not need opioids. For example, many orthopedic surgeries respond better to NSAIDs than to opioids because of the pain type. Most bone and connective tissue pain is caused by prostaglandin release and resultant pain and inflammation. NSAIDs are far better for that compared to opioids, if they are not medically contraindicated.

      3. If your on the Buprenorphine Transdermal Patch 5mcg/hour will pain meds still work? I have to have spine surgery Thursday. I need to know if I should just stop the patch

          1. I am having a c seaction.tomorrow.i haven’t had a Suboxone since yesterday at 2 pm and I’m not to take any more until I have surgery.. my question and concerns are..I hope everything with sugery n stuff goes just fine with no issues..that’s my only worries and baby is gonna be okay..

      4. I know I’m a bit late on this post but I’m dealing with a lot of the same issues being discussed. I had gallbladder surgery this past Friday and I’m on suboxone for 6yrs. Got prescribed 7.5 vicodin that’s obviously not working bc I wasn’t told by either Dr to stop doses about a week before surgery so the amount of pain I’m feeling is unreal!! In the hospital I was fine bc I was getting intravenous pain relief. When I came home I was fine but later that night when everything from the hospital wore off all hell broke loose and EVERYTHING STARTED HURTING!!! Some Drs judge you for being in treatment so they ain’t trying to hear how much pain you’re in. Being in so much pain just to take pain meds that don’t work bc you’re on suboxone is extremely unpleasant.

        Thank you Dr. for taking the time and effort to read and reply to the comments and post. Does make you feel better knowing there’s at least one Dr out there who cares so thank you very very much!!!

  30. Hello and thank you so much for an important and well-written article! I have no addiction issues, but a very complicated and lifelong chronic pain situation, and after decades of being on a fentanyl patch with Actiq for breakthrough pain, I have recently switched to buprenorphine for the around the clock pain, which for a while seem to be helping much better, and lowered my Actiq use need. I had to stop using the Belbuca film (900 mcg 2x/day) because of my Sjogren’s disease dryness, since I was not able to dissolve the films even over hours and hours of trying. We then briefly tried the Butrans patch at the highest dose (20 mcg/hr), but my classical Ehlers-Danlos skin issues and other allergies just led to too much discomfort and itching and tearing of skin. So as of today I started with a 2 mg sublingual Subutex tablet. I am supposed to still use the Actiq up to six times daily for breakthrough pain. ***My question is this: I am already way less comfortable than I was with whatever amount of Belbuca I was actually absorbing – – and I am afraid I am not benefiting as much from the Actiq. I also am concerned because with some frequency I need surgery (LOTS of medical complications/dxs) as well as have periodic medical emergencies that require IV opiate control. My doctors and the manufacturers do not seem to know at what level of I am already way less comfortable than I was with whatever amount of Belbuca I was actually absorbing – – and I am afraid I am not benefiting as much from the Actiq. I also am concerned because with some frequency I need surgery as well as have medical emergencies that require IV opiate control. My doctors and the manufacturer do not seem to know at what level of buprenorphine it will block too much of the opiate receptors to allow for breakthrough pain medication or surgical control. Would you possibly be able to assist with this information? Thank you again!

      1. I never comment on anything, but this kind and gracious reply moved me so much as I have been researching this issue for my mother (exact situation you present above-upcoming surgery, 100% successful Suboxone OAT program, faced with fear and anxiety bc her drs. are telling her there will be no availability of pain medicine bc of her maintenance program). I just wanted to say thank you for the most informative article I have found on the topic, and for your kindness in offering to help this lady who is truly in need! The healthcare profession needs so many more doctors like you!

  31. I was on 16mg subutex when I was pregnant my c section was scheduled for 9/1/15 I was told to keep taking it until day of surgery which I did. They gave me a block in my abdomen and diladid via iv plus Suboxone 8mg everyday. I was in the worst pain of my life I cried for 3 days was sent home with dilauded and told to keep taking my subutex. I flushed the dilauded at home because it didn’t work. They treated me like a child amd a junky. Told me to sleep it off amd quit crying I wasn’t getting anymore meds they already gave me what they could. How in the world can they treat a patient like this in a time that should be so happy and memorable was a disaster. I teuly hope doctors and hospitals get it together I will not have any surgery again unless it is am accident and I can’t help it I refuse to do anything elective because of the incompetence of the drs. My son is 3 now and to this day I have ptsd over the while thing.

    1. So sorry to hear this I fully believe that you were treated terrible.As a nurse I don’t harbor the disgust so many of my colleagues do when dealing with SUD or anybody walking the journey you are on.More so now than ever that my son is on Sub I live it daily with him I really want him to try and get off this He had dental work and it was a nightmare Once again I am very sorry for how you were treated and. good luck going forward

      1. I don’t believe subs are all they make it out to be, I’ve been somewhat studying how subs effect people I’ve read countless stories people new to subs start having horrible anxiety, most take it to be off of drugs but need something for pain also at high doses I’ve read people say I feel like I’m in a cloud I can’t focus and it’s not a relaxing feeling that people think we’re getting it’s awful when you all of a sudden feel like you have OCD and take hours doing one simple task,, the other pain meds I really don’t think they tell people how difficult it is to treat pain or even a situation that’s life threatening so many doctors aren’t aware of what subs do, I honestly say if you can get off subs and live a clean life then do so as fast as you can,, good luck

        1. Much easier said than done! Unless you are this person… u shouldn’t talk about how easy or hard this struggle is… for u truly do not know! Nor does it seem that you understand.
          ———————————————————
          Unfortunately I must take Subutex daily due to a physician assisted addiction in fall of 2015. (Migraines – Stadol – Neurologists)

          In the later part February 2016 I was placed on Subutex due to extreme vomiting & defacating upon coming off of stadol from to persistent migraines. (Little did I realize at that time but it was the nasal spray that was causing the daily migraines.)

          I have tried my DAMNEST for years to WEAN myself off of the Subutex from literally the first moment I began to take it!

          I wanted off of it at the beginning because of stigma fear of how doctors, neighbors, librarians, nurses and everyone else in the medical profession and the world – viewed me!!

          Once ANYONE figures out that you are on Subutex or Suboxone they immediately look at you and treat you different; it is highly saddening.

          I was initially started on 2-8 mg Subutex a day! I went from that level down to 2-2 mg a day then I basically snuffed myself OFF of the Subutex so that I wouldn’t be looked at as a dang drug feine!

          I am working on my masters degree … a happy mother to 4 absolutely beautiful children and didn’t want the stigma & label!

          Nearly 3 years in to this chaotic situation that was not my fault – almost a near death experience due to my family doctor / nurse practitioner of 18 years neglectful act of not watching what she prescribed me… after she initially sent me to a Subutex dr – she prescribed me a toxic recipe of meds were prescribed to me and I almost died…. (this happened in early 2016 when Walgreens didn’t have Subutex or Suboxone) so I was forced to use a different pharmacy to get the Subutex.

          I have weaned myself off Subutex until I was only needing them 1 – 8 mg pill every 2-3 weeks (most pharmacists or doctors possibly even manufacturers will say it does not last this long in your bodily system) & I know it is not a mental thing!!

          I have decided after forcing myself to struggle to get off of the Subutex that it is NOT worth it! There is no reason why I should not stay on the medication and live my life as normal as I possibly can.

          The hazardous biological changes that occurred within my brain to the dendrites, neurons and synapses due to the physician assisted opioid addiction have FOREVER ruined my REGULAR and natural brain structure. NOW it is impairtive that I take Subutex to keep the synapses in my brain covered otherwise I am forced every second, minute, hour, every day, and every week, to suffer through withdrawal and ALL of the very ugly faces it throws at me …

          Then once I get through those 2-3 weeks with no Subutex no matter what – I now have and carry an extremely uncharacteristically mean and abnormally evil personality about myself when I choose not to take the Subutex! (Personality wise!) I have never in my life been like this!! Ever!

          So I guess at this point I might as well suck it up and waste all of any more spare time that I may have on going to two weekly 1 hour and 45 minute groups a week – sitting in rooms with between 10-20 mostly former or current heroin users who also need these pills to keep them alive! This is because in the State of Ohio if I don’t do all of these groups and meet with my counselor twice a month – I am NOT allowed to be prescribed my medication that I MUST have to LIVE A somewhat NORMAL LIFE!

          Life sure could have been better than this!!!

          Mind you I’m still working on this masters degree!

          We need more attention to be called to this situation! Please contact me if you wish!

          I have a few more important things to add here as well!

          All of this has set me back many many many years wasted on this journey that was NOT my fault but was my consequence and has thrown me in to an entire different planet! I did not understand WHY I was sick initially…. now after almost 3 years of having to take Subutex…. and forced to go through twice weekly groups and see a counselor twice monthly….

          Forced to be in group therapy with heroin addicts, alcoholics, NA, AA, you name it – I literally have been scarred for learning a lot of information that I truly never needed to be exposed too! Sooo many of my new found acquaintances have suddenly died off due to their heroin addiction by overdosing throughout the years!

      2. Hi Karen.. I’m wondering if you could answer my question. I’m due to have 3 teeth removed next month. I have to get anesthesia.. Dr said it will take less then a hour. I’ve been a small dosage for 6 almost 7 years.. I’m a wife , mother, and a fulltime employee. Ive been very successful since I put my old life behind me and got on suboxone. It was a life savor for me. I’m planning on not taking anything 12-20 hours prior to getting put to sleep. What are you thoughts? I read it was a nightmare for your son?

        1. Care, You should take etodolac if there are not medical contraindications. Speak with your dental surgeon. It’s an NSAID that has less risk of bleeding compared to others. It should be started the day before and will be more effective than opioids.

  32. I’m not sure if you are still reading these comments but I’ll leave my story anyways. I was on bupe alone for my pregnancy due to opioid dependence. I started bupe at 8 weeks pregnant. My pregnancy was high risk due to hyperemesis gravida if that’s spelled correctly. And my son had heart problems. He was also breech my entire third trimester. I had to have a scheduled c-section for a Monday. Saturday night was the last dose I was allowed to have. I didn’t take anything until my surgery. And recovery is when the doctors gave me Vicodin and ibuprofen. I spent 3 days there on that and on Thursday I started bupe again. I wish they had never given me the Vicodin after Tuesday. It didn’t help the pain anymore. I was relieved when I started taking my bupe again. I don’t know if this helps. I was taking 6mg bupe twice a day and a week later my dose was increased to 8mg twice a day.

  33. Dr Jeff!

    I have been taking 16mg/4mg of Suboxone for over a year for opioid dependency. I am due to have outpatient knee (meniscus repair) surgery next week. My question is: will the suboxone block the anesthesia?? Or worse yet depress my respiration while under the general anesthetic? I am not worried at all about the pain resulting from surgery since I have a high pain threshold. And I have specifically advised my orthopedic surgeon and primary care doctors that I will not take any pure opioids (ie Percocet or Norco).

    Can I continue my Suboxone from now until the day of surgery? Will I be able to continue my suboxone the same day when I get back from the surgery?

    1. I had a c section April 2017 i have been on subetex for 2 years now for addiction. I was told to take my normal dose the morning of my scheduled csection in which i did. after my csection i was givin nothing for pain! they gave me 1 8mg sub at 6am and another at 9pm before 8 went to bed. I was in serious pain I could not move or do anything it was a horrible experience and I was very mad the hospital didnt give me anything at all to try to manage the pain. MI agree when you said a lot of doctors arnt trained on treating patients who are on buprenorphine. I think information on this should be more readily available so the patient doesnt have to suffer as much for an emergency situation.
      thanks so much this was q good read

      1. I had 3 c secs on subutex. I declined all pain meds prior to operarions. I was fine n walking that day a couole hours later. Ibuprophen worked wonders. I was shocked.

        1. Im sorry I’m not trying to be rude or anything just a llittle shocked. You said you have 3 C-section and was able to walk after two hours. I have 5 C-section and was nowhere near able to walk after two hours on any of them with pain isn’t it without pain medicine. The Epidural spinal block does not wear off in two hours.

          1. I read your reply and I just want you to know that everyone is different! Also, C-section incisions can be performed in two different way’s- Classical and traditional. This could make a huge difference in the amount of pain one would feel depending on the incision. Weight also play’s a big role- The more weight you bear in the area causes more pressure. I had 3 c-section’s myself, all classical incisions due to my first being an emergency, and I was up and walking that day with no pain either. uncomfortable, yes, pain, no! So we are all different! And no suboxone for me!

    2. No stop hard as it is ig even possible but i had back surgery and woke up 5 shots dilaudid and then morphine pump with no relief the whole 3days was in the hospital. About 2 days after returning home on perk 20mg I started feeling a little bit of relief like a 10 to sn 8…

  34. So, I have a question…. Because I seem to be a bit of an exception. I typically take between 16-24mg of suboxone a day, for just shy of two years. But here’s the thing, that doesn’t block the effects of opiates for me. Maybe to an extent… But only if its a really low dose, which due to my tolerance I wouldn’t feel the effects of anyway even if I wasn’t taking suboxone. Meaning that 10-40mg of oxycodone would have no effect on me with or without the suboxone…. Or at least I wouldn’t feel that effect, no pain relief, or euphoria or anything like that. At the height of my addiction I was dosing anywhere from 120-150mg at a time, roughly 3-4 times a day. Hence the suboxone! But, I’ve had times where I’ve relapsed and used oxycodone in the 2 years I’ve been on suboxone, I’ve never waited days before using… Most the time I’d take oxy the day after having taken my subs, some days I’ve used oxy the same day as my subs. Especially in the beginning of my sub use I kept using, so say I hadn’t used oxy in a week or so… At that point I lowered my dose to 60mg (because I was worried about lowered tolerance from abstinence and therefore possible overdose) I absolutely felt the 60 mg, pain free, euphoria, itching (which weirdly enough, as an addict I loved that feeling), as soon as I’d use a small (for me) dose my tolerance would shoot right back up… But using 120mg after using suboxone still felt exactly the same as using 120mg before ever having taken suboxone. With the marked difference that I don’t start to withdrawal 6 hrs after a dose of oxycodone. So why am I different than seemingly everyone else? Why does suboxone, even at doses of 32 mg a day (the suggested like ceiling effect max dose) have no opiate blocking effect for me? Also… I can dose oxycodone, then go back to my dose of suboxone say 6-8 hrs later without any ill effect- as in I’ve never experienced precipitated withdrawal due to taking suboxone after having used opiates within the opiates half-life timeframe. I’ve just assumed the reason for that was because I still have suboxone in my system from the doses prior to the oxycodone. Although I’m not sure…. I also don’t understand why I don’t experience the blocking effect? Since having switched from the strips to the tablets (like 4 months ago) I’m able to stay on just the subs and have only used oxycodone along with the subs once… Right after having switched to the tablets (to see if the tablets actually blocked opiates… They don’t either) the tablets however seem to help me alot more than the strips. They actually control my cravings, help enough with my pain for me to manage an active lifestyle, and of course curb any withdrawal symptoms. I finally have a life again- which is amazing! The strips made me feel awful, still craving, still in ALOT of pain, as well as really depressed, and almost “zombie” like, really messed with my sleep… I’d bounce back and forth from insomnia to always sleeping and napping away most my days… I felt like they were just taking away the withdrawal so I could “wait to live” I wasn’t able to do anything, it was horrible. That’s why I’d relapse! The pain meds all started because of a few health conditions and accidents then I just wasn’t able to control myself, I wanted to always be pain free (not realizing that pain meds wouldn’t take away all my pain) then getting to where I had to take those massive doses just to avoid withdrawal. I finally feel like I have my life back, its been amazing! But I’m just curious how a drug meant to block opiates…. Doesn’t do that for me. Any ideas?

      1. Hi doctor,
        I was in the hospital in December for a month for issues with my ovaries i was on 2mg IV dilaudid every 3 hours. I left the hospital and got very sick so went to the pain management doctors office who saw me in the hospital i have never had to take pain meds before but he said to help with how horrible i was feeling he suggested suboxone, i did 8mg for 4 days and 2mg for a few days. It’s been two days since my last dose. The pain in my ovaries have some back but I’m scared to go to the ER Incase the suboxone shows up in there system and they thing I’m seeking. I still have my pain medication prescription of 4mg dilaudid pills. Can i take that since i was only on subs for a short time and my last dose was two days ago? Please help, the pain in terrible.

        1. I can’t hrlp you with this. The safest option is to examined by a medical doctor prior to making any medication decisions. It could be an unrelated medical problem or a new problem related to your ovaries.

    1. wierdly enough I got excited when I read this, the blocking effect isn’t there for me either and you are literally the only other person I’ve come across who’s in the same boat. I can dose 8mg in the morning and be relapsing 6-7 hours later while feeling the full effects of whatever opiate I’m taking as long as it’s close to the dose I took in my full blown addiction, even my addiction specialist who’s been working with addicts since like 1972 and had been prescribing subs since it came out doesn’t understand why, I’ve just chalked it up to “different people, different body chemistry” but it would be nice to understand why the blovking effect isn’t there for some of us as it’s it can make recovery difficult

    2. Oh and also the lack of precipitated withdrawal! I don’t get PC either, I’ve taken fentanyl then dosed a sub 2-3 hours later and been totally fine. I almost wish I got the precipitated withdrawal because it’s almost too easy to switch back and forth and get high a few times a week and keep up the facade of being clean to everyone around me

  35. Ok, u all convinced me No surgery!!!! i have Lobectomy scheduald for July 12 th, nope, nadda, no way,, i been on Suboxen for 7 yrs, ever since i had hips replaced,, started using to get off post-surgical pain-killers 2-30mg oxycodones every 6 hrs, for 3 months, ,but to go back further, i had 3 back surgeries over 6 yr period 1995-2001 ,but all those operations wer done while on Methadone, no need to wean off for surgery, just add mad amounts of oxycodone and oxycontin, which is wat they did back then,, shit i knew woman who was getting a 200 mg capsule of pure oxycodone, 8 a day!!!! For break-through pain , hahahahahaha, she had 80 mg contin for long acting,, o ya ,,those wer the days!!
    Now i have nodule of what they think is cancer in upper right lobe, wants to take whole lobe ,in July, but afer hearing all ur horror stories im having second thoughts, im perscribed 16mgs a day but i buy xtra ,up to 32 mgs now,, how f… do i go ubder knife knowing what u guys went through? Shit, i have to wean down for year at least, be on 2 mgs for 20 days before opiates will work for post -op pain, i do want to thanku for opening my eyes, Dr Jeff

    1. Same with me. My nodule is 6cm and I am removing my right half. Dana farber cancer Institute, theyre saying stop taking my buprenorphine (not suboxone no nalonone pure buprenorphine brand name subutex) 3 days prior to my surgery on the 13th. I will be switched to a narcotic such as oxycodone. After reading this that suggests stop taking buprenorphine 2 to 4 weeks prior to surgery I don’t think it is enough time. What do I do.

      1. I just had surgery on Monday morning and I stopped taking my sub it was 2 days the day of surgery made the 3 day without it and then they sent me home with oxycodone 5mg and I felt it but not like i think I should I have to take more then the 1 or 2 ever 4 hrs it was more like 4 ever 2 to 3 hrs

        1. That’s how I was with my foot surgery I had in the 7th I stopped on wed and had surgery Friday after surgery they sent me with perk 5 one every 6-8 hours but I told them they weren’t working they gave me directions to adjust the dose.

    2. Hi Donald, u and I have the same suboxone usage histiry of 7+ years. I’m scheduled for a major back surgery on 9/11/18, and have been asked to cut out my suboxone and replace with oxycodone for the last three days before surgery. I too am a bit skeptic about doing this, really cutting out my suboxone, the only thing that has kept me from being bed bound was a scary thought. HOWEVER, this will be my third back surgery and each time I have been able to cut back off of some sort of opiate ending up on the suboxone. Yes, it has been a miricle drug for me, but i have weighed out my challenges with my back surgery coming up and have decided that it can only benefit me to give this last surgery a try, hence I will be cutting out my suboxone until after my surgery. Hey i may not even need any more meds after this….YA RIGHT, but I am possitive that this surgery will be a success and my opiate dosage will be drastacally reduced providning me with an even better quality of life. So, please dont give up, always stay open minded.

  36. Hey doc Jeff, I ran out of my Norco 40mg per day and my pain man doc is out on Vaca, so I found some sub, I’ve taken .25mg every 12 hours for last 3 days, my question is how long from now would I have to wait before my Norco will work again? I can get a refill tomorrow. Have not take sub before. Total of 1.25mg in 3 days

      1. what about 150 mgs oxy aday took 16mgs/8mgx suboxone i day 24 hours can start back oxy r longer mighty sick man right now.don,t want to take anymore subs because health requires many painful procedures

    1. what about 150 mgs oxy aday took 32mgs/8mgx suboxone how long before can start can start back oxy mighty sick man right now.don,t want to take anymore subs because health requires many painful procedures

  37. First of all, thank you so much for this forum! Great information and dialogue. I have been on suboxone for a year now and have weaned myself down to 2mg a day. Today, I had ankle/fibula Fracture repair surgery under general anesthesia. I had my normal dose of bup up until last night and none this morning. I have been prescribed oxycodone 5 for post-op pain.
    Should I be worried about overdose by taking (2) of the oxycodone every 4 hours while allowing the bup to wear off?
    Please explain as I may have misunderstood.

  38. Wow. Sounds like some people were luckier than I was. My suboxone doctor told me it was up to my surgeon when to stop taking prior to my surgery. I had sleeve gastrectomy on 5/29. My surgeon had no idea that I even needed to stop taking the subs at all. (Its alarming how many medical proffessionals dont know anything or much about this drug.)He ended up calling the anesthesiologist and they suggested that I stop 3 days prior to surgery….with no offer of anything to help with the withdrawal. So I went into surgery on day 4 after stopping the subs cold turkey. I felt bad but not as bad as I had the last time I had tried to quit cold turkey. I was prescribed 16mg a day. When I came out of surgery I wished I was dead. I was in the most pain I have ever experienced in my life and I have 2 children. This pain was worse then anything imaginable. I could barely speak I was in so much pain and the tears just slid down my face and there were no thoughts in my brain beside PAIN. The person that was taking care of me post op was looking at me like I was crazy. He kept saying Ive given you as much as I can give you. Finally he talked to someone else…I imagine a superior….and I heard him say : “She was taking Suboxone!! You cant treat her like we would normally!” So they ended up giving me fentanyl and dilaudid through the IV and apparently maxed.out what was allowed/safe….but even then I was still.experiencing major pain…..however nothing like what I had first felt. Next few days post op was Tylenol IV, IV Torrdol, and Dilaudid 4mg(taken orally) every 4-6 hours. The dilaudid did almost nothing. The IV torrdol helped the most.I spent 4 days in the hospital for a procedure that most people only stay overnight and it was all due to my pain being uncontrolled. Sent home with a script of # 20 Percocet 5/325. They barely help. Its been 8 days since surgery…and 11 since stopping the subs. Ive got restless leg like crazy in my legs and arms and its constant. Idk if this is from withdraw to Subs, some kind of nutritional defeciency..even though Im taking all the recommened vitamins and minerals…or something else altogether. Im only taking 2 to 3 of the Percocet 5mg a day because I dont want to get back into the habit and its not really controlling my pain anyway. I was hoping to just stop taking the Suboxone after surgery because I thought my withdrawal would be minimized from the pain meds. But at this point Im still in pain and feel like Im going through withdrawal at the same time.

    1. Your body is experiencing precipitated withdrawal. And yes the restless legs and arms are common when stepping down from subs. I take 2 mg. Klonopin to help with the comfort and to be able to sleep. All in hindsight I wouldn’t have ever taken a sub if I knew then what I know now. Yes it’s the “gold standard for opioid addiction or dependency, but I’d rather suffer the week of hell quitting the pain meds cold turkey

      1. No it is not percipitated withdrawal
        She stopped the an extremely high dose of Suboxone 8 days ago by the time of this post and is on a low dose of a short acting opioid
        She’s is regular withdrawal. Suboxone, although not a full agonist, is very powerful non the less, and 15 mg of Percocet ain’t gonna touch that

        Precipitated withdrawal occurs the other way
        When you take Suboxone to soon AFTER a full agonist opioid, not before

    2. It was not precipitated withdrawal…it was because you were taking so much suboxone that your mu receptors are used to being filled up…only taking 5mg of percocet 3 times a day is not going to fill the receptors as much as the suboxone was. Your in withdrawal. I hate to say it but you would of been better off just staying on the suboxone. Taking a opoid after suboxone blocks it out but does not make you withdrawal, taking suboxone after a opioid will send you into precipitated withdrawal…people dont understand how it works…I’m in the same boat..I just got out of surgery and take subs. I’m worried taking the percocet will not be enough and I’ll feel withdrawl… and I will have to wait 24 hours for the percocet to get out of my system before I can take my suboxone again..it sucks.

  39. Hi I have a question. I’ve been very worried and stressed because I’ve been on suboxone for a year and a few months now and I just discovered I’m pregnant. I don’t want to get into any judgmental arguments I just would like my question answered, but sadly for horrible reasons I will not discuss I must get an abortion. I’m not sure what they give you in the abortion surgery and I’m not sure how long before I need to stop taking my subs if I do indeed need to stop. I’m just scared and confused. I really need help with this question or some what of an opinion on the medication part.

    1. If I’ve heard correctly. Pregnant and people with very bad lovers are put on subutex. It is buph without the noloxon.

    2. I’ve had a bad miscarriage that resulted in a surgery to remove baby and placenta. I was under general anesthesia and had IV morphine then Percocet 10/325 at home. I was not on Suboxone at the time FYI. Now I’m on it and that miscarriage was almost 10yrs ago. But the surgery is similar to one another, I was in the beginning of second trimester too.
      I have to have rotator cuff surgery this year and my pain management doc said an emergency surgery they could push and override pain with fentanyl giving a higher dose than to anyone else. An elective surgery I can stop a week before and start my Percocet again and be fine for surgery and post op, just need to be vocal and have pain doc communicate with surgical/medical team very closely those first few days. Hope this helps, good luck and God Bless.

    3. Sorry to hear, you probably have already had the procedure looking at the date you posted.
      I hope it went as well as possible. I know what you went through was hard, and I just want to send a little support your way. Only you know what was.is best for you. Clearly you are trying your best because you do take Suboxone, as do I, and if anyone has anything negative to say just remember they have never, not once, walked a day in your shoes. As for having to terminate a pregnancy, it is a sad thing and a lot of people do not understand. I live in Canada where the largest opinion (but not the only opinion) is pro choice. I know that sentiment varies from place to place, and even within oneself, as a woman, it weighs extremely heavy. Just because it wasn’t a miscarriage and it was a decision you made does not mean you do not get to mourn, and be sad, upset, angry, hurt, depressed. It is a loss none the less, I hope you stay strong and continue to do the best you can everyday. As women we must stick together, regardless of religion, race, economic status. And us opiate users/addicts/former addicts (however you wish to classify your journey) must also stand together, against the stigma and the judgement. Opiate Addiction sees no boundaries. The doctor, the janitor, the lawyer, the mom, the priest…all susceptible with just one R/X or night of experiment.

      I have scheduled surgery in 3 days (that I might now cancel) and I appreciate what this doctor wrote and everyone’s comments, I cannot tell you how alone I felt only an hour ago.

      Thank you ALL! xoxo

    4. I’m so sorry to hear you had to go through this. I hope everything worked out for you and you are recovering well.. Best wishes to you

    5. I’m so sorry you had to go through that. People don’t know what situation you’re in and cannot judge what’s right for you. I know by the date of this post that everything is probably done now, but for future reference I have heard that Methodone has been studied long term for use during pregnancy, whereas Subozonee has not. But of course you would talk to your doctor THOROUGHLY before making any decisions! Good luck love

  40. I am a 50 year old female with chronic back pain. I was initially treated with Percocet but felt that it left me feeling drowsy. The pain specialist switched me to suboxone.
    I take it as needed (pretty much everyday). On Friday I went for surgery for an anal fistula. Post surgery I was given fentanyl to no avail. They kept trying to manage my pain. In the end I was given 500mcg fentanyl with no relief. I went home with 25mcg patches but have had no relief. I have stopped taking suboxone and I am wondering when the fentanyl will kick in. The pain is excruciating

    1. Stacey, This is a very dangerous situation. The buprenorphine in Suboxone could be blocking the fentanyl and likely was doing the same in the hospital. When the buprenorphine is completely eliminated from your body (2-5 days), the fentanyl could kick in and result in overdose – this could be a medical emergency and should be death with proactively.

      1. @Jeffrey Fudin

        I was on 16 mg of suboxone for 6-7 months. I was taking it for pain and depression because oxycontin was losing it’s tolerance, but it actually made it worse. Prior to that, I was on oxycodone for 4 years. Then 5 months ago I quit suboxone cold turkey and 2 days later my doctor started me on oxycodone again. Now I take 40 mg every 6 hours.

        While it helps for pain up to 80% and I didn’t have any major withdrawals except severe depression, I do not feel any euphoria whatsoever. I am not a high chaser but my doctor indirectly said that oxycodone “high” will mask my depression until I get professional help. So 5 months now, I cannot get off oxy because depression gets horrible and what is even more weird, why is there no euphoria after 5 months since i quit sub. What is wrong with my receptors?

          1. I have double back surgery on June 27, a and I’m on 900micrograms of belbuca twice a day for the chronic pain, after getting off of auboxone after 10 years of 16 mgs a day. Any idea how long I should stop the bebuca before I have this awfully painful surgery? The docs keep kicking it back and forth because they don’t know, they see the micrograms and pass it back to the surgeons, who don’t know… My pharmacist came up with 5 days, show up for surgery in withdrawal… Taper from 900mcg as much as possible? Any words of wisdom or advise would be so appreciated
            Thabks

          2. I have a question ! I’m going into surgery September 7th for a lapidus paragon 28 nail to be put in my foot ! If I start weaning myself down to 2mg of suboxone a day starting now and them stop it completely 3 days before surgery, will I be able to feel the pain medication given to me after surgery! Doc said this surgery is one of the most painful post op to have on your foot and I won’t even be able to touch my foot to the ground for four weeks after ?

        1. Sounds like anihidonia, a type of depression caused by stopping opiates, U feel like its a “grey world” feeling down most of time, life sucks,, its ur brain saying , “hey ,wers that kick-ass feeling i had for so long” ? Google it, sounds like u may be suffering!

        2. My Drs took me off of my percocet and put me on suboxone not due to addiction but because if the opioid epidemic and what they are required to do so I complied! It was the worst decision of my life! I was on the suboxone for about a year & it didn’t work that well so when I went back to work I went back on percocet. Asks now the dose that worked for me for YEARS (never had to increase) no longer is as effective. I stopped the suboxone almost 2 months ago & am now struggling with even more constant uncontrolled pain! I wish I would have never agreed to be a good compliant patient and make the switch! I worry that the percocet will never be as effective as it was before and I now will have to go to either a higher dose or something stronger! Anyone have the same issue or know if it will start working as it did before?

      2. Dr
        I’m so scared reading all these horror stories. I’ve been diagnosed with liposarcoma in my adomen where now they must remove my spleen, my left kidney and part of my pancreas and possibly part of my bowels. My pain management doctor who out of state right now said to stop my Suboxone strips 20 hours before taking any pain meds. My surgery is planned for the 19th. 6 days from today. I’m so scared to start the withdrawals alone at home, I’m going to be in such pain. I took my last Suboxone yesterday at 5 pm and my family doctor has given me 18 5-325 of Narco I’m so scared this will not be enough to get me through the withdrawals before my surgery. None of these doctors are aware of Suboxone and what it’s used for?? Please I need help, I’m ready to cancel my surgery. And just let what ever happens happen with this cancer. I’m so scared of feeling pain during my surgery and not able to let them know, after surgery I’ll have a opening in my adomen 25 inches from them opening me up to remove all these organs plus the 2 tumors that have attached them selves to these organs. I’m so scared. Will the Narco 5-325 be enough to stop the withdrawals after 20 hours of withdrawal from Suboxone strips of 8 mil 2 times daily for 6 years. I’m 63 and very scared and feel alone as no one understands what I’m scared of. I’m just waiting on my Dr office to open so I can go in and explain why I’m so scared of only having only 18 pills of such a low dosage to get me through withdrawals before my surgery. Before Suboxone I was on 80 mil of morphine 4 times a day. Please help..

        1. Christina, Your doctor should do a more gradual taper is possible. Also, to treat withdrawal, if there are no medical contraindications, your doctor can prescribe clinidine or Lucemyra.

    2. I’ve been on Suboxone for 3-4 years and had a double mastectomy. My sub doctor didn’t want me to go off but let me decide. No way I was staying on Suboxone for this surgery. I was prescribed 10/325 Oxycodone prior to surgery and luckily I stopped Suboxone 7 days prior to my first surgery and it took that long for my opiate receptors to clear. The withdrawal from the Suboxone sucked and I did have to begin taking my opiates before surgery but I took as little as possible and I had complete pain control when I woke up from surgery and for several weeks after during recovery. I had two more surgeries and had to repeat this process and feel that it worked very well.

  41. Hello all. I had surgery this past Monday, it’s Friday. I’ve been on Suboxone, Subutex and now zubsolv for 4 years. The surgeon handled things well. Pain was a little unbearable for a couple days and I’m still in pain. I was prescribed 15 5/325 Percocets taken every 4-6 hours. My last sub dose was 5.7mg Monday morning before the hernia surgery. Haven’t had any since. Took my last Percocet at 6pm today. Would I be ok to continue my zubsolv Tonight? My legs are going crazy, I noticed this last night but it wasn’t as bad. Now I’m wishing I just sucked it up and didn’t take the Percocet. I need my bupe back. I plan on waiting until tomorrow morning before I take a dose, but I would love to sleep right now, just scared I’d go into precipitated withdrawal if I took a small amount. Any help would be greatly appreciated. Thanks and God bless you all.

      1. Hey there, thank you. I ended up taking like .7 mg waited 30 minutes and took 1.4mg. Not saying that this would work for everyone. Based off the half life I think the bupe was still binded pretty well to my receptors, although the Percocet did help with pain. When I seen my sub Dr yesterday he said I would be fine, but I was hesitant because I asked him about precipitated withdrawal and he had an expression of confusion. I swear the place I go to, while thankful for them, I do not believe they are well versed in this kind of therapy. They’re actually pretty screwed up. But anyway, thank you for this article, and all the posters who share their experience.

      2. I just had surgery today. I stopped taking suboxone 3 days ago and started taking subutex (the form without the naloxone) at about half of my normal dose for the last 3 days. My pain is controlled pretty good on tylenol, advil and 15mgs of oxycodone every 4 hours. In my experience, because I have done this twice now, if you take the subutex prior to surgery, you can still feel the effects of narcotic pain meds AND you don’t have to deal with withdrawals or taking those narcotic pain meds prior to surgery to control said withdrawal symptoms. I didn’t see my scenario mentioned in the article. Is my casey atypical or maybe just not thought of when the literature was written? Please reply I am anxious to see your thoughts on this

        1. I wish i had did what you did and switched from my suboxone to subutex instead my doc told me to stop the suboxone two days before and gave me 10 mg oxycodone to take every 4-6 hours before surgery! I been in hell i swear the oxycodone does not hold off the feelings of withdrawals and i cant wait to be back on my suboxone!

        2. I HOPE & PRAY MORE THAN ANYTHING IN THE WORLD THAT THIS IS AN OPTION FOR ME AND IF SO, THAT IT’LL WORK!!! I CAN’T HANDLE WITHDRAWAL IN ANY FORM BUT ESPECIALLY NOT FROM SUBOXONE!!!!! IT’S A NIGHTMARE LIKE NO OTHER!!!!!!

        3. Dustin, How much Subutex were you taking and what kind of surgery did you have if you dont mind me asking. I take subutex and I have tapered down to where an 8 mg pill lasts for over a week. I am just doing a very small amount to knock the edge off of withdrawals. I have never taken a whole 8 mg pill. I normaly take about about a qtr of an 8 mg per day. I am wondering if I will be able to control pain post surgery while taking just a tiny bit until the day before surgery and not taking anything the day of surgery. My dr said I will be okay with this small amount of subutex but I am concerned after reading these painful horror stories.

  42. I too just learned that I’m about to have to undergo a scheduled surgery – fundoplication surgery after my uncontrolled GERD (even after 40mg of esomeprazole and 600mg of ranitidine) wasn’t enough to prevent me from aspirating on stomach secretions and I breathed in one morning and felt the liquid run down into my lungs which turned into the most painful 8 hour cough I’ve ever experienced. Right now I take 16mg of generic Suboxone daily even though I’ve asked my doctor the last two times to please write the prescription for 12mg so that I can start the process of coming off of the medication even though I know it will be months to years before I can come off comfortably. I’m not terribly scared about pain control though because of websites like this that help advocate for Suboxone patients, and I’ve come up with a plan that my gastroenterologist likes and I have a meeting lined up with the anesthesiologist to discuss pain control afterwards.

    I’m going to request to stop taking the Suboxone 3-5 days before my surgery and be switched over to 10mg of hydrocodone q6-8h so that even though I might not be completely withdrawal free I will have adequate enough control to make it to surgery morning without constantly feeling like I want to vomit. My GI doctor has no problem with this and said he will prescribe me enough medication pre-op to get me through to that day. I really don’t want to, but I fear that my pain control is going to be a very narrow target to hit since it’s been over 5 years since I’ve had a full opiate agonist so I’m hoping they will allow me to stay in the hospital post-op for 2-3 days or so while I’m on a PCA so that I can be closely monitored and have a vial of naloxone handy in case pain management is too aggressive. I fully believe in my plan and right now I just hope the meeting with my anesthesiologist is as fruitful as I know it will more than likely require more pain control than what can be provided orally – not to mention the surgery already involves my esophagus.

    Post-op I’m hoping to be able to be on pain medication for only 10-14 days or less following my surgery, and once I am fully ambulatory and in minimal pain I will stop taking all full agonists and wait until I’m in moderate opiate withdrawal and then start back by taking half of my daily dosage of Suboxone and eventually work my way back to 12-16mg of Suboxone. I plan on being absolutely truthful with my pain control and not be afraid to speak up while also not giving in to any temptations to ask for more medication when I know that I don’t need it. I really do want to be on full agonists for as short of a period as I possibly can, wait for moderate withdrawal symptoms to kick in (roughly a 26 COWS score), and then start back on the buprenorphine at half of the normal dosage and work my way back up to my pre-surgical dosages.

    My Suboxone doctor isn’t thrilled with the idea of me having to stop the Suboxone but understands that adequate pain control is the best way to get me ambulatory and on my way to healing faster so he’s giving my plan his blessing as well. The next time I go in to see my Suboxone doctor I’m going to ask him to prescribe enough for 16 days instead of 30 so that I only have enough medication to take one or the other and have no extra medication left over, and should I end up with any left it will just go into the toilet and flushed. I know that us Suboxone patients love the idea of hoarding medications just in case we get cut off, but I’ve prevented myself from having any more than 5 days worth of extra medication in my possession because my doctor is only in office Monday-Wednesday and I prefer to keep just barely enough around to have in case I require another prior authorization in the future – other than that though I have disposed of extra Suboxone before and even told my doctor about it and he told me that I was the first person that ever told him they flushed their extras and he now knows that I am sticking to making sure that I am fully accountable for myself and keep no more medications around than absolutely necessary. It’s gravely important that I remain truthful and use as little as humanly possible because there is a huge amount of trust involved, and it works both ways. I’ll always advocate for myself though, remain truthful and vigilant, and refuse to work with doctors who don’t fully understand how Suboxone works and that sometimes but not every single time it takes more aggressive pain control than the average non-addict requires. My future depends on it, and there’s no one who takes that responsibility more seriously than I do.

    1. Hey, how did everything go ? You sound like you have a good head on your shoulders. I’m on Suboxon and have been on them for Three years . I have a few surgeries I want planed like cosmetics and I’m terrified!

  43. My question is how long should somebody be off Buprenorphine before they can go through surgery without being “high risk” For pain management and could just be treated as a normal patient?

    1. I’ve gone through something like this. best to always not take sub at least 2days before a surgery is preformed so they can anasthestize correctly. after surgery resume take home medication and don’t start back on sub til 12-24 hrs after last dose of percs/norcos. since you weren’t on percs very long you shouldn’t have to worry about going into massive p/w. Taking any pain meds while taking buperenorphine is a total waste because you only feel like 25% of analgesic effect after the first day, if you wait 2 days maybe 75% of the effect, you have to be off buperenorphine 3days to feel full effect of prescribed opioids due to the fact that bupe binds harder to the receptors than anything else. Then, say you wait 12 hrs after last perc, you should start back on bupe with low dose 2mg wait 30min-2hrs if you need more take another 2mg and repeat til youre back to your comfort level. thats what worked for me. i think if you have to schedule a surgery they should give you two day dose of iv buperenorphine for before surgery, since it leaves faster through iv route than sublingual. as long as you dont do it day of surgery docs should have easier time anasthestizing patient with lower doses. just my opinion after dealing w surgery while on buperenorphine.

  44. Hi. I am scheduled for a c-section tomorrow morning at 11:30 am. I have been on subutex 8 mg ( 2 x daily) for over 3 years. I am terrified of the pain I will be going through again. I had a c-section in 2016 for my daughter and was also on subutex. I tried to talk to my doctors about the fact that they were giving me my subutex medication but also on top of that they were giving me Percocet for pain which absolutely did not touch my pain whatsoever. I was in absolute agony for several days. I feel like I cannot get anyone to listen to my concerns and that they really just don’t believe me. I don’t even know what to do at this point.. Especially considering I have no choice but to safely deliver my child via c-section. I have a feeling I’m going to just have to suffer once again. Any advice would be great but I’m guessing it’s too late for that.

    1. Sarah,

      I suggest that you share the following two articles with your doctors.

      Bettinger JJ, Fudin J, Argoff C. Buprenorphine and Surgery: What’s the Protocol? In Kean N, 2nd ed., Opioid Prescribing and Monitoring—How to Combat Opioid Abuse and Misuse Responsibly. Chap. 6. Pg. 73-78. Pub. Vertical Health, LLC. September 2017.
      Fudin J, Srivastava A, Atkinson TJ, Fudin HR. Opioids for Surgery or Acute Pain in Patients on Chronic Buprenorphine. In Aronoff G, ed., Medication Management of Chronic Pain: What you Need to Know. Publication pending, Trafford Publishing, 2017.

      1. Hell’o my name is Lois and I’ve been going to a suboxson clinic for over a year they started me out with 4 for 2 months then 3&1/2 for 3 months then 2&1/2 now 2 so what I want to tell you was I did not take that much during the day,, I only took 1/2 for 7 months now I’m taking a 1/4 I’ve been putting the rest away incase they cut me off. I had learned from my sister & friends how dangerous these can be & she showed me that I didn’t need that much & the place I was going to kelp telling me I had opide in my urin which I promise you I did not I have to take Tylenol because I have real bad rumatoid arthritis I’m 65 yrs old and I really didn’t want to be on them but they cut me off my pain medication which I was on for 30 yrs I’m not proud of it but the pain in my body is unreal because I also have osteoporosis also I’m just eat up.Anyway the woman Dr. I had would just talk to me so badly she had never been on drugs she said & would ask me how I got that way to begin with she was not a good Dr. to talk to her patients if she’s never been down that road she wouldn’t let me finish talking when I tried to explain to her my condition at Londons Womans clinic. I can’t understand why the DEA is letting them give out Soboxson when there not trained for that & don’t understand addicts, but what I want to say I read your article and everything you said was very true. I think there the worst medication they ever put out. Yes it’s help me with my withdraw but it also gave me side effects itching sores in my head, oh how I wish I could find a good Dr. that can help me and yes I put quite a bit of those back because my sister was right When she said that the woman I was going to was really bad about putting people out but I seen that for my self when I was going I watch people walk out crying because they got cut off I felt really sorry for them, but I’m working my way off & I wished I never heard or ever took any of those.They are the worse med. you can take.But thank you so much for your article you can’t imagine how much that help me. Your friend, Lois

    2. Good God!!

      Get clean. Go to a 12 step program!! If not for you, for your children. That is the most self centered thing you can do to these children!!

      1. You have no idea what you are talkung about. Until you understand the real issues behind opiod receptors,chronic pain, rapid metabolizers,and the difference between tolerance,dependence,and addiction…. be quiet!

      2. 12 step programs have an incredibly low success rate. Medication management statistics blow away 12 step programs. You don’t seem to understand the nature of addiction either physiologically or mentally. Judging people making educated decisions to treat addiction is just wrong. Please update your addiction knowledge. In no other area are patients directed to use a book written a century ago and rely on willpower and others suffering the same affliction. The only reason 12 step programs are still around for alcoholics and addicts is because it’s free. Court systems, and yes, rehabs rely on them to “help” and no cost. You get what you pay for.

      3. Not nice Christine. A holier than thou approach is unbecoming of anyone!

        12 step programs can be great for some people,
        however a lot of us are in this place because a doctor pushed pills down out throats (and even if thats not the case) and our bodies became dependent on them in order to feel the slightest bit normal. There are no words that can fix what the body is doing itself.
        And let us be completely honest there is nothing ANONYMOUS about those 12 step programs.

        SO ON TOP OF THAT TO USE THE GUILT OF CHILDREN, WELL THAT IS IN FACT DEVIOUS!
        A lot of 12 step programs are religious based, that is another thing you cannot force on someone.

        You really should be ashamed of yourself for writing this comment in a forum of vulnerable people at varying levels, but I feel a person who would write this comment feels no shame.

        PEOPLE- MOTHERS-FATHERS, Suboxone may not be the best and ideal situation to be in but it is better than the last and may have saved your life for you and your children/families

        A great doctor once told me “throw away the guilt of your addiction of your past acts, your addiction is being handled now…something in your life made you open to getting addicted and possibly those medication eased the unbearable emotional pain you were in at that very ime in your life. And just maybe, if you had not been on those medications, something even more drastic could have happened. Accept it, and keep moving along your path”

        GOOD GOD CHRISTINE…you are terrible!

        1. Jawhol!! Thanks; you hit that one dead-nuts. I suppose she’s some sort of addict-hater? IDK. My girlfriend has a family member who’s an ER nurse and she HATES addicts. I’ve been on 4mg of Suboxone for 4 years and I’ve changed my life…….I’m talking a complete 180. She knows about my past and she hated me b4 she met me. Man, when she comes over for supper, which is often, I try to find an excuse to beg off. She just exudes contempt for me and for her job! I suppose I should practice some acceptance and forgiveness because I can’t change her, u know? Anyway, it still pisses me off. Good post, Megan!!

      4. The most self-centered people I have ever known come from a 12 step program, cling to “their story” of partying 30 years ago, while they are nearing seventy, and stay clean by only surrounding themselves with other AA members who go out to lunch and vacation together for decades, and tell each other how marvelous and special they are, recycling the same narcissistic and self-absorbed psychological disorders for three decades. They think they are superior for being sober, and because they have held down a job and have been monetarily successful…as if the real world people don’t do this…As an outsider, I have seen no growth where they have a self concept that they have grown tremendously. if anything, a decrease in growth and a false self-concept and pride that I have never encountered in “real life”. Not one of these people have ever made amends to me, they seem to only make amends within the cult. These people are my family, and it is so sad and yet disgusting because their conceit is so thwarted to which they are blind because they continue for 30 years in the same regurgitated cycle of narcissism. No growth whatsoever. People who are not in AA can clearly see through them. It is sad, but I have absolutely no respect for them. I have gone through major physical issues and not one of them ever called to check in over a year, while I was the one who held al holidays, birthday parties, at my home for 30 years. They only talk to people and family members in the program and shut me out, or pretend to “love” me when it is convenient for them. Good, God! Talk about self-centered.AA is a cult. There are much more mature real world ways to get clean than following every word from a book written by a disturbed limited man years ago.

      5. 12 step programs are bullshit** and all the ppl that believe in is has been dropped on their head to much as a child I am here to tell you I was in programs it didn’t work but here is what did work it’s called God and your own will power and your own mind sit to stop you have to want to stay clean yes it comes up all the time to use and that’s just a sec thought nothing more so when that sec thought comes up take that sec and jump clap sing count 10 sheep time you get to 10 the thought is gone when it comes back do it again mine was hug my child that warmed my heart

      1. Hi. I am on here because I too am having surgery sometime in the near future, being switched to opiates ahead of time sounds like a great idea I had an emergency appendectomy while on methadone and it was no fun. I definitely plan on cutting way back I am prescribed 2 4 mg tablets a day but have gone a day or two without them without thinking about it and without feeling bad. I typically take one if my back is hurting if I’m tired or cranky I don’t feel like I have to take them. Maybe I’m Wrong but I really don’t think it will be hard to cut back or stop.. I’m guessing that addict In me is preventing that from happening LOL. I read that Subs are completely out of your system in 3 full days does that mean if I didn’t take them for 3 days and had surgery opiates would work? Thanks for the great info Dr.Fudin!

  45. I have a surgery scheduled next week for a hip replacement and I’m not at all feeling comfortable at this point about how my pain will be managed. After meeting with my surgeon and bringing this issue up, they set me up with an appointment with the anesthesiologist to discuss the problem of me being on suboxone and pain control. The anesthesiologist seemed really suspicious when I told him that I’ve read that higher doses of opiates are sometimes needed for patients like me on suboxone. He said, “I can’t just increase the dose, especially if you’re already taking one that is stronger than morphine.” I really don’t think he understands how Suboxone works, but he also didn’t seem much interested in learning about it either because I gave him my suboxone doctor’s number and he said that wouldn’t be necessary. I don’t know what else to do. I’m really afraid I’m going to wake up after surgery in complete agony.

      1. Hi Dr Jeffrey can u help me?

        Sarah Jerge
        March 3, 2018 at 2:29 PM
        I am prescribed 50mg vyvanse and 2 1.4zubsolv per day. I do not take anything else illicit or not prescribed. At my sub dr I’m drug tested regularly my last test was + fetanyl heroine and cocaine. I’ve never done fetanyl or heroine on my life and haven’t done cocaine in atleast 10yrs and Im a total homebody no way this was put in a drink or something crazy. A few years ago I had cocaine show up too and same meds but not taking anything else, how can this be? No one believes me but I seriously have not done any drugs and feel like I could be totally screwed ever time I take a urine test bc I can’t explain these + results but know that I haven’t used anything. My daughter could b taken away and I’m not lying I’m so sad. It’s been over 30 days since the test so I can’t do anything ab it and my sub dr discharged me and recommended inpatient. This isn’t right I’m so sad and don’t even know who to band at I kno he has to go by the tests but I kno I didnt do any of those drugs.! This sucks.

        I wouldn’t reach out and waste ur time or my own if I were using these substances I’m afraid trust this result may persist in ny urine screens if I can’t get to the bottom of it. I was also told that all of my other tests were diluted and impossible to be human because of the low sub level, I have never done anything like this bc I never was trying to hide anything any advice is really appreciated.

        1. Hi this probably won’t help but one of my tests came back positive for something but it wasn’t a street drug it was a prescription drug and it showed up because of a combination of other prescriptions I was on. Sounds like it’s a little too late for that for you. And it also sounds like that’s not a possibility but I thought I would throw it out there. Good luck maybe you can find another sub Dr I think they’ll take anyone they will here in Florida anyway and I don’t think they need your medical records. Hope this helps

        2. Hi hun,

          This has happened to me before. I get tested every appointment (2-3 weeks) and I am fortunate to have a very great doctor, to the point that I would tell her if I took something, a urinalysis would not be needed. However, back to the point…I am not sure how your clinic works, if it busy there could have been a mix up in samples or entering the results on the wrong persons documents. My doctor also told me it could be unconscious contact, like on a plate or napkin at a restaurant. It is crazy because years ago I did take cocaine and it did not show up in my test but when I didn’t 6 months later I tested positive. A lot of docs are numb to excuses (the best one is “i ate poppy seed bagels” lol) but even then it may be true the doctor may just “over it” IF you are sure you did not take anything and your family is at stake demand a blood test and hair sample test.

          Come in everyday and leave samples, take another urinalysis at another office.

          I am a mom, I can feel your urgency.
          I wish you the best of luck hun, i hope it works out. Stay Strong

  46. Hi Dr (and friends in recovery),
    I am really glad I came across this forum and have a question before I move on.
    I am having surgery in 5 days. I have just stopped my Suboxone (2mg 3x a day) yesterday and started Morphine 15mg 4x a day (middle of the day yesterday and they will adjust if needed). I definitely feel the morphine, but feel like I am in withdrawal too (muscles mainly). I have been on Sub for over 5 years. I have made it clear that I want to be off of everything after this.
    Sadly it took a few months to be taken seriously that something is actually wrong with me, etc (likely endometriosis, hopefully nothing more serious). I am completely bedridden at this point and had to voluntarily/temporarily place my son, who has special needs, in foster care, a month ago, until I am well, because I am so sick. I suffered in pain with no answers because of being a suboxone patient. Thankfully my addiction medicine team (that I’ve had since the beginning) has advocated for me and I am hopefully on the road to getting well.
    If one good thing has come from this, it is that I have decided that I no longer want to be on Suboxone after this, even after 2 or 3 failed attempts at weening off over the years (didn’t relapse just felt horrible).
    My recovery is extremely important to me, which is why it is hard for me to reach out when I’m suffering in horrible pain. I woke up this morning and thought, well, “do I need the morphine?”
    “Yes dummy, you’re not going to get up to pee until it has kicked in, it is prescribed to you by a pain management doc who needed confirmation from your gyn surgeon that you’re actually sick.”
    I would just like to know if the aches are going to subside once sub is out of my system (how long) etc.
    Thank you.

    1. PS also don’t want to be on pain meds after this either (hoping to be well and off of all of the above ASAP). Before I was in recovery I was in a dark place in my life (and although originally prescribed pain meds) stayed on them much longer than needed and was in a very deep depression, so was obviously taking them not for their intended reason.
      I am currently hell bent on resuming normal life with my son and have told all of the doctors since day one that I’ll be running a marathon once they fix me =)
      I am even keeping a list of what I don’t like about being on pain meds in case anything creeps up along the way (just in case; although I’m at a much different and better place in my life now and have a much different perspective on life. I’ve had to overcome a lot during my recovery. This is just another speed bump)

      1. Hi , I just read your statement. How are you ? Did you find out what was wrong? I have endometriosis and it makes me want to kill my self on some days . I hate life like this . I feel trapped into always needing something for my pain. I’ve been on Suboxone for 3 years . I pray I can come off one day .

    2. Update,
      I have an amazing pain management team. I believe they may have been unsure how to approach me at first because I had been a suboxone patient for 5 years. I made sure to keep them in the loop about how I have been feeling, including initially feeling like I was experiencing withdrawal in addition to my debilitating pelvic and abdominal pain.

      First, 15mg of morphine ER was added to my regimen 3x a day. My pain was still not adequately controlled, as I was still at the near-passing-out level when doing any activity such as showering or attending a doctor’s appointment, having labwork done, etc. Initially my doc told me to stay the course. I thought this over, and after a horrible night of pain last night, and almost going to the ER. I wrote him an email describing exactly how I felt. The nurse followed up this morning saying he would return tomorrow. I requested a call from the on-call doctor, as my surgery is tomorrow.

      Doctor on call and I had a long discussion about what I am dealing with, the fact that my surgical recovery is now expected to be longer than initially expected, and that yes, my pain needs to be treated aggressively. He has doubled my morphine ER dose, and for today taking IR morphine 6x a day instead of 4, tomorrow switching to dilauded. He has also prescribed a narcan Nasal spray in case of emergency because of the high doses of medications prescribed. He does not think it will be needed but wants it to be here just in case. I am very grateful that my pain is being treated, and feel comfortable that I will not be suffering uncontrollably after surgery.

      I have a completely new respect for pain medication, for the doctors and pharmacists that prescribe and manage it, and the people who rely on it for quality of life.
      I was extremely depressed when I was struggling with substance abuse over 5 years ago. There was one pain management doctor that absolutely should not have been prescribing me these medications. I was mobile, pretty healthy, young. I was not taking them for pain after a certain point.

      When I got off of them I swore I’d never take pain meds again unless I had cancer, and that anyone who did was weak.

      Then I got sick, with something besides cancer (99.99% sure.) but still debilitating. I treat my pain meds with extreme caution. When the doc asked me to count my meds so he knew what prescribe, I had nothing to hide. That was a good feeling! I will fortunately/hopefully not need these for more than a few months at most and then taper off.

      Looking forward to updating everyone on my surgery and then eventually my tapering off of meds. Cannot wait to be healthy again!

          1. Dear Fudin, I have been on Suboxone with Naloxone 8 mg. 3xd…I am having elective surgery soon and am concerned as to whether I should taper down and when to do so, etc..to find an effective pain management regime prior to, during, and post op….I have read some of your literature and you seem to provide the most accurate information and hope you can give me a better insight to appropriate treatment…I appreciate any advice! Heather

          2. Hi,
            I am having surgery on Jan 26, 2018 for endometriosis and an endometrioma cyst also needs to be removed. The cyst is 8 Cm and has now increased the time of the surgery from 90 min to 6 hours. I have been on suboxone for 2 years for chronic pain. I am in withdrawal due to my tapering down. I have read horror stories about being in opiate withdrawal pre-op. I am scared and my doctor said it’s not a problem. Nobody will help me. Please I need help!

          3. Do you have a number my doctor can call? He doesnt know much about sub and i had elective rhinoplasty and neck lipo friday. They left me with oxycodone/acetaminophen 5/325. When my bf called ti let them know i was atill in severe pain, he said hed call in ledpro. That has not helped either. I cant eat ans can barely drink because of the pain. Ive been taking the oxycidone every 4 hours since i left the hospital and somhow, ive been withdrawing. But no help with pain.ive been onsub for 7 years.i need help. The pain is unbearable

      1. I am hoping you are doing better now that months have past. I am in a similar situation since 2007. I was finally dx with endometriosis and vaginal fibermyalgia (spelling) after bleeding out and passing out. Surgery after surgery and being treated with muscle relaxers, the pain increased. My belief is do to the surgeries and scar tissue. I got to the point where I was treated with Percocet 7.5 3x’s daily. It took about a year until I got to the point where I became obsessed with it. Not wanting to take more but splitting in half and then more and taking them in weird times. I thought this is how you don’t become addicted. It became a ritual and then to the point my anxiety would be all day. Then to the point that I was taking more than needed bc I had broken them up and would take a crumb here and there and there. Then I would take 2 7.5s at a time. At this point I could still go days without bc I would run out. Then I had a hysterectomy which they botched. Pain increased. I found out my endometriosis was destroying my bladder. It I sliced like the busiest road map and I bleed out. So now my pain pill obsession increased. I was told I would be on Percocet or fentenyl for Ever. I was so worried and would always make statements that I don’t want them but I was blabbering basically. After months I said I want off. Dr warned me but I said no more. We started the tapering process and bc of my rituals, didn’t work. Now I’m at the point of opioid addiction (mental/worse than physical) always running out. I did have the withdrawals for one week that was death to me. I was so upset bc I’m a therapist- not an addict. The anxiety from my love HATE relationship with Percocet was destroying me. I did go to the ER bc I didn’t know what was happening bc of course, a wealthier, highly educated, white girl from Ohio could be a drug addict? Ohhh I was! They were treating me like a piece of crap. I said I don’t care what they do for me but the pain has to stop and my sickness. I knew it would be a Percocet. I did get a few. Felt better and called a dr to say- I’m done. Bc my addiction was in my control and mainly a relationship I hated, the dr said I don’t need in a program but that he could manage my pain with Subutex, not Suboxone. The moment I took 2mg, my life changed. No more anxiety, no more physical/mental torture, no more having constant thoughts of when I shld take my next pill. I cld have 2 mg and go about my day or two days. I was supposed to take 8mg a day so they lasted months. Now to present after being on them for 3 months. I am in pain management mainly for pelvic therapy, so I thought. I did this in Ohio bc now my hip is out of place from endometriosis attacking it. Best therapy but I guess Vegas doesn’t know that bc the dr said nope only another procedure or pain meds. I said I’d like to continue with Buprenorphine. He refused and gave me Percocets after I told everyone I do not like how I feel on them. Dr said I can’t always get what I want. I got the script and the moment it’s in my hands, that anxiety and ritual began processing. I took one and nothing-bc if Buprenorphine. I put the rest in my medicine cabinet Incase of breakout pain down the road and continued my Buprenorphine. After I was out I went back and said I refuse more Percocets. Dr agreed to my wishes but said there is a procedure I HAVE to do as well. I said no more poking and prodding but he said he knows best and I don’t, while screaming at me. I actually do know more bc it’s my body and I am a huge researcher-part of ritual to be that one who doesn’t get addicted. But I hesitated and agreed. I took the script to the pharmacy and when they gave it back I realized the dr now wrote it for 90 10mg Percocets! I told the pharmacy it was wrong and I won’t take it. They refused to take back. I called my insurance and they said sorry, called dr and he acted like it was so crazy mixup. I told the pharmacy how dangerous it was to let me leave. I wouldn’t take them or sell but they don’t know me. After an hour, I had to leave with them. I ran straight to dr and said to destroy. They wrote the correct one, like that ass didn’t know what he had done. This was a nightmare bc insurance refused to pay since they paid for Percocets. I paid. Sooo today- I had the procedure even though I was scared and hate my dr. Remember I have endometriosis and severe IC (bladder) and hip issues. The nurse said ok so where in your back does it hurt? What the hell??? My back, my back isn’t the problem. I explained the procedure and name (long) but u go up vaginally that the dr told me. The nurse said no, it’s steroids in you lumbar and spine. I panicked and the nurses went to check, confused themselves. Came back, still no dr, and said well we aren’t sure but dr said it should help. I said, how, they shrugged. I’m already with iv andon meds to begin to sleep. No getting out of this. I said no pain meds but found out after, fentenyl was administered. I woke up and left crying and scared. My husband took pictures of my back bc the nurse showed me where the needle was going. All on lower area. Guess what?! I have bandages up by my neck, middle of my shoulder blades and 2 on my spine. Now my back hurts!! Think my pelvis, right side by ovary and bladder feel better? That would be a no! My point is, I guess, that patients, more than Drs are blamed for addictions, and misuse, and are never believed for pain that can’t be seen by the naked eye. My experience from the past 10* years tells me we need to be more aware of what our body tells us and research everything. Always ask questions- doctors aren’t God, although don’t tell them. It’s extremely scary. Ps. I have to do this every week for the next 6 and then all over in less than a year for ever if I want relief. I want to take my 2mg a day-get some actual pain management with pelvic and physical therapy but I no longer am in control of my wellbeing. That dr God is bc obviously he knows best and NEVER screws up.

    3. The only med I’ve ever found to counter bupe is SUFENTANYL. It is an analogue if fentanyl but like 100 times stronger and literally blows the suboxone out of ur receptors. Ask for it. Only one stronger is for elephants (yes I’m serious) and it’s carfentanil. It’s like 1000 times more potent than sufe tanyl. Ask it can not hurt and G-d speed.

  47. Hello, I am a suboxone patient and take a total of 12 mg per day of the sublingual films. I just had emergency gallbladder surgery. I was able to be off sub for approx 36 hours prior to surgery with no w/d. I had immense pain immediately after surgery for which I was given a total of 4 mg I’ve hydromorphone over a few hours time. All docs involved were aware of my situation. My pain has been controlled with 1-2 7.5 norco q4-6hrs. I’m now 40 hours post op. I haven’t yet had any w/d symptoms from the subs and pain is pretty much ok. I’m very sore but it’s tolerable. I have been on sub for 3 years. Would this be a good time to come off subs completely or am I still facing some nasty w/ds? I’m ready to move forward in life without needing a crutch. Thank you!

    1. Hello, Ready to be free!!!
      Omg!!! I hope you are doing well! I also hope you read this and respond! I just rwad this article and I’m in a full blown panic mode!

      I’m having my thyroid out on Wednesday. My last dose of suboxone was around 10am this morning. I took 4mg. I’m prescribed 4mg twice a day, so 8mg a day.

      This article makes me feel like I should reschedule my surgeon as now I’m worried about getting adequate pain relief or being overdosed after getting home…like something he mentions in this article!

      I’ve been on suboxone for almost three months. Please can you give me some advice as it seems you had some success with your surgery and pain relief?

      Any info or advice you have would be greatly appreciated.
      Thanks
      Erin

  48. i hope you don’t mind me writing again, I must have a hundred questions or more. do you know if there is any info on using benzodiazepines; clonazepam ect. after sergery in combination with opioids to control pain? how long in advance should a person be completely off suboxone 8/2; ? I mean from the time they took the last film till the scalpel touches their skin for a hip replacement surgery so that an opioid pain killer will work completely the way it’s supposed to as if you never took bups at all? the v.a. hospital here in West haven connecticut has never treated my pain properly. I’m thinking: it can’t just be me. is there any way for somebody to look into this? i found they are taking patients in pain, even patients on opioid pain meds are steered on to what they say is a (PAIN MANAGEMENT CLINIC) switched to or given bups and find themselves stuck in a (SUBSTANCE ABUSE PROGRAM). urine tests, come in every week or month or whatever they say or suffer! clean urine, complain it does not help the pain, it does not matter.you are stuck! (follow the money) i think a deal was made somewhere behind closed doors and someone is making A LOT of money!!! if I told you how much bup goes into and leaves this hospital there is no way you would never ever believe me! i know people that work there. it might be a godsend for junkies to take the rest of there lives but it’s a nightmare for people in PAIN. i have so much more to say do you mind if I write back again? you are the only one I can get to listen. i have allot more problems than my hip replacements. motor neuron disease, discs in spine, ect., ect. i will at least let you know how the hip goes. JO€

    1. I don’t know if I have to register to reply but I found this by googling suboxone during surgery. I have hip replacement surgery end of October and terrified. I take one film 8/2 mg sub in a.m. For two years. Pain dr plans on Only using suboxone. How does that work! Being wide awake while being cut into! Does anesthesia work? Do you think I should switch Dr’s?

    2. YOU ARE NOT ALONE!

      I think they forget that we were in pain in the first place, legitimate life altering pain, I am not here to label or judge someone who got hooked without a script but I did, and most people I know going through this did. They want to lump us all in as opiate abusers, but why is everyone forgetting that there is a legit diagnosis and pain problems that initiated that first R/X

      Good luck sir! I feel you!

  49. i am a 59 yo man. wt. always about 145 lbs.i have 2hip replacements that were done at the v.a. hospital back in 1979. i have always been a very honest person. i told them i did a little partying when I was a kid ; and they have treated me like a drug addict ever since! my left side just blew out about 2 weeks ago and it is painful as hell! i have been on suboxone 8/2 3tad for a year or so which does almost nothing for the pain unless i sit still if I can find a comfortable position. i have been very naive and not knowledgeable about this drug at all! i am scheduled for surgery soon (no set date). there’s not too much that has ever scared me in this world.(I AM VERY SCARED)! especially after the way I am being treated now. i forgot I am also on lyrica 200 mg 3tad that seems to help as much or more than the bups. nobody will tell me anything besides (don’t worry mr mayo weel take care of you). please give me some advice. (a vet getting the most horrifying treatment by a V.A.HOSP. you can imagine!)

      1. I just need a knowledgeable person to listen. My situation is hopeless. At 830 am in the morning, I will be released from the best form of legal relief I’ve ever had. So if someone can explain this: I am on 12my of sub film per day. Also, I take 3200mg of gabapentin a day. Lisinopril am plodipine, estradol. I take my Med religiously. This morning , I drove to my doc. Attempting to hold my urine for my drug screen. I didn’t make it until they called my name. I had to urinate. Five mins later they hand me a cup. I urinated. I can pee every ten mins although a small amount, I managed. The doctor came in and said I had NO sub in my system! None. Also he showed me that I had none the month prior. Of course I say impossible! He sounded irritated and showed me the results from last month. 0 sub but my gabapentin showed up. I commented that all I could imagine is that one I emptied my bladder. I was handed a cup 5 mins later. And I thought maybe the metabolites had not had time to pass into my bladder. It’s all I could think that would cause that. Instead of doing the only thing that would have proven me honest, testing me again then. He’s asked me to return in the morning, take my meds in front of the nurse, wait 30 mins and test. That will not prove that I was honest TODAY! If it shows, which I’m sure it will after a 30 min wait, then I’m a liar. I am not. I take my sub religiously. Now my stress is compounded by the fact I’m about to head in for neurosurgery for a massive pituitary Adenoma. Will have to go into this suffering when the laws that protect everyone but a chronic pain patient, tie a doctors hands here in Tennessee and force a person with long term severe pain to go to a sub doc for whatever amount of relief it can give an individual. Myself, I’d say about 40% relief of pain compared to say Oxycontin which provided about 70% relief. For some reason legislators can’t grasp that a person in the throes of chronic pain. Eventhough they exhibit NO addictive behaviors, will still become physically addicted to their legally prescribed pain meds. In this year 2017 the first sentence of a drug control law should be to protect those they were invented for. We deserve it as a right! To not be allowed to loose our quality of life and crawl from doc to doc begging for relief while being labeled a pill seeker. So in the morn, I’m back out there with no help all because my Dr. Truly believes I do not take my subs! If only he could see me without at least them as relief. Then he would know. Something is NOT right with my drug screens. I need help. I know there is none! I’ve fallen through the giant crack created by big pharm lobbyist and those who meant well as they were writing these laws that tie my doctors hand and label us all pill seeking addicts. Oh well. Here I go again! Why even invent pills that give relief!? Then get mad when people get hooked. Then jerk their meds away. Then allow them to find a sub doc that’s only allowed ,by law, to write you a 9$ a dose sub. Because the 2$ per dose ,subtext is illegal for him to write for you due to the absence of naloxone. Which. In no way. Stops an iv user from shooting subs. All the iv users laugh about that lie. So the suboxone is all your allowed to have, the most expensive available. And the only drug in history to not open up to a generic for at the end of the mandatory 7 years they must wait before a generic can be made. The only drug ever!??? The one that solves the most problems with the least cost! Oh my, how I dread in the morning. My back pain and legs are so bad without my meds. No lifestyle is possible. My poor six year old grandaughter gets the short end of this. I’ll be too stooped over for pta and chaperoning field trips. Life as she knows it is over. But who cares,? No one who can change anything. Thanks for listening.

      2. Hello!

        I am on 16mg subutex once a day.

        I have surgery tomorrow around 5:30AM.

        The last dose of subutex was taken two days ago mid day. So I once surgery happens it will be 48+ hours since I’ve taken any beupenorphine. And of course, naloxone has no part in this conversation. I am wondering what I should tell my sergeon tomorrow morning, and wondering what might end up happening to me: what medication will they give me while I’m in surgery? And what medication will they give me after surgery? Will it be any different if they know or don’t know about my subutex use?

        I do not plan to take beupenorphine post op, but will continue use and recovery after I am healed.

        I hope someone can get back to me.

        Thank you,
        Brooke

  50. I have a question. I switched from suboxone for chronic pain to generic bup (no naloxone) before my up coming surgery. I thought it was only the naloxone that blocked pain meds after surgery. I had a hip surgery on suboxone and it was a nightmare. I cannot go off buprenorphine because every time I have tried, I had a really bad reaction-actually a psychosis. Do I need to be prepared for poor pain management post surgery even though I” not on the naloxone part?

    1. Scared; The naloxone portion of Suboxone is not absorbed. It is placed into the product to [presumably] deter people from abusing the buprenorphine, and if naloxone is injected, it will in fact block opioids. FYI, buprenorphine is a partial opioid agonist which means it does have some opioid activity. It also has some antagonist properties, and it is more highly bound than other opioids to the receptors where al of these drugs work. Buprenorphine will have some activity to block pure opioids such as morphine.

      1. Hi, I’m a healthcare provider and as only some doctors in my state have certifications to prescribe suboxone and subutrex its not something I was very familiar with. At the new facility in which I work we have an OB who delivers women on these medications. They do a standard spinal and the OB encourages the use fentanyl and duramorph as is usually done. However postop the patients are only managed with NSAIDS until their partial opiate agonist is resumed. I asked what is the benefit of giving narcs intrathecally but not iv. It was then explained to me that these meds block peripheral mu receptors but not centrally so that intrathecally they still have some benefit. I am having a hard time finding literature to support this. I am attempting to understand it so I can provide good care to these patients. Can you offer any insight to utilization of this class with the pregnant pt?

        1. Merry,

          The statement ” It was then explained to me that these meds block peripheral mu receptors but not centrally so that intrathecally they still have some benefit” is incorrect. Buprenorphine readily passes the blood brain barrier and is more potent and has a higher binding affinity than both morphine (especially) and fentanyl. The peripheral receptors are not blocked so much by naloxone because it isn’t absorbed orally although some is absorbed transmucosally. Any naloxone that trinkles down the the GI tract will block opioid receptors within the gut. The bupreneophine will provide good analgesia because it has a very high mu receptors binding affinity, but there is a plateau on analgesia and it will protect againt respiratory depression because it passes the BBB and has a higher binding affinity than even naloxone.

          That said, by directly flooding the CNS receptors with fentanyl by the IT route, you will get some “on-off” competitive binding with buprenorphone because their lipophillicity is similar (think about the starting doses – almost identical). Duramorph is a waste of money! See Fudin J, Srivastava A, Atkinson TJ, Fudin HR. Opioids for Surgery or Acute Pain in Patients on Chronic Buprenorphine. In Aronoff G, ed., Medication Management of Chronic Pain: What you Need to Know. Publication pending, Trafford Publishing, 2017. The book was just published last month and is available Medication Management of Chronic Pain: What You Need to Know.

          I hope this helps.

          1. Dr jeff.
            Its james from yesterday morning. I agree about consulting another surgeon. I’ve made several calls. My flma paperwork is allready rolling on this. I’m scared i may loose my job. That said. Here in arkansas were told were the leading state in the us for written prescriptions of pain meds. I’ve hot s dead end road ever doctor I’ve called. Everyone is so judgemental and knows nothing at all about buprenorphine. It fathoms me how we can get a pain pill with a scratch on out hand here. My only hope is to try my behest to cut down 2 days early. I cant tottaly quit. I’ve asked to be givin short acting small dose opiate to help me from withdrall for 5 days prior to surgury. Omg !!!!! They say no you subutex doctor says you only need 24 hours to quit before surgury. Thease people here do not care. They been telling me at the clnic I go to for months now. Oh mr worley when it’s time well work with you doctor hand in hand during your surgery. Lie. Wont even get a doctor on the line. Only a CSR. But they’ll gladly take my $240.00 a month for my maintenance they call it. My insurance will not pay visit. Itll pay for 2 strips a day only. But i just get the subutex tabs. Their $2 a peace at pharmacy. I see the people for scans on 17th to see if I’m health enough. I’ll tell them what’s going. I see doc the day before surgury and I’ll definitely have it in his notes i need to see anesthesia before my surgury. But it’s at 5:00 am next day. I dont know what else to do. I have very good insurance and it pays %100 for all. I was needing a bylatteral but changed it for sure. Like i said. 3 days prior I’m only going to do 1- 8mg tab each day prior. But I know that’s not going to work. I’ve done my research. Heck i know more than my doctor and my segeron does about the med. Including the pharmacy

      2. I am going in for a blood transfusion in today so I’m wondering if they will need to match a blood type with suboxin in it because I take half of 3 mg daily

          1. Mr jeff. Good morning. I’ll get straight to the point. Suboxone saved my life. About 2 years ago I entered a program in hot springs arkansas. At that time I was opiate tolerant. 200 mg oxy a day to keep from being sick. Suboxone saved my life. Due to insurance reasons 2 months ago i had to start taking generic for subutex. Buprenorphine without naloxone. I’ve talked to everyone for moments now in theory because I need both knees replaced. I. Only 43 but knees are shot. Everyone telling me they have had sugury but their doctors took them off subs 5 days prior to surgery and gave them light opiates for those 5 days to keep from withdrawing and their surgeries went fine.
            Thst said. I’m schuealed for knee replacement July 26th 2018. Today is the 13th. I hear from my surgeon nurse yesterday very rudely that their was no need for me to quit my my subutex before 24 hours before surgury. No need for and pain meds before surgury at all. That she had talked to my clnic and they said I’d be fine. Knowone cares at all and dont even seem to listen to me at all. If i dont have this surgery I’ll prob loose my job because I cant hardly walk. Not to mention my herniated c7 disc in my neck. I’m scared to death and dont know what to do. Please help me.
            Phone 501-249-5814
            Nokieworley@gmail.com

          2. James,

            You always have the option of looking for another surgeon. At the very last, you’re entitled to a pre surgery meeting with an anesthesiologist to discuss this. See the following links and feel free to share with your providers.
            http://paindr.remitigate.com/wp-content/uploads/2018/02/2017-chapter_Buprenorphine-and-Surgery-Whats-the-Protocol.pdf
            http://paindr.remitigate.com/wp-content/uploads/2015/09/2015-01-04-FINAL_UPDATE_BUPRENORPHINE-CHAPTER_WM.pdf

        1. The active therapeutic ingredient in Butrans is buprenorphine.
          Suboxone contains buprenorphine for therapeutic purposes and naloxone to presumably protect against abuse of the product. The naloxone is not otherwise intended for any therapeutic purpose.

  51. Love the info here. Personally, my experience with pain and subutex is understood by, if not doctors. Over the past 40 years, I have produced at least one kidney stone per year in excess of 1 cm, and have had to deal with the associated pain.

    I take less than 1mg subutex daily and when I show up at the ER in renal colic from a stone, I explain that adequate pain relief will take abnormally large amount of painkillers. In the ER, the preferred treatment is IV toradol plus dilaudid. Because I’ve managed to keep my subutex dose very low, I can achieve relief, usually. On one occasion, I need to be admitted for pain control and a PCA was administered. I went through 75 mg of dilaudid that night and had the stone treated the next day.

    I returned home from the hospital today, after having a portal shunt adjusted. Prior to the procedure, the doctors told me they had a problem, that fentanyl wouldn’t work due to the blockade effect and that they didn’t like to use general sedation with propofol for this procedure.

    Only because I was able to effectively communicate my certainty that enough fentanyl would overcome the small subutex dose, and that I would absolutely tell them if I wasn’t receiving adequate pain control did they proceed. They ended up using 350 mug of fentanyl and some versed and I was fine. They thanked me and acknowledged that the understanding of subutex is not nearly well researched enough.

    Subutex is a good drug, with benefits not yet researched. It’s antidepressant efffects are noted in small studies of refractory depression but it works bettter than any ssri for me, but my depression isn’t severe.

    I believe suboxone is stupid, and that the addition of naloxone is not only superflouos, but dangerous in certain situations. If there were a method to reduce the half life of buprenorphine, it would be an even more ideal drug to treat dependency without the risk of inadequate analgesia in emergency situations.

    1. I’m having elective gastric sleeve surgery in 4 days. My doc that rx’s my suboxone (4mgs daily) told me to stop the suboxone 6 days before surgery and has given me Percocet 10 mg to take 3-5 times a day. Do you think being off suboxone the 6 days and on the Percocet will be enough time for the suboxone to be out of my system so I will be able to have pain control post op?
      I had surgery 2 years ago while on suboxone and was told to stop the suboxone only 3 days and wasn’t given any opiates before surgery. It was a the worst experience of my life. I woke up in in recovery in severe pain for hours nothing would touch the pain due to the suboxone still in my system.
      I hope I’ve got it covered this time and my post surgery will go smooth. I would greatly appreciate your input on this.
      Sincerely
      Susan

    2. Mickey, is the reason you take the subutex primarily for depression? I am wondering because I, too, was recently prescribed low dose subutex for refractory depression that has stopped responding to SSRIs which I have taken for over 20 years. TMS, ketamine and ECT were also not effective. ALSO, in common with your own story, I have chronic kidney stones. I am due to have a stone broken up in one week, and I am wondering what I should tell the anesthesiologist regarding pain management. My subox doc said I can just take more subutex AND my post op meds (oxycodone). I don’t know if it’s because I’m on low dose that he said that or not.

      Mickey, I was wondering if I leave my e-mail address here if you would please contact me. I am trying to find other people being treated with subutex for depression so we can share info and experiences. My contact info is annnonm@gmail.com. Thank you.

  52. Hi i just started back on the suboxone yesterday but at this time I’ve got gal stones so was taking oxy condone for the attacks. So because you can not mix these 2 what do I take for the pain of an attack as this pain is unbearable. I’m really adamant about gettn the bladder out as its in your body for a reason and people I know who have had it removed still encounter same pain. So the only thing that helps with gal attacks is the 40mg oxycodone I take.
    Can anyone help with any information on what information i can do as I’m scared I could go into with drawel

  53. These posts and article references by Dr. Fudinhave been invaluable to me prepping for my surgery, however the unfortunate reality is that most surgeons and even anesthesiologiats are unfamiliar with buprenorphine, subs, etc. I am currently on a 15 mcg Butrans patch for severe hip, sciatica and disc pain, and have been on the patch for about 4 years. 9 years ago I had breast augmentation, and six months later a revision. Last fall, one implant deflated out of the blue. We had just finished building our dream home literally two weeks earlier and our finances were drained, so for an entire year I wore a mastectomy product on one side to hide the disfigurement. It became increasingly painful, so I decided enough was enough and scheduled my surgery. I explained the Butrans patch as well as possible to my surgeon, who responded that since I was already receiving pain meds via the patch, I should be fine with low dose codeine after and Tylenol. I asked him and my prescribing doc (who is a family doctor and is not well versed in Butrans either) if I should stop taking the patch and both said no. On surgery day I was able to speak with the anesthesiologist, who also didn’t quite seem to “get it”, but prescribed my Oxycodone 5 every 4-5 hours. My surgery ended up taking 3 hours- the old implants were removed and I had extensive sharp scar tissue and capsular contracture. He then had to create two new sub muscular pockets for the new implants. When I woke up I literally thought I was going to die from the pain. The nurse gave me whatever she could through my iv until I was able to get into the wheelchair and go home. Since then I have been in constant pain and unable to move a muscle above my waist. My doctor switched my script to dilaudid 2 mg once every 4-6 hrs, which has helped a little. He said at my post op he isn’t sure there’s anything else he can do. It has been 3 days post op and I can’t believe I’m in such severe pain still- and I’ve had five children with no epidurals. I don’t know if I should call him again (although now it’s the weekend), or go to the ER (seems dramatic). I still have about 15 pills left but don’t want to take any more than I’ve been directed to. Had I known it would be like this, I would’ve stopped the patch a long time ago.

    1. Dear Fitmomof5,
      I am truly so surprised that your doctors did not ween you off of your patch!! I simply can not fathom why??? FYI…If your going to have any more surgery…I am saying you should stop your patch..Like if you know the surgery is in a month then you need to start weening ..I know you will be in pain with the sciatica as well etc..etc..I have the same problems.. But when you go and get cut on ..those patches are going to block your opiods..I hope I spelled that right.. opiates..Lol.. any who…Yes you have to stop otherwise the pain medication that they give you before & after your surgery will not work on you..YOU WILL FEEL everything!!
      I am so amazed that your doctors do not know this..If I was you I would be in the market for a “competent”doctor!!! I mean it!! I simply can not for the life of me understand why they would do something like that to you!! That is so horrible!! Either way I know that within that 4 to 6 weeks before surgery..Its gonna be hard for you but consider after your surgery and you want the pain medicine to work properly.. Listen to me I am not a doctor but I know all about soboxone etc.. Good Luck next time..You should be asking the anesthesiologists where he got his degree..Like WTF!! is wrong with those people??

  54. sorry forgot:
    so anesthesia seems to work fine with higher doses. – well for me with a relatively small dosage.
    But the pain treatment with opioids does not work afterwards while on suboxone. why is that?

    i figure, the amount of suboxone makes a big difference, too; wether you can top it with medically induced drugs.

  55. If the opioid – dose is high enough- and the buprenophine – dose low enough, the opioid still wins. I cannot tell you chemically, but as a suboxone – recipient, who had 4 surgeries and some relapses with heroine.
    The anesthetist “just” needs a higher dose. Probably there are still some receptors left- and the relaxing effect of opioids are – as you have shown- way stronger than buprenorpine.
    The real big issue – just for the patient- comes after the surgery. if the receptors are blocked by morphin etc- buprenorphine kicks them off and somehow does not connect itself. The withdrawals are unbearable. You have to wait until the last bit of the medication leaves your system-so when withdrawals start- only then you can start subxone again. it´s really awful. the reason it´s crafted that way is to punish the patient for going out of line, but for what price?
    i recently had an accident, a car drove into my bike. what happens if you cannot tell the doctors your story?
    Your idea to let the patient stop his medication may make the most clinical sense, but there is an important reason, we take those drug. leaving the patient alone- and then giving an ex-junky opioids and sending him out will mark the path backwards for him.
    Thank you for delving into that subjects. It feels that most doctors do not care about the fate of this black sheep- they brought it on themselves, let them rot. And thank you for explaining it very basically.

  56. I split my 8 milligram Suboxone in the fours I can take one 4th and 6 hours later take pain medication and it works just fine just recently had a kidney stone removed

    1. Hi Robert. I just started back on suboxone program yesterday but for last 9 months I’ve had gal stones and I been on 40 MG oxy condone.which has been the only medicine to relieve the pain of a gal attack so when I was reading ur comment. Maybe there is a way I can use the oxy condone for when i do have an attack. As I’m really adament in getting the bladder removed. I am surpose to stop the oxy condone but when having a galattack the pain is unbearable. Do you have any suggestions as is know suboxone don’t help with pain.. is could go on methodone but then ist gives me options to USA which ist not what I want. Any info would be much appreciated.

  57. Does the lowest Butrans patch, 5 MCG, still cause other opiates to not work and could it still cause precipitated withdrawals even in such a low dose?

    1. I’ve recently had emergency surgery- my appendix burst last Thursday and I went to the ER. I’ve been on 14mg of suboxone since April (and I’ve also gained 65 pounds since then). My last dose of Sub was on Thursday morning-8 mg. I haven’t taken any since, my pain was relatively controlled in the hospital. I’m about 60 hours post surgery and on day 5 of no Sub. They have me Vicodin to take home and I’ve been taking Oxys. Tonight I’m sweating, having cramps, and I don’t feel well at all. Could this be withdrawal from Subs still or possibly a problem with the surgery I’m wondering. I definitely am not feeling the pain meds working so I suspect the Sub is still working.

    2. I had a complete Hysterectomy last year. My OBGYN knew all the meds I was on! He told me to take my suboxone on the morning of my surgery.. After I came out of the operating room the Dr. Told me that the anesthesiologist had a fit because I stopped breathing a few time.. I never hurt so bad in my life! The pain was worse the giving birth, I hurt so bad that I was out of my mind and told the nurses the pain meds were not helping and I just wanted to die.. I remember the pain and having morphine shots and screaming because the pain so intense.. I figured now since I’ve had procedures in the past and never felt pain like this, then it must be the suboxone I was on..

      1. YES INDEED Ms.Shellis, That is unbelieveable!!! I am so amazed these days at the number of incompetent doctors who are out there.. People have your doctors checked out!! Its ok to do that!! A Good doctor does not mind if you ask questions!! I recently had a nightmare appointment with an orthopedic surgeon..was very ignorant..I got up and I left I told the people thank You and I walked out! You do not have to take advice from a doctor if he is wrong…You have the right to see whomever you please! Thank God I did not continue to go there,..You see Its ok to research your doctors,procedures..hospitals & clinics..etc..There are many great institutions out there.. But remember there are also a lot of docs out there who simply are too rushy.incompetent,careless.& just plain stupid..So BEWARE!!!

  58. I am struggling with this very issue. I am going to an oral surgeon to have all four of my wisdom teeth removed..some which are sideways and stuck in the bone. I have seen someone i know go through this, without this added complexity, and even on very high doses of percocet, he was suffering. I told my suboxone doctor i was going.to have this surgery and i was told i would have to get off the subs, but he was not going to get involved. Basically i was told to go with nothing a few days before surgery and hope that the standard dose of vicodin or percocet would have to not.only help the pain but keep me from withdrawing. In other words, im completely on my own with absolutely no special procedures. I am the biggest wimp when it comes to pain. Is it normal that my sub doctor would not help me prepare or even want to get involved? He made it sound as if it.was the oral surgeons job to address my pre surgery withdrawal and post op pain. I’m-so terrified that im literally thinking.of just not getting the surgery. To.expect me to arrive at surgery in full withdrawal sounds rediculous to me. Can anyone advise me or steer me in the right direction? Thanks.

      1. Hello, I am schedueles to have surgery this coming week. I was on methadone maintenance for two years and at the end was only on 5mg daily. I have been totally off of this for 15 days. Should I still mention this to my oral surgeon. I know o will be put under and after reading heavily about this topic I’m started to get worried that even with me being off, it’s only been a short time. Should I be concerned?

        1. Leah; Methadone is very different than buprenorphine. But, YES, all of the doctors, nurses, pharmacists, or any caregivers involved with your surgery prior to or following the procedure should be aware of this in order to best treat your pain and avoid certain risks.

      2. Eye doctor future my name is Shannon I am going in for surgery on July 11th 2016 I need to know when the appropriate time to quit taking my Suboxone I’ve been on for about four and a half 5 months at 24 milligrams a day I don’t that is a very big surgery they cut my stomach open and possibly fixing hernia in reset doing about restructuring and I don’t want to feel the pain cuz I had the gastric bypass so I know what it’s like not only that I had a C-section and my gallbladder out that it’s been painful as can be if I stay off my Suboxone for 9 days should I ask my Suboxone doctor to prescribe me painkillers now so I don’t go to withdrawals waiting for my surgery yeah I have an appointment with them on the 6th and he said I could take it to that day and then he would take care of it from there but I don’t think 6 days after four and a half months of 24 milligrams is going to let me feel the pain reliever so what is your suggestion it is I took it today but I don’t think I’m going to take it the next 9 days I know I didn’t take it at 3 and I start feeling pretty crappy so I took so I took some and I still feel crappy but alright I’m throwing up and all but should I ask him to switch prescribe me medicine before hand this is a sticky situation and I’ve never had that do this before be on Suboxone to get surgery is there a way to reverse Dubuque and the lockdown or how do I bring it to my positions attention he’s going to have to give me more pain medicine preferably through a pump so I can get it more often and higher doses instead of one milligram Dilaudid like 3 or 4 milligrams of Dilaudid what is your suggestion I would appreciate what you have to say you have a lot of knowledge and words of wisdom I also have another surgery on July 15th and chances are he he he he always gives me Tylenol with codeine 3 so I’d appreciate your reply I’m nervous I don’t want to feel the pain thank you Shannon

    1. Trust me on this: ibuprofen works better than ANY opioid for tooth extractions, and best of all, you can continue your regular Subutex / Suboxone.

  59. These are some truly heart breaking stories. What is so sad, you have a person who wants to do the right thing and get off drugs. From then on when suboxone is mentioned to the majority in the medical community, they either have no idea what it is or classify you as a drug seeking “trash patient” and literally could care less if you live or die. Like most other things in life, you are on your own to research and try to do what is best for you. I take suboxone and that is my experience with it.

    1. Austin Cowboy, I have also heard that too..but not too much where I am at..I live here in New Orleans..Most every doctor I run into knows all about soboxone…Most people here understand what it is because its been around for a while..I guess the groups all talk about it ttoo.. So there is a lot of info on soboxone .. If there is a doctor that asks you about soboxone..I definitely would not see him.. He is not with the times and he definitely isn’t doing his home work..Our country ..actually our city and all across our state are having a lot of overdoses because they are cutting dope with fentanyl..People are dropping like flies..just here recently there were like 12 people that were in the news just last month alone..If you hear people degrading you or anyone else ..you know that is just ignorance!! No Worries..Keep on Truckin!! If u Clean ..maybe GOD is doing you a favor..AMEN!! Good Luck

  60. I am fairly certain that the naloxone in the ‘save shot’ is what eventually resulted in an overdose and killed Prince. Prince was for yrs on Fentanyl, Dilaudid, and would’ve needed MUCH larger than normal doses of opiates to counteract the effects of withdraw the shot gave him and when it released from the mu-receptors he was a goner.

  61. I asked weeks prior to surgery about how long I needed to be off suboxone (16mg/day) and the prescribing MD assured me 48 hours was fine and people do this all the time without issue. My concerns were obviously potential issues with general anesthesia and also post op pain management. 3 days prior to surgery, I asked my surgeon his thoughts on suboxone and surgery and he asked me what it was and said he’s not familiar with the med and to ask the prescribing physician. That day I asked one of the prescribing physicians who told me I shouldn’t need to stop until 24 hours prior to surgery. He then phoned another of the physicians who advised that I stop 48 hours prior to surgery and take pain meds 5 days during recovery, then resume suboxone therapy. I voiced concern about withdrawal while stopping suboxone 48 hours prior to surgery and was brushed off and essentially ignored. In all, I inquired with 4 different physicians on two different days about how long to stop suboxone before surgery.
    Fast forward to the day of the surgery. The anesthesiologist came to speak with me and was very concerned, letting me know the prescribing physicians advised me to stop suboxone 2 days before surgery but that she advises patients to stop for 2 WEEKS at least. Her concern was post op pain management and she said I’d be receiving more opioids in hopes of bringing my pain level down to a 5 or 6. I reluctantly agreed.
    When I awoke from surgery, it was pure hell. My pain was a 10+. I spent an hour and a half moaning in agony. I was given 5mg Dilaudid, 10mg Percocet, and a shot of Toradol in that time which brought my pain level to a 6.5 and I was sent home. It was a horrible, extremely painful recovery, second only to the ORIF I had years before on a comminuted radial fracture. It topped D&Cs, lithotripsy, and debridements. I’m confident I endured much more pain than necessary because of the Suboxone and terrible instructions to only stop 48 hours before surgery. I’ll never make that mistake again.

    1. Hi. I’ve read almost all the comments but yours’ most resonates with mine. I am opting for an elective cosmetic surgery. What scares the hell out of me is that my own doctors ones not know what Subutex IS!!!! How scared am I, of NEVER WAKING UP?! I’ve re-considered but still want the surgery, G-d help my vain self. I am currently on Subutex 8mg. 3x daily. I’ve attempted to wean, not great luck there. Will I be able to take pain meds after my surgery?!? I’m so lost. Where may I get REAL ANSWERS??? Thank you so much for listening to me. I’m very scared I won’t wake up. I’ve not yet spoken to my anesthesiologist but will def do so before scheduling surgery. Any input is helpful and graciously appreciated.

      1. I am having cosmetic surgery August 16th, I take 8mg 3 x a day as well. I had a full knee replacement and it was a nightmare. You must come off the suboxone 2 weeks prior and have a pure opiod otherwise you will be in horroible withdrawal. Your tolerence for pain meds is completely different now, you will have a high tolerence from the Bup. I am going to talk to my perscribing Dr next week and he will have to tell the surgeon how to proceed and what to perscribe. The minute surgeons hears you are on suboxone they think you are seeking more pain meds and limit your amount when that is just not the case. Please let me know what happens and if you have any advice.

        1. I concur with Elizabeth & it was TERRIBLY frustrating. I’m not proud of it, but I grew up watching my father hit my mother as well as doors and walls. I swore I’d never lay a hand on my wife, but the rage/frustrated behavior was carried forward as it related to walls and doors. Well, as you might guess, in one of the rarely occurring fits, I punched a wall in my town home, not knowing, it was drywall backed by concrete firewall material 2 inches beyond the drywall. Suffice to say what followed was the immediate cessation of anger & onset of tear inducing pain as I knew I had badly broken my hand. I am on 8MG a day for both dependency, but also chronic pain due to a degrading spine, and while it’s often not enough, I’ve never ventured back into short acting opiates. I’ve had 12 operations prior to this, which lead to addiction to narcotics, that while not terrible, wasn’t sustainable. I went to the hospital, where I was judged for hitting a wall & for being on Subutex, but at least they knew what it was & gave me IV Toradol before putting it in a half cast & referring me to a hand surgeon, which I knew was going to be the path the minute I hit the concrete as I’ve broken my other hand 9 years earlier, where I refused surgery because the fracture wasn’t nearly as splintered nor displaced. Even in this instance, I wanted to avoid surgery & planned to ask the surgeon to set it and cast it if possible without an operation, because I have always feared suffering severe pain because of my long term use of Subutex in fact, turning down a 5th knee surgery that I needed, but wasn’t going to risk the misery that came from the prior 4 which were well before I’d developed any type of tolerance & the pain meds only brought my pain down to an 8 outside of the hospital setting. Anyway, I met the surgeon, who was quite respected, and explained I was on Subutex and opiate dependent, and while nice enough, said he’d not be able to operate until I’d established with a pain management Dr. where I live in South Florida. Well if you know anything about the rapid expansion of online pharmacies and walk-in pain management clinics in Florida, you know that they were distributing million of opiates without little or no medical requirement and once the Fed’s caught wind of that, they HAMMERED that system leaving a lot of necessary pain patients out in the cold, and a lot of junkies turning to the street. In doing so, they punished legitimate pharmacies, set limits on dispensing, and made it terribly difficult for legitimate pain to be controlled by Dr’s and you could go to 4 pharmacies and they’d turn you away saying they didn’t carry that medication, which is utter nonsense.

          The reason I know this, is because I was fortunate enough to have a friend that was a nurse, whom knew a pain management Dr. that would accept me within days, mind you they don’t take insurance & they determine if you’re pain is covered. With apprehension, I went to visit, knowing I would need to be off the subs at least a week, but probably much longer. My surgery was scheduled for 2 weeks out, pending confirmation of a pain management Dr. accepting me, and by the time I got in, I had 5 days until the surgery and was still taking 4MG of subs a day.

          When I arrived 20 minutes ahead of my appointment time, I realized very quickly that it was a first come, first served operation and my appointment time didn’t matter. That first visit, I waited 6 hours to see him, at which time after reviewing my medical and pharmacy records he proceeded to hard sell me on 25 different reasons why I needed to start a pain management program instead of a short term solution for the surgery. I was resistant, but open willing to consider it given that I have knee and shoulder replacements likely coming withing 5-10 years. Anyway, he sent me home with one time released oxy and one short acting oxy of a low dose to prevent detox from the subs and control my pain until the surgery. As soon as the subs started to separate, what he gave me wasn’t covering my pain at all, and not only that, I was having mild, but unpleasant detox symptoms. I called and the nurse said I could come in and reevaluate at which time I clarified that it would be an unknown wait time. You see, the Dr. works all of the area with hospitals, so he arrives at the clinic whenever it works out, sometimes as early as 2, sometimes as late as 7, at which point you have 12-20 patients pouring out the waiting room. This entire scene made me feel sick, but I didn’t have a choice, but to stay the course until the surgery was done. As you might expect, I exceeded my prescription which was for 7 days just trying to stay out of detox by 1 day and I was to see him 2 days before the surgery for a refill. I waited 9 hours that day to see him at which time I was scolded about not staying on schedule despite my legitimate concerns. He upped the dosage slightly, and in fairness, I’d not taken these meds ever, so I didn’t know what would be effective.

          During the prior two weeks, I’d had bad lower back pain, but ice, anti-inflammatory meds, and more ice, generally cleared those up in 2 weeks. Unfortunately, that wasn’t happening during this cycle of pain, so when I arrived for the hand reconstruction, which was outpatient, I was armed with 10MG X 2 of oxycontin, and 5MG 3 times a day of Oxy and I just assumed the pain Dr. knew what needed to be done. I had a block, which was terrific, the surgery went well & was given oral percocet despite the anesthesiologists instruction to give me IV dilaudid, another drug I didn’t know, but he’d said based on the subs, it was advisable should the block wear off quicker.

          Once they released me, I was fine until I stood up to walk to the wheelchair. My hand didn’t hurt because I couldn’t feel it, but where I’d gone in mobile and vertical with manageable but substantial back pain, now I couldn’t stand up straight. I had to remain at 45 degree bent at the waist posture otherwise my right leg was in unbearable pain. The hospital staff said I was just stiff and that it would abate so I figured, ok, sounds reasonable and I went home. I should add that I’d asked the pain Dr. what I was to do if the meds weren’t controlling the pain, and he told he’d have to get me admitted to do any better, and at the time I was thinking, it’s not going be an issue.

          Well, once home, the lower back/leg issues were getting worse, so I decided I would try and “walk it off” thinking forcing myself vertical and walking would loosen up a pain I’d never experienced. Within 5 minutes, I was on the floor, literally in tears. The block wore off early, but it was only mildly uncomfortable, but my back was blindingly painful. We headed to one of the hospitals he rounded at, and I’m in unbearable pain unless in the fetal position holding me right leg up to my chest with my hands. While we’re waiting, the pain Dr. starts to hustle out of the hospital, which was just pure chance, and he told my wife to take me to another hospital that he was heading to right then and he could most likely get me admitted.

          As requested, we headed that way. 7 hours later, I received my first oral dose of something & they took me to X-ray where they kept telling me to straighten out and hold still, but I literally couldn’t and at this point, I’m in tears. I’m admitted 14 hours later and put on a medication routine that wasn’t controlling the pain, but in fairness, wasn’t going to, because it was nerve pain primarily. He came in 20 hours after admittance and I told him to please recommend a solid neurosurgeon because I knew it was my back in some way. Thankfully he knew one that could fit me in, because I’m not sleeping, not eating, and can only lay there in pain holding my knee to my chest as a minimal pain reducer. The surgeon shows up 10 hours later and says I have an opening 2 days from now, but we need an MRI which makes sense right? I say, lets schedule it pending the MRI.

          At this point, I have told the pain Dr., the staff Dr., and the nurses that I will NOT be able to lay straight nor still for the MRI. They ignored me and sent me down the morning before my surgery & sure enough, it wasn’t going to happen. I thought my surgery was going to be delayed much longer because that was the only opening he had for 2 weeks. Fortunately, they found an anesthesiologist that could put me under 5 hours later, and the MRI showed what the neurosurgeon suspected & we moved forward, the whole 7 days at this point in complete misery because I wasn’t even able to be sedated enough to sleep.

          I’ve slept a total of about 6 hours the entire time I was in the hospital, and didn’t sleep at all the night before the surgery & I’m in pain I didn’t know was possible. He did the operation, and I was on a pump of morphine with a 7 minute self-administer at 1MG doses, but without pressing it every 7 minutes, I was in agonizing pain and all I wanted to do was sleep. The pain in the leg, thank God was gone, but the wound and associated damage done during the operation made moving tear invoking and about 2 hours after being sent back to my room, the machine locks me out and they don’t explain this to me in advance, don’t listen to me when I say it’s not controlling my pain, and my pain Dr. shows up at 2:30 AM after instructing them to take me off the pump and put me back on the prior schedule. By the end of the day, I was so miserable that I couldn’t take it anymore and I started insisting that they reach him to where I became a nuisance. He shows up aggressively telling me how I’m wasting his time and that my pain was controlled & I got so angry I said this isn’t going anywhere, I think we should part ways, and I’d like you to release me from the hospital now. This made him angry, but my thought was I could be in miserable pain at home, and at least comfortable.

          You see, no one cared that I was in pain. They cared that I had a tolerance that they couldn’t understand and treated me like a drug seeker. I had no respiration depression on 2MB dilaudid IV every 8 hours and every 6 hours 10MB of short acting oxy, but neither did I have any noticeable analgesia. He complied wrote one final script, and I went home. My wife found another pain Dr., but because of the laws, my script needed to be followed until it was complete before they could see me which I did, but the pain was still so bad I was just miserable.

          I saw this Dr. which was a little more considerate, but she was an Opthamologist by specialty and WAY more expensive. She was a little more aggressive, but I never got any pain relief until the nature healing process was reached and no pain should be present. Just to see if I was crazy, I took double my dose of Oxycontin and 100MG 1.5 days worth of short acting Oxy all at one time and I experienced NO and I mean NO noticeable relief, and was going into light detox on schedule every day. I quickly decided I was done with this and was going back on subs because it was clear, that I was going to suffer with any surgery until a dosing protocol is established for patients like myself that have a tolerance that is absurd from what I can only assume is years of subs.

          Sorry to be so long winded, but in 10 days in the hospital, I had a total of 5 hours of 7 of 10 pain relief while on the pump until I was taken off, and then I went back to 9-10, tear invoking pain.

          I hope you can use this, and I’m back on subs and have been since October and did not continue with the pain clinic, but I’m going to reach a point in the future with my multiple orthopedic issues & to quote my neurosurgeon the spine of a 90 year old (I’m 41) where pain management is going to be a serious issue and I’m terrified that when that time comes, I’m not going to be able to make it on what the state/feds and other agencies will permit.

    2. Jen, thank you SO MUCH for this. I was Googling around looking for answers, and not having much luck: I’m having major joint-replacement surgery in 2 wks, and can’t get a straight answer, either. (I can’t even get a callback or response to e-mail from the surgeon’s office.) Some drs are very casual, like the one that told you 24 hrs is fine, no worries; others are very concerned and think I should’ve been off yesterday.

      Thanks to you, I’m going to start titrating down from my 16 mg/day right now. I don’t know if I can get totally off it, but your horrible, horrible experience (I’m so sorry) has now helped someone else. Thank you.
      – Also a Jen

    3. Hi,
      I’m about to have a hysterectomy and I’m terrified to talk to either doc about my suboxone use. I’m down now to 4 mgs, and I also don’t know when to stop. I thought about taking a few tabs or Percs after stopping sub before surgery. Did they make you come back in for a lot of random drug tests?
      I was also going to supplement my medicine as I know they won’t give me enough- or medicine strong enough but again worried about pain!
      What was your post op care like? Frequent drug screens? If so…how often,
      Thank you so much… Your thread really helped me!
      ASAP please..surgery in 2.5 weeks, doc appt about the whole procedure etc is next week. I know they will ask about my prescriptions and they know I’m a recovering alcoholic.
      HELP

  62. I have had the worst pain expierence ever. I was on Suboxone while pregnant and before I could get switched to subutex, my water broke. They did a spinal tap for the pain which worked wonders because I had a c- section I couldn’t feel anything. Then after my c-section they gave me Norco’s for the pain and once the spinal started to wear off, I started to feel the worst pains I have ever felt in my life. I’ve had 3 c-sections prior to this one and never have I felt this much pain in my life. Come to find out they were injecting me with Naloxone and told me that is was toradol. When I got home I read my paperwork on the medication they were giving me and no where at all does it state toradol so they lied to me. Every time someone came in to give me medication I would ask what they are giving me and they would only say “it’s your medication” as I thought to myself “duh, but wtf is it” …..From what I remember my doctor stating that it would be very dangerous to be on Naloxone during or after surgery because it would block the pain meds and my body could go into shock. Is this true and can anyone tell me why the hospital would give me opiates and an opiate blocker at the same time . I told the hospital that I needed to be switched to subutex and they acted as if they never heard of it and didn’t know what it was for. They said there pharmacy doesn’t carry. If they never heard of subutex, shouldn’t they know what Naloxone does? Personally I think they were trying to torture me for being on Suboxone while pregnant. They were judging me because of my history. This whole situation was a nightmare, I was in so much pain It hurt to talk. Anyone have any input on this.

  63. I have had two surgeries now going to have my third. One total knee and on March 7th will have the other knee done. Last time I was off my 32mg dose a day for 10 days and I could not get out of pain for four days and the shrink keeps saying four day before surgery is fine. I had to talked to his boss for the next to go off 21 days and I still think it’s not enough time. Am on Morphine two weeks before the next knee and it’s not even fazing me. But I hope it will be better.

  64. I am very intrigued to read this vast answers and questions about the use of pain killers in our patients.
    I have only one small answer today and that is that we have hardly understood the powers of our minds that influence the out come of our natural endorphins.
    Ramesh Gupta M.D.

    1. Dr. Grupta…..
      I will now direct my query to you, as no one else has come forward with an answer…my name is Sam, my post was on May 9, 2016… Perhaps you can assist me in some sort of advice, please??
      Thanks kindly

  65. My question is I’m still on 30mg of Methodone (down from 100) yet I have major surgery in couple weeks. Upon Reading your 2013 discussion about BUP etc and when taking that how and why difficult post op pain mgt is SO IS THIS THE SAME IF TAKING METHODONE? AS TIGHTLY ON RECEPTORS AS BUP? As long ?
    I THINK I CAN PHASE DOWN TO 10 MG b4 surgery then cold turkey full day b4. Thoughts? NOT ASKING MEDICAL ADVICE. THANKS TOM

  66. I would greatly appreciate any advice on this..

    I am 24 years old and i am scheduled to have my tonsils cut out on december 7th. Today is Nov.26th so i have a little tome before surgery…. My situation.. I am on an extremely low daily dose of Subutex.. 2mgs a day. But from my experience 2mg is still alot when it comes to needing surgery. For my tonsil procedure i will be knocked out not sure what drugs they will be using. Anyways i have had an experience when i had a bad tooth cut out a few years ago when i was taking much higher doses of subutex. 6-8mg daily. I went for the tooth removal the tried knocking me out woth fentanyl and 2 other drugs. Dentist surgeon dosed me 3 times and i was still WIDE awake but couldnt feel much of anything.. My point being i am very scared for my tonsil surgery. I can definitely stop my 2mg subutex without to much heavy w/d because i am at a low dose. My question.. if i am off of subutex for 7-10 days before my surgery, will i be ok to recieve anesthesia and it actuallg do what it is supposed to???? Please please help me i am real nervous. Thank you so much

    1. Jeffrey, I cannot give medical advice on this forum. You should speak with your medical doctors (especially the anesthesiologist) about the procedure and how best to approach this for you individual situations. It would be wise to review and share this article which is posted on my RESOURCES page on this site, 8.Fudin J, Srivastava A, Atkinson TJ, Fudin HR. Opioids for Surgery or Acute Pain in Patients on Chronic Buprenorphine. In Aronoff G, ed., Medication Management of Chronic Pain: What you Need to Know. Publication pending, Trafford Publishing, 2015.

  67. Apologies for not proof reading before posting. I’m currently taking one 8mg/2mg suboxone strip per day. Thank you again, Emily

  68. Hello all. After extensive Internet searching I am so happy to have found this website. I’m going to tell my story for background. I’m a 33 year old mother of 2, I’m currently unable to work because of my spinal issues. It was so hard to leave work after 20 years of non stop employment. (Started babysitting at 12, full time over summer and just about every weekend&a few nights a week until I started at the local hardware store…I earned an accounting degree working full time and raising my 2 daughters) I love to be active. I was in 5 total loss car accidents by the age of 30 (I was only the driver in 1 of these) and being an equestrian, I have been thrown off of my fair share of horses as well. I’ve suffered from low back pain since my teens. I saw a chiropractor on and off from 16-25 & only took ibuprofen or Tylenol up until that point. My family is full of addicts. My parents are alcoholics. One of my uncles died due to his alcoholism the day before he turned 30 (drinking and driving an atv, he hit a pole and broke his neck). My living uncle is an alcoholic addict, has been on every drug, but is now abusing prescription narcotics after having a 5 level cervical/thoracic spinal fusion. One of my aunts has been sober for 10 years and the other aunt is an active alcoholic. Of my 8 cousins, all but 1 is an addict/alcoholic addict. So, growing up I saw the bad things that happen to alcoholics, addicts and their families. I went to the age of 25 without so much as smoking weed. I was divorced at 24 & stayed single until I was 25. I have a great relationship with my father, I have a disastrous relationship with my mother. (My parents separated 11 years ago). My mother is in very poor health, she had a triple brain aneurysm when I was 15 & I was her caretaker at 15 until I was 31. We lived together on and off, due to her medical issues and my life situarions) she also has poorly managed diabetes (she thinks she can eat whatever she wants still & not check her blood sugar) she’s had 4.5 fingers amputated and a below the knee leg amputation. She has severe diabetic neuropathy as well. I’m not sure if it was due to her misery that she treated me as she did then and still does. She’s mentally/emotionally abusive now, when I was younger and she could still get around, she would physically abuse me. When I started dating again after my divorce, I picked the worst man ever. He was an addict, I didn’t know that, I just knew that occasionally he would use opiates to party with. I refused him when he offered, at first. My grandmother died shortly after we started dating and my world fell apart. My grandmother, Oma, raised me from 2-10 as my dad was always out of town and my mom was too busy being drunk when she wasn’t at work. One night, I decided to take him up on his offer. It was love at first snort. It was all over from there. For about 2/2.5 years we did great. We would buy up whole scripts, support our habit, sell the rest and make money. Then, our habits got to be where we weren’t making any money and we were spending our own money. Then he lost his job. Things got pretty bad after that. We ended up breaking up but he was still a big connection to drugs for me and he had started screwing his suppliers over so he wasn’t able to get the deals he once got and I ended up going through a previous ex who used heroin. I used that for until February of 2014. I only ever snorted or swallowed opiates, I never used the needle. On February 5, 2014 I went into treatment and started suboxone. I started on 12 mg, that worked well and I stayed on that dose for a little more than a year. I am currently seeing a therapist every other week (I saw her once a week until August of 2015) in November of 2014 I started experiencin horrible pain. Walking was difficult, I was miserable. I had x-rays and CTS & no diagnosis. I was given naproxen, cyclobenzaprine and lidocaine patches. They helped take the edge off, but I was still teetering between a 5 & 7 on the pain scale. I learned to deal with it, mostly. I had to stand and bend at my job, I would often leave in tears. I made numerous visits to my primary MD, urgent care and the ER for pain. I was very transparent about being on suboxone, I wasn’t searching for opiates just answers. I finally got in to see an orthopedic surgeon in May of 2015. He looked at my x-rays and CTs and diagnosed me with isthmic spondylolitheses and stenosis at L4 L5. He sent me for an MRI & also found a cyst at L4 L5. I wanted to do physical therapy and see where I was at before having a spinal fusion, cystectomy. My insurance covered 3 months of physical therapy and it did help, a lot. It didn’t help enough though. I wanted to have surgery because I want to get back to being active. I’ve gained weight from my inactivity which is really depressing me. My current partner has been amazing. We have known each other for 18 years and have been together for 3.5. He’s been there through the worst of my addiction, my recovery and my back issues. He’s very supportive and understanding. My insurance company is requiring that I have 3 steroid injections in my spine before surgery. I had my first injection on October 9 th. The Dr that did my injection commented on how swollen my spine was. After the injection, my pain has been so much worse. I started on gabapentin 300mg/3x per day in hopes of pain relief. It has helped, but it hasn’t been enough. I am so miserable. I barely sleep, I just can’t get comfortable. I can’t sit too long, I can’t lay down in one position too long, I can’t walk around too much. I’m scheduled for my second spinal injection this Friday, November 13th and I’m not hopeful that this one will help because the first injection made my pain worse. I’m terrified of being in even more pain. It’s a quality of life issue for me at this point. My partner and I have talked about the need for pain relief and I’ve also spoken with my therapist about our decision. I’ve decided that since I’ll need to be off the suboxone prior to surgery (I saw my spinal surgeon last week Thursday and he wants me to be off of the suboxone prior to surgery because he doesn’t want any complications regarding treating my post op pain, which will be immense) & I believe the spinal surgery is eminent & I’m desperate for pain relief that I am going to get off suboxone so that I can usee opiates for pa in relief before myou surgery is scheduled. I see my suboxone Dr this week Thursday, I’m going to tell him my decision and ask for help on weaning off in 1 month. My partner and I have a plan for locking up the prescription bottle and administering my doses to me. I really didn’t want to take opiates but I’m unable to tolerate my pain any longer. I’m also scared that the prescribing Dr might not take my tolerance into account and will think I’m “drug seeking” if I ask for a higher dose. I’m just tired of being miserable and not participating in life because I am in too much pain. I’m terrified of advocating for myself in this situation. I’ve been sober for 21 months now. For the first 9 months of my recovery I was so very happy to get my life back. I was relishing in spending all my free time with my family. My children are the most important part of my life. It breaks my heart that I can’t take my older daughter driving or go on walks and bike rides with my youngest. I wish terribly that my spine was perfect and I was living life as I wanted to, not tucked away at home like a hermit because I’m in too much pain to do anything. Sorry for the novel. I would really appreciate any help. Thank you for your time in reading this. ~Emily

  69. I’m 31 weeks pregnant with my second child and take 4mg Buprenorphine, 3 times daily to help with chronic lower back pain. I will be having a scheduled C-section at 39 weeks gestation. Do I need to titrate off the Buprenorphine before surgery to effectively respond to anesthesia (I’ll be fully under) and control my post op pain using opioids? I ask this because I was able to titrate down to 2mg, twice daily for the 3 days prior to my first C-section and pain control was disastrous. I’d like to be more prepared this time around.

      1. Dr. Fudin,

        I greatly appreciate the additional literature and plan to share it with my team of health care providers (pain mgmt Doctor, OB, and anesthesiologist). It seems the best option for me is to wean off the Buprenorphine at least 1-2 weeks prior to my C-Section and use short term opioid therapy to alleviate my chronic pain. Do you have any additional resources/literature I can provide my healthcare team to educate them in prescribing the best opioid that would result in the least risk to the infant while still mitigating my chronic pain? It’s extremely important to me to find the medication which will result in the least complications and/or discomfort for my baby once born. Thank you.

        1. Good luck. My Dr suggested when I told her I wanted to go off suboxone to get ready for a 2nd knee replacement (the 1st was knocked out of place due to an accident) She said to stay on suboxone and they would give me fentanyl patches!!!! Very scary…

          Really truly best wishes

  70. Dr. Fudin I am scheduled to have a stabalization of the sternoclavicular joint and is suppose to be a very painful surgery. I have been taking 24mg of Suboxone for about a year. I have managed to get my dose down to 6mg a day. I plan on stopping the subs. 5 days before surgery and waiting 2 days and on the 3rd day start taking Norco 10. I am only taking the Norco to help with the Sub. withdrawal as i know it will not help with the pain. Do you think that will work as i do not want to go into surgery in withdrawals. I have done all this on my own because my surgeon knows very little about suboxone and my sud. Dr told me to stop the 24mg 2 days prior to surgery and i would be ok. After doing some research i came to realize that i needed to get my dose down as low as i could before surgery. Thanks For Your Time.

  71. I have been on suboxone for a little over 5 years. I wish I never would have got on it. I’m 28 years old but when I was 19 I was shot in the abdomen with a 12 gauge shot gun. Needless to say, I have had 11 abdominal surgeries. This last one really got me.. I had 8 hernias, bad mesh that needed replaced, terrible abdominal adhesions, and scar tissue to be removed from all over the place. I did not tell my surgeon I was on suboxone in fear I would be treated differently. The surgery didn’t go as planned. When they opened me up they saw my small bowel wrapped around my colon. So they removed 6 feet of my small intestine, remover some adhesions and other scar tissue. That was all they could do because I was high risk for infection. I was in SICU for 7 days. The pain I was in was the worst I’ve ever experienced.. I couldn’t speak, only moan in pain. They kept dosing me with duladid, bupernex, and fentanyl. I kept begging for more, my blood pressure was 170/130 and around that for the first three days. FINALLY, I told them who my Dr was and that I was on suboxone. They called my sub doctor whonis also a pain doctor. When he got there he put me on a duladid pump which gave me 0.5 mg every ten minutes. I was relieved somewhat by this point. But I think also because the sub had time to get out of my system it helped too. A little advice to all of you… if you ever know you are going to have surgery, stop taking your suboxone about a week or two ahead of time. The pain I went through, I’d rather get shot again!

  72. Hi there, I’m a 37 yr old female , with no history of addiction, I had been in a car accident in Aug 2009, broke my back leg hip and also frontal lobe brain trama , I was treated with oxycodone, and neurontin, for a few years after, I didn’t want to be on it any longer, chose to go holistic, it went great for 4 years, about a year ago my husband and I moved to a very rural country area, I’m used to jihns Hopkins and university of MD leval care, its harder to find doctors here anyway I start with severe pain again 6 mths agi and couldn’t walk right I was told it was drop foot and sent for a mri, they found a synovisl cyst and that two places that had been held together where my back broke had seperated almisr 8 mm the pain Dr hereput me on fentynal but I was very allergic to the adhesive, so he put me in suboxone, I wasn’t familiar with it. My pharmacist asked me if I was aware thus was typically used for opiate addiction, but she heard it for psin before, a few days later, I ended up I. Er for a fall, they treated me horrible, due to suboxone, they said I want telling them the truth that suboxone wasn’t a first choice psin meds for a non addict. I called my pain Dr from there and he told me to have them give me ketamine for pain relief, and he would calm there also. I told Dr what he said and they thought I was crazy. Now ive chosen to go back home to Baltimore to have surgery, I’m nervous that this medication is really going to mess with this. My surgeon via phone said he disagreed completly with this pain Dr and asked me to have him switch my meds to a plain opiate, and sign a release from. Care … So he can take over. I am on Medicare and they to have problems getting my preop meds authorized since suboxone blocks insurance co to fill any opiates without all kinds ooverrides, … My question. Is why would a Dr push a medication that is to help addicts . when there is no history, and also against what a surgeon has requested? I asked the pain Dr to contact the surgeon, and I was told its difficult for him to do that since I choose to go with my own surgeon ( who I have history with) that he’s not a neiboring Dr. I’m really nervous, the pain Dr said “just stop taking it the day before, or I can just stop now, I asked what should I take for pain? He said nothing???? Please give me insight.

    1. Jillian, Click on this link (Fudin J, Srivastava A, Atkinson TJ, Fudin HR. Opioids for Surgery or Acute Pain in Patients on Chronic Buprenorphine. In Aronoff G, ed., Medication Management of Chronic Pain: What you Need to Know. Publication pending, Trafford Publishing, 2015), print, and bring it to your doctors.

  73. Just want to share my story in hopes it helps someone, dr or/and patients. It is a long complicated story so I’m going to just summarize and try to include only relevant info. Had been on suboxone for 3 years along with intense outpatient treatment when I had a Roux en y gastric bypass surgery. Even though overweight and needed to lose some, I was otherwise healthly both physically and mentally. Spent 12 months preparing mentally for surgery as I had concerns about post op pain meds. My suboxone dr had contacted my surgeon twice to make sure a plan was in place and I thought for sure everyone was in the same page. In pre op room surgeon and anesthesiologist were running around and consulting with pharamacy to figure out what could be given to me. Sorry, I had to 8 mg of subutex 5 days before surgery. No one seemed to understand and I was finally told that there were several things they could use but I might have more pain then others. I completely trusted them and off I went to have the Rout en Y along with gall bladder removal. I woke up in the most severe pain ever. I honest could hardly get any words out but told nurse I had severe pain. Family was told I was given pain meds and they left thinking I was in good hands. Nurse in the PACU came back and said that I had been told that I would be in more pain and was being given Toradol for pain. I had no clue what that was but knew tha patient next to me that had the same surgery was alert and walking around. She was on morphine. My blood pressure which has always been around 117/72 area was skyrocketing to what I remember at one point 180/ something I couldnt remeber. I was continually given shots to bring it down, which didn’t work. Skip ahead, day two in PACU and not able to speak, had a drainage tube also that went directly over my diaphragm that caused intense pain when I moved, again had no idea where the pain was coming from as it was so intense. I was just in survival mode. Family did not know as I wasn’t able to communicate and just sent them away. Asked finally on day 3 for my suboxone which I was continually told that they did not have any and were trying to get some!! Now in withdrawals. Blood pressure still high. My mind could not properly function enough to really realize what was going on. Finally day 5 before being discharged was given my suboxone. At that point after taking my dose, I did feel well enough to realize what had happened but was so thankful to have made it through, that I tried to use it as a positive. Little did I know. To summarize the last 3 urs post op, had over 7 surgeries including a revision due to an extremely large ulcer, reversal due to an ulcer that actually ate thru to my old part of stomach and then a removal of all of my stomach except for a small pouch, again due to major ulcer. Because I was labeled an addict, never mind my 3 years of documented sobriety, every time I went in and complained how bad it hurt, I was ignored. 2 doctors looked at my family and told them I was just constipated, nothing more. Meanwhile, I could not eat during all of this and got down to 98 lbs. Each time they did surgery and saw how horrible shape my stomach was in, I was hopeful that things would change. They never did. I did end up with a different surgeon as my original one moved, and was given some adequate pain control while in hospital, for awhile. I choose to go back on suboxone every time I left the hospital and have remained sober. But I am now left with chronic abdominal pain, unable to eat more the. 2 or 3 bites of food without intense pain and told by my gastro surgeon that there is nothing else that can be done. I suffer at home, frozen by fear and unable to pursue anymore medical advice. Lost my job of 14 years and have not worked in 2 years. I just do not want anyone ever to have to go through this!!

    1. Elizabeth,
      I almost cried after reading your (8/29/15) experience w/ surgery as a patient on buph. I have had over 9 orthopedic surgeries due to severe osteoarthritis in the last 12 years (both hips replaced, 3 open rotator cuff repairs w/ a complete reverse shoulder replacement on right shoulder, cervical fusion, just to name the most invasive of the surgeries). As one surgery followed the next, I eventually was unable to physically recover from the trauma. I developed a pain syndrome that was initially treated w/ opiates. Not surprising that I became tolerant of the opiates, and long story short, I ended up w/ a physician who treated opiate dependent patients. For the past 2 years, I have been on plain buph. 8 mg x 3 daily. Now I know that this was WAY TOO MUCH. Too late. Now I am looking at a rotator cuff repair on my left shoulder (why this happens, I do not know) on 11/5/15. My pain dr. told me to discontinue the buph. 24 hours prior to surgery; use the post-op opiates; go back on the buph. when ready. Sounds simple, but after doing a lot of research, I realize that my day-of-surgery medication will have to be fine-tuned…and when I go home…will my pain be controlled? Shoulder surgery is rough. What will work for me post-op? I live alone and only have help for 2 days post-op. I’m afraid.

      1. Suzanne, maybe my story will give you a little insight? I too am on 32 Mgs of subs, for 3 years now for pain control. I had a scheduled surgery for my gallbladder to be removed. I informed my surgeon I was on it, and he said to discuss it with the anesthesiologist since I was VERY concerned about post op pain control. I met with the anesthesiologist and was told to contine with the bupe and to take my dose the morning of surgery. I questioned this and was told that’s how it’s done. Needless to say I woke up in recovery literally writhing in pain. The anesthesiologist and the Dr were arguing about what else to do. I had been given the max amount of Fentynal , dilauded, and ketamine. The nurse kept telling me “I’m so sorry your suffering, I can’t do anything else right now to ease your pain”. Day surgery turned into a 5 day inpatient stay. Had me on a dilauded pump at the max dose, AND get this- keep bringing me my bupe dose 3 times a day!!!! Plain and simple I was tortured. At my follow up the Dr actually laughed about what a “hard case” I was.
        My mistake was not doing enough research, not making sure my surgeon knew enough or was familiar enough with Suboxone. I pray your surgery goes well!

  74. I had a mastoidectomy and a cholestetoma removed on Aug 18th. As I commented previously, my suboxone doctor thought upping my dose of suboxone would be adequate for post surgery pain management. Well there were two complications. The first was some leakage of brain fluid because the cholesteotoma had actually grown much deeper than my surgeon thought. I’ve had a previous cholesteoteoma and mastoidectomy in the same left ear in June 2012 which complicated the MRI readings so they didn’t realize how deep it went. Needless to say I woke from surgery with a ferocious headache, really a bad migraine in strength. It took so much Fetanyl for them to overcome the pain I was kept in the ICU for a day and a half due to the possibility of respiratory depression. Besides giving me 300 mcg injections twice I was also put on a personal pump which gave me 50 mcg every six minutes with no cut off. This kept me from a 3-5 on the pain scale. The complication was once leaving the hospital the suboxone did absolutely nothing for my pain. The first day I got very sick from the amount I took (32mg) trying to control the pain actually. The first three days out of the hospital were horrible. Luckily now the pain is down to a level which ibuprofen is sufficient to keep me close to comfortable. I’m really trying not to be angry with me suboxone doctor when I see him next Friday. I know he had my best interests in mind but I don’t think anyone should have to go through what I did. Waking up from surgery in such a state was really very traumatic for me.

  75. I’m scheduled for surgery on the 18th of August to have a cholestetoma removed from my right ear. My surgery is on a Tuesday and I see my suboxone doctor the Friday before. I’m currently on 8mg of suboxone a day. Our plan is to raise my dose to 24mg taking the suboxone every 6-8 hours to maximize the analgesic effects. I just don’t feel comfortable going with traditional pain medication as I’ve relapsed from similar surgery in the past. I’ll check back in after my surgery and let you know how effective our plan for managing my post operative pain was.

  76. I was scheduled for lunbar decompression on 4 levels. I told the doctor about my suboxone treatment and he said to get a release from my suboxone doctor. No problems with that. I was told to stop taking sub 48 before surgery. I am currently on 2 1/2 strips a day 8 over 2. Day of surgery 7-24-15 was sent home on 2 mg dilaudid every four to six hours. After the anesthesia and the numbing stuff wore off I was in horrible pain. Called the surgeons office was told I could take 2 but that was a large amount. Went to emergency room the first night and they gave me a 8mg dilaudid shot which helped quite a bit but wore off in the middle of the night. So I’ve been in horrible pain along with withdrawals every 2 hours cause the dilaudid doesn’t last long. I wouldn’t have had surgery if I knew my pain wouldn’t be controlled. Beware please make sure they understand what suboxone is.

  77. When switching a pain patient from 4 mg of buprenorphine, three or four times daily, to a pure opiate agonist, at what dose do you tend to see an equivalent analgesic effect? In my limited experience it takes at least 40-80 mg of oxycodone to even come close to the pain relief patients get on 12-16 mg of buprenorphine a day.

    1. Olivia, Theoretically oxycodone wouldn’t be able to overcome buprenorphine in a meaningful way until the buprenorphine is out of the body, and bupe have a long half life. The danger of doing other drugs high is that tyhe patient will often tolerate them until buprenorphine leaves the receptors and then therers a chance of opioid-induced respiratory depression and death. recall that buprenorphine has a higher affinity for opioid receptors than naloxone does.

  78. Can a plastic surgeon deny you of surgery for being on suboxone? My ex broke several bones in my face, and I’ve already had 2 surgeries but they did not know I was on suboxone even though I wrote it down. I need a rhinoplasty and I made sure they know I’m on it. Now they need to find out if they can perform the surgery. Can they deny me due to this prescription?

    1. I had surgery and I was afraid to tell them about the Sub/Bup, come to find out it was helpful and I was given special attention to my pain management. A note from your clinic or doctor that states your on sub..is a good idea.
      You should not be treated differently, since you are treating your addiction.
      It’s scary doing this by the book at first. The fears of withdrawal and judgement from past experiences, and not accepting ourselves are very real.
      The world is evolving , honesty is the best policy( rolls eyes) is actually true. If you are not treated well please report the person or place.

      1. I am having a bone graft from hip to mouth this week. In 2 days. I just stopped my suboxone today for a 3 days off prior to my surgery. I’m scared to death of the pain meds not working. I have my suboxone doctor talking to my surgeon but I’m not sure if that is enough to help me. It is out patient but fairly painful. Anything I should know that you did before your surgery? Trying to flush my system of suboxone?

        1. Rae-
          You’ll be fine although I would stop the Sub four or five days ahead of surgery. I just had some pretty nasty surgery and stopped three days prior and it wasn’t quite enough. You’ll need to transition back to the subs which isn’t fun but you can buy some products online that help. Good luck.
          Jeff

  79. I’d like to know what I can take to override suboxone withdrawal. I tried half a percocet and nothing happened. However I do understand the potential for a spontaneous withdrawal because of it’s silly antagonist. Am currently in rehab for pain management for osteoarthritis and had swopped gabapentin for suboxone. I had to withdraw from tramadol as well. Had been on 900 mgs Gab Pentin which was making me stutter. My main problem is the constant feeling of being treated like a drug crazed junkie. I know I share the same physical traits as a recreationally dependent user and am not judging but in here, one of the new docs is transitioning from being an ER doc to an addiction specialist. He is treating me like a drug seeking moron. His mentor is one of the top 10 best addiction doctors in North America. .Because of his mentor’s status, he seems to have the need to give me the least amount of suboxone increase. It scares me as there’s a cut off that takes the sub to its point of redundancy. I tried to offset it with 200 mgs gabba pentin. No stuttering. I’m worried long term as I do plan to have elective surgeries in the not too distant future. How do I deal with this young doc who seems to relish in the success of the intended anti convulsant which is easier to spell than the Gabby Hayes drug!
    I’ve always been able to communicate about dangerous meds intelligently and knowledgeably. This guy wants to use as little sub as possible. He’s like an insurance company and suboxone is a payout for a claim! Had to practically beg for toradol or naproxyn. GP does kill the pain effectively but it was that side effect I couldn’t live with. I did persevere though…Still here 6 months later and am nearing an amount of sub that will carry me from 7 am to 10 pm. I’m not looking to anyone to side with me, rather to be objective and offer an approach as to how I can be vulnerable and ask for what I need to manage the pain. We do get along as people but with doctor stuff we lock horns and I end up getting defensive so I really really need your input.

    1. Teri,

      Gabapentin can be very helpful for neuropathic pain. The withdrawal experienced from tramadol at FDA approved doses is generally expected to be from serotonin, not opioid agonist activity. I cannot give medical advice by this forum.

  80. if there’s a dr that would be willing to give me a suggestion it would be greatly appreciated. I’m 42 years old and had a total ankle replacement in 2006. I’ve had issues with opiates for many years and am currently taking 8mg suboxone once daily. My prosthesis has loosened to the point they are doing another total replacement in 3 1/2 weeks. I realize the best thing to do would be stop taking suboxone now but for me that’s not realistic. Would switching to subutex be the best option for me. If not what should I do? I would really appreciate some feed back from a dr or somebody that can give me an educated answer. My email is jdlambrecht@hotmail.com. I see sarcastic comments on these sites from people who obviously have no clue so please refrain from obnoxious comments as we are dealing with people’s lives. Thank you ahead of time for any sincere suggestions

    1. John, I suggest speaking with the anesthesiologist in advance and ask him/her to consider treating you with intravenous buprenorphine post-op and adjuvant medications that are commonly used.

  81. I am a physician who prescribes Suboxone. Although the medication half life is fairly long- if you cold turkey you will be really sick day 3…the pain relief effect lasts maybe 6 to 8 hours. If I have patients having surgery I will stop their meds a day or 2 before surgery and put them on short acting pain meds, or just have them take the last dose the evening before surgery. As the sub dose reduces the number of open opiate receptors increases. These can be overridden with pain meds. The opiate dose most doctors use even after surgery are lowered then anything an opioid tolerant pt would need. I usually make the pt come in for a preop exam and write this stuff I out so that there are no issues. I do let them know the pt mAy need higher pain med doses then average to relieve pain as they are tolerant. If someone is having a knee replacement and may need continued pain meds I usually recommend fentanyl patch i- not acutely post op but for subacute. It is potent and harder to abuse.. And avoids pill taking issues.. Once the patient is past the acute pain time frame I have them return to office to review re-starting Suboxone and avoiding precipitated withdrawal. If someone is having dental work ( I have seen too many people relapse after getting a few Vicodin which did nothing for them) I up their Suboxone to 32 mg (4 of the 8/2 ) plus ibuprofen and add Tramadol which really should not help but seems to so I go with it..
    I have done this successfully for a number of patients. I do find that higher dose Suboxone can provide better pain relief then a ton of pain meds. I have a lot of pts that cannot wait to switch back. Finally if you are planning elective surgery a peep consult with pain manageable net for the hospital can be helpful but irs rare patients think ahead enough to do this. This is true life experience from a real doctor helping patients through surgeries without fear and with comfort.

    1. Thank you! Your comment makes perfect sense. My husband who is taking Suboxone has a minor surgery Friday (May 1st) and I have been constantly nagging him to get back in touch with the surgeon’s office and ask about this bc the surgeon’s nurse just said to bring that med at his pre-op appt the day before. I am not convinced that his nurse/staff had any idea idea of what my husband was asking when he called yesterday. He isn’t worried about post-op pn, as it is a simple CT release; he is only concerned about MAC anesthesia (IV Sed w/local) and whether or not it will work well just during surgery. Obviously he *could* go without any MAC. However, as I work in surgery myself, I told him that if it were me I would absolutely want some sedation during this procedure (no one wants to be wide awake in the OR during any surgery whatsoever…at least I have never come across a pt that does!).
      I intend to show your comment to his Dr.
      Thank You!

    2. I have a scheduled surgery for May 18, 2015. As I should, I contacted my doctor who prescribes my suboxone. I am currently prescribed 8/2mg x2 daily. After consulting with my doc, he advised me to continue my normal dosage throughout this procedure. This makes absolutely no sense to me! Let me add that, I did not speak directly with my doctor; I don’t know if I was given inaccurate information. If these instructions are accurate, is that something that’s able to be done without feeling the pain during, and after surgery? Maybe he meant up until the day before surgery? I am going to call my doctor again to confirm; however, he is hard to get in touch with. So I wanted to to ask opinions of others.

    3. my name is Diane and i am on zubsolv 5.7mg twice a day. I have been on suboxone for 12 years and I was switched to this one year ago. I have been lowering the dose but now have to have spinal surgery. How long does it take to get all of this out of my system so I can have my surgery? I had my parathrrois taken out two years ago and they almost could not put me under. I am not worried about pain as I have gone through 4 broken ribs and many other things without any pain relief. But I will not start having nerve damage in my hands and feet all because of an opiate blocker that I have been wanting to come off of anyway and afterwards just take a straight opiate blocker if need be.

  82. I have been on suboxone for about 3 yrs and I am anticipating having to have surgery. My question is two fold. 1. Can suboxone be switched to a regular pain med before any surgery is done so that I don’t have to go into the surgery in withdrawal from sub’s and the regular pain meds can already be in my blood and working 2 . Or can a patient who is on suboxen films that has the naso blocker in it be switched to pure subutext that doesn’t have the blocker in it and would it be a strong enough pain killer.

  83. I was in an auto accident at age 19, (with my two little girls) leaving me with multiple internal injuries, shattered pelvis, broken neck, ribs, jaw, back, tail bone, punctured lung with 5 holes. I recovered, even had two boys after, however, I started taking Norco at age 42. At first I took it as needed. At age 45…I was needing 6 a day and with that I was able to work and had never felt and looked better. I was 5″6, blonde, 125 lbs. working, raising four kids, (16 yrs of marriage, there dad left and could not be found) literally on my own. I was 6 months shy of 47 when I accepted a ride on a motorcycle (no helmet) from one of my kids’ friends when we crashed. I shattered my ankle (which was the same side I had shattered my pelvis) 32 staples in my head because of traumatic brain injury. At first I was in shock but needed Percocet and Norco. After 3 months I tapered down but winter time; over a year after accident, I crawled to doctor and he put me on Fentanyl patches with Norco. Within 3 months I couldn’t breath and weaned myself off patches; went back to doctor and he up my dose back to 5 Norco a day. Year and half to the day after accident I am in need of another surgery on ankle. I have severe arthritis in my back and started pain shots. I now relay on my pain medicine (only Norco) and dependent; I told my surgeon my doctor prescribed 150 Norco a month but he was good about refills early. After the surgery the surgeon had me take two Norco instead of one for a week. I told the surgeon I would run out of the Norco my doctor prescribed way to early but we discussed a plan and he wrote me out a lower dose Norco script so I could wean myself down. I didn’t think anything of it and continued with my doctor refilling my Norco. In to my second month I still needed additional pain meds and went back to surgeon for another lower dose along with my Norco. After 2 months I was able to get back down to only one Norco at a time, but still taking 6 to 8 a day again asking my doctor to refill early. The next thing I know my doctor calls me in to the office and drugs tests me, he scolds me for having two different doctors? I told him how my surgeon had to give me more Norco because of my pain tolerance and how he tapered me down. It didn’t matter! He told me he will never give me another script early. I will only get 5 a day no matter what!!!! Then the doctor had me do a urine test. The following week I was called back into the office and was told that my urine tested negative for Norco???? WHAT??? I had to give another urine test and this time sign a release for a lab to test me for a=z drugs. In the mean time I got sick with bronchitis. My doctor’s P.A. (my doctor couldn’t see me?) did a recheck on my lungs and told me that if I would quit smoking my lungs would heal…I DO NOT SMOKE. She said it says here on your chart you do??? She then asked me about my home life, about my 3 kids??? I said, “I have four healthy living children” She looked puzzled and said that my chart said I have 3 kids and one of my children I claim to have miscarried but records say I aborted it. Now I went to her side and looked at the computer. My chart said I was a uneducated smoker, in poor health…. This chart was completely not me…My doctor continues to urine test me every month. The tension I get from the nurses is worse than I have ever felt. I have to see my doctor tomorrow and I am so overwhelmed with anxiety I am writing this to you at 3:50 a.m. for I can’t even sleep. I am in so much pain. I feel so pathetic. My whole life has changed because of my tbi. Because of my pain. I don’t know how to handle this?????

  84. I have been searching for answers everywhere and hope you can help. I was in car accident 11+years ago with head injury/hip injury. I was immediately put on oxycontin. I went home and spent the next 6 years on prescribed narcotics(morphine, perocet, methadone(worked best for my “inoperable” pain)). I decided I wanted OFF. I was never mentally addicted and was watching my body&mind get eaten up by these meds. So I stopped methadone at 30mg/day. I made it a month and was still falling apart. I crawled into the hospital and eventually was told of this new option that would “eliminate withdrawals but let me feel pain” . I say great, do it. So I remained on suboxone for 5 years. All together at least 11 years of non stop 24/7 narcotics. Fought drs to get off only by weening myself and constant reminders that I am not going to stay on this. So I end up having a disc go at work and end up needing surgery. I think, perfect timing to end it for good. So I stop taking suboxone 10days before surgery, no problems, goes well. Fought my Dr from my hospital bed, refusing to be put on subutex for pain control. She thought the typical narcotics to relieve surgical pain wouldn’t be effective. Finally my surgeon overrides the drs choice and sends me home with the same thing she gives everyone else. Vicodin 10 mg/1-2 every 4hrs as needed and Valium 5-10 mg every 6hrs. It worked perfectly fine, and came off them 2 weeks earlier than typical. So now I go through withdrawal for the second time in a month. Rougher than the suboxone but faster in some ways. Here’s where I need help-I have zero desire to ever use narcotics/suboxone and have been done withdrawing since at least July 16. Then I am so far into being deprived of vital nutrients and vitamins that I am confused and don’t realize that I am having every organ shut down. I had diarrhea for over a month straight. Didn’t urinate for 4-5 days, diarrhea stops for 2 -3, start realizing I don’t feel pain, trouble breathing, heart rate fluctuations, bp fluctuations, my breathing is shallow and heart starts to ache/cramp…now I panic and start searching/ calling everywhere…no one knows about what happens after such a long term use has ended. I do research, find that I am out of all these key vitamins and dehydrated cause drinling water only was causing me to retain instead of filter. So I force fed. Food I hate the taste of, vitamins, all of the things that these organs needed to come back to life. Don’t get me wrong, I feel almost entirely better but I am constantly playing catch up to not decline immediately. I’m worried about possible auto immune system changes because of the shock of coming off this med. I’m not sure if it’s necessary to say but I was also taking ibuprofen(600mg) after stopping the vicodin, and had to be put on metronidazole (500mg) for an infection. Discontinued the ibuprofen when I realized my liver was effected more cause of it. Please help give me some answers. I live in Maine and my 11+ years of pain killers and choosing to be off is not anything they’re knowledgeable about, when it comes to the after math. Thank you for your time, finger’s crossed–Kelly

  85. What is truly said is the doctors prescribing theses subs don’t know squat. It’s sad but true. The Internet has much more data then the BS

  86. I, too, an a suboxone patient preparing for surgery however my dose has been 1/2 to 1/4 of the subs 8/2mg sub films. I’ve titrated down to 1/5 and plan to cut that as my rotator cuff repair surfer is in 2 weeks. My plan is to stop altogether on Tuesday before my Friday surgery. Do you think I’ll be ok to go with the normal routine of a non addicted patient? I’ve always kept my dose low in order to eventually come off of them completely. I am in no danger of relapse. I don’t want to be addicted to anything! Another topic I get, but I also want to be assured of pain control with the way I’m doing it. Any thoughts please.

      1. Dr fudin,

        my name is Shannon I had a disorder called pseudotumor oculi, I had two biopsies and which the surgeon had cut my eye muscle so therefore had to find another surgeon to correct the problem, and in the meantime from the pain and swelling I developed a dependency of opiates and I’ve struggled with them for the last 5 years, I’ve had my first surgery to straighten out my eye because when they had performed the biopsy, they had cut my eye muscle and in turn, my eye was stuck in the corner by my nose and they wanted to straighten it so the first surgery made it more centered but it’s too high, therefore, he has to do another surgery on it. However, because of my dependency, I finally got on suboxone I’ve been on it for 2 weeks I go to see my surgeon December 23rd which I’m guessing that they’re going to schedule the second surgery therefore the questions I have, is, how long before surgery should I stop taking Suboxone and what do I do for the withdrawal sympoms? Being that it’s my eye is a very sensitive area and the last surgery was very painful. However if I tell him that I’m on suboxone he might refuse to do the surgery because he is inexperienced with suboxone. I have waited too long almost 2 years to get my eye straightened and don’t want to take that chance of him refusing to do the surgery. Not only am I anxious to get my I corrected I have a lawsuit against the previous surgeon that performsed the biopsies that caused my eye damage, and time is of the essenc . So again I just want to know how long I should be off suboxone for this surgery so the anesthesia and the pain medicine will be effective? Thank you for your time, and anxiously awaiting your response.

        Shannon

  87. Hi,

    It is almost the beginning of June and I am weaning down from 2mg of Suboxone a day to 1.75. At the end of June I will probably be on .5mg a day. I will hopefully be off totally by August. I have an elective surgery in October. If I have been off Suboxone for 2 months am I OK to go have surgery with out any complications. I will be having general anesthesia.

    1. There’s certainly no risk regarding pain management or withdrawal. The only risk now is relapse for substance abuse. Stay in close contact with your behavior health folks and medical doctors and hopefully all will go well. Best wishes for a successful surgery and speedy recovery.

  88. Very interesting blog and posts. I’d just like to add a brief account of a recent patient.

    This person had been prescribed 8mg subutex per day for addiction maintenance therapy (by a local clinic that I am not professionally affiliated with) for about six months prior to our initial consultation. The patient complained of moderate lower back pain (no doubt alleviated to some degree by the continued use of buprenorphine) and numbness in the dorsolateral region of the right thigh, resulting from falling off of a ladder. Upon radiological examination, 1 ruptured and 2 slipped discs were identified and surgical intervention was recommended.

    The patient openly described his buprenorphine therapy to me, and I contacted his “doctor” at the bupe/methadone clinic. After a brief discussion of the patients case with this doctor, who I am fairly certain spends less than 2 hours a week at the clinic, I asked him to change the patients bupe prescription to 4, 2mg subutex per day.

    I then suggested (4 wks prior to surgery) to the patient to try and only use the 2mg subs as needed, to prevent relapse and manage the pain until the surgery. I explained that any reduction in tolerance achieved prior to the surgery will just mean less post-operative pain.

    Two weeks prior to surgery I asked the patient to bring their subutex prescription to my office to discuss the titration. The patient reported titrating down to 6mg per day one week prior to this meeting (which the pill count confirmed), however seemed to be experiencing some mild pain. Lucky for me (and more importantly, the patient) they seemed committed to their recovery from opioid dependence, so I suggested continuing dosing as low as possible and waiting as long as possible to re-dose.

    On the day of the surgery, the patient reported taking 4-6 mgs buprenorphine per day during the previous week (taking just 2, 2mg doses the 3 days prior to surgery). Because of the patients reduction in tolerance to bupe, and in the interest of not promoting relapse by treating post-operative pain with full mu-agonist drugs like fentanyl or morphine (which inherently produce greater euphoria and potential for abuse), we elected to use IV buprenorphine for post-operative pain.

    The patients pain was managed reasonably well with 1, 4mg oral dose of bupe, and .3mg IV buprenorphine every 4-6 hrs while under constant monitoring by nursing staff, and myself.

    After about 24 hours, the patient was discharged and prescribed the previous addiction maintenance dose (4, 2mg subutex per day), but plans on reducing the dose by 2 mg per day next month.

    Hope this account was still informative, despite my brevity.

    Dr. White

    1. Dr. White.

      This os actually extremely helpful and I am grateful you shared this experience with our readers. We have done taken the exact same approach in a few instances and the use of IV buprenorphine of course is a very sensible option of which is unfamiliar to most clinicians. I think for moderate uncomplicated surgical procedures, IV bupenorphone for these patients should be utilized more regularly. It’s all about education and comfort level on the part of clinician and patient.

  89. Thank goodness that a forum exists where the sharing of information regarding elective surgeries while on buprenorphine therapy can take place. I had a tumor removed back in 2010 and my pain Dr had me transition back down to Fentanyl to make things easier for the surgical staff. However, as anyone who has undergone such a transition knows, stepping down to Fentanyl from buprenorphine is not fun in the least. It’s rather stressful and miserable and it is certainly not something that is enjoyable to experience when you already feel horrible and are in need of said impending surgery. However, the more miserable process is the transitioning back to buprenorphine from Fentanyl……something that I cannot imaging anyone would desire to undergo right after they have undergone an elevtive or planned surgery. It is absolutely pure hell and any physician who routinely and blindly suggests this process should experience it themselves to better understand what they are asking of their patients.

    That said, I recently had 6 hemorrhoids removed and, in preparation for that surgery, we took a competely different approach that was MUCH easier to handle. I remained on buprenorphine. I worked with my surgeon to have him contact my pain physician because I preferred that he, not the surgeon, manage my pre and post-operative pain issues. He agreed (especially when I asked him to convert his desired medication (Vicodin) to the equivolent dosage of the 24MG of buprenorphine I was currently taking each day. After he performed the conversion he quickly agreed to hand over all post-operative pain management to my chronic pain physician 😉 . Additionally, we contacted the anasthesia group and explained that they would need to be prepared to use Buprenex for pain control during surgery. Additionally, my pain physcian prescribed 10 vials of Buprenex for me to self-inject as needed for post-operative pain.

    To be honest, it was a very painful recovery. However, surprisingly, I ended up using only 4 vials of Buprenex for pain control. My normal daily dosage of buprenorphine (24MG) was enough to control the post-operative pain, in combination with remaining on a liquid diet for 3 weeks, and taking an NSAID. A limited amount of pre-surgical planning resulted in the sufficient management of my post-operative pain, as well as I could have expected.

    So please, continue sharing the exeriences of those physicians who are routinely not transitioning their patients off of buprenorphine and onto other opiates in preparation for elective or scheduled sugeries. The process is incredibly stressful, taxing on ones body and, in my case, was totally avoidable when sufficient care and planning have taken place in advance. I hope more patients are afforded the opportunity to have more involved dicussions about this topic with their pain physicains and their surgeons.

    1. Thank you John for sharing your experiences. I’m certain that experiences such as yours are appreciated by our blog followers and clinicians alike. Real life experiences and input from clinicians (successes and failures) are the things that make this blog a success. Again, thanks for sharing!

  90. I am posting as a patient, not as a physician. I am scheduled to have shoulder surgery in 3 days and I have been taking Buphrenorphine for long term pain in my back and shoulder. I am taking my last dose today, about 1mg, and will not take another dose for 72 hours before surgery. I have not disclosed taking this medication for chronic pain, to my surgeon or pre-operative staff. I know this is not wise, but I am concerned about disclosing this, actually I am petrified. In the past when I have disclosed my off an on buprenorphine use, I am immediately treated as the lowest form of human society. I am not a bad person, I am very successful in my field and am a full time single father. I like pain pills, but have never been addicted. I chose this medication when I was told that pain management was going to be a long term issue for my back issues. I never take more than 1 mg, should I be concerned about my surgery and post-op pain? I want to be forthcoming, but the minute I am it will immediately limit my pain control options, at least pharmaceutically, and worse it will prevent effective and honest conversations with my doctors. Any advice? As my surgery approaches, my fear is growing rapidly. I guess I am choosing pain over judgement, but don’t feel that I should have to? I have taken a TOTAL of 3-5mg of buphrenorphine in the last week, .5 – 1mg per day on average depending on my pain. Am I a low enough dose that I should be fine by not taking any for 72 hours before surgery? Any advice would be greatly appreciated, especially from this group. I am fine with pain for a few days before surgery, its after that scares me.

    Excuse typos – sent or posted from my Galaxy S4 Android!

    1. Michael,

      Thank you for your post. First I want to point out that this is not a good forum for personal health issues. But, your case helps to illustrate the importance of the original post, that is the difficulty and the dilemmas in treating pain postoperatively. The most important issues for you are #1, if the buprenorphine you are using is prescribed by a legitimate medical doctor. If it is, there should be no problem having the prescriber speak with your surgeon, as there is a good chance that for this particular surgery, buprenorphine can be used to treat the post operative pain. It also depends in part on whether or not you are receiving a local block or general anesthesia. If on the other hand you are obtaining the buprenorphine from an illegal source, that is problematic; it is unsafe for you to enter surgery without telling your surgeon, but more particularly the anesthesiologist that is responsible for your procedure. You are being unfair to yourself and to all of the providers that will be caring for you prior to and following surgery.

  91. Very interesting read. You are completely correct that education needs to be available with empirical data available on how to treat subutex/one patients. As a health care professional and a subutex patient I have seen both sides of this equation. Many physicians do not have the proper education or resources to address this and when they do, often nurses or pharmacists are unwilling to dispense the necessary dosages. The amount of narcotic necessary for me to currently receive adequate analgesia are worrisome for many. I would love to see some clinical trials that reflect this and hopefully form that evidence based “safety net” of data that clinicians need to feel like they can adequately and safely treat these patients.

  92. I have patients who need foot surgery and may be taking suboxone. I will give them a prescription for a schedule II or schedule III substance that they can take at home, usually hydrocodone 10/325 or oxycodone 10/325 1-2 po qid. I’ll give them enough for a few days and see them back in. They will require higher levels of post-op pain medication, but they usually can manage it , but oversight is necessary.

      1. This is for the Podiatrist. I have needed to have bunion surgery on my right foot for at least 12 years and have not because of the Suboxone and lack of insurance, Now I finally have insurance but my bunion is so bad I cannot walk for long distances and my other foot now has a toe which is sticking up and over. I can only wear wide tennis shoes and sandals so I have to do it. I would like to know what you would do for pain control? I have always had a low tolerance for pain and high tolerance for opiates. They do work but not something like Vicodin. Your thoughts would be appreciated. Myrna

        1. Myrna,
          Generally bunion surgery is quite painful, and for that reason it is a model surgery for drug approval studies. Nevertheless, the pain is manageable. Since you’re on Suboxone, you would probably do well with intravenous buprenorphine following surgery and with IV ibuprofen immediately upon the start of surgery. Be prepared in advance though; most clinics and hospitals do not stock either one of these drugs. Following surgery, your doctors should work together to adjust your Suboxone dose upward temporarily for managing the pain with an anti-inflammatory. This is assuming that there are no medical contraindications to anti-inflammatories.

  93. Dr Fudin,
    How safe is decreasing the dose over the span of 2-4 weeks if the patient is taking Suboxone for addiction maintenance. I know that the doctors I deal with generally reduce maintenance doses by 1 to 2 mg per week over the course of months or years, and I imagine the risk of relapse that comes with dropping someone from 8 or 12 mg over the span of just a few weeks is significantly high. From what I hear from patients the withdrawal symptoms from missing just one dose are extremely unpleasant and can imagine the additional anxiety that the would add to elective surgery. Also would the patient need to titrate back to their therapeutic dose following discharge at the same rate over 2-4 weeks?

    1. Owen: You bring up some excellent points. The bottom line is that stopping Suboxone is a benefits versus risks situation. If the risk of relapse outweighs the benefit of stopping it, than it shouldn’t be stopped. Although I discussed the science in my blog, there are some practitioners that have seen good results with continuous high dose of pure opioids and/or controlled boluses without stopping buprenorphine; still there are others that have seen disasters as you’ll see below.

      To support the notion of leaving patients on Suboxone, even with elective surgery, read Dr. Lynn Webster’s comments here separately. He has been successful. Also, Dr. Pam Macintyre (Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and University of Adelaide, Adelaide SA) weighed in from Australia via email. She too has been successful when carefully titrating patients that remained on Suboxone therapy. See Macintyre PE, Russell RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care 2013 41:222-30.

      The purpose of these blogs are to stimulate good discussion and encourage experts in the field to share their experiences so we can all learn and improve outcomes for our patients. I am usually called upon for the disasters, so that’s what I see. I do appreciate your comments. Keep them coming bro! AAAE, Jeff

      1. I was on 4mg suboxone a day when I got in a major car accident. I had to be cut out of my car but faired pretty well considering. I was in a lot of pain and they gave me lortab for it. I had to take twice as much but it worked so long as I stayed on the suboxone. I went off the lortab within a week because I was building up a tolerance fast and my pain was manageable. I am planned for surgery soon. I plan on staying on a low dose suboxone but will be letting my surgeon know. I think I will be fine with a little extra pain medication. Going off the suboxone would not be good

  94. I use to think I had to taper patients off suboxone before elective surgery. It was a nightmare, particularly if the suboxone was for addiction. Discontinuing suboxone increased craving, often caused withdrawal and increased the risk of relapse. It also made it very difficult to manage the pain post-operatively. I could never tell if the bup effect was still on board or if the demand for opioids post-op was rooted in the persons disease of addiction or just nociceptor activation.

    After several of my patients struggled with this process and some relapsing I decided to not discontinue suboxone for elective surgery. They continued to use their normal dose of suboxone even on the day of surgery. I used hydromorphone for post-op pain. Fentanyl would be preferable but because most patients would need to be transitioned from a PCA to an oral opioid I wanted a drug that could be used for both. The dose required to treat pain while suboxone was on board may have been a little higher but within a range that wasn’t frightening for the nursing or surgical staff. Usually the dose was no different than if suboxone would not have been used.

    I have been surprised how well this works. It is a myth that mu agonist are ineffective when Bup is on board. They can be used in combination very well and have additive analgesic effects. The major advantage to this technique is that people with addictions don’t experience withdrawal or craving and that we don’t have to struggle with another induction and titration phase to re-establish suboxone therapy.

    Lynn Webster

    1. Lynn,

      It’s so great of you to share this! I’ve received a number of e-mails with similar experiences to yours and I’ve received others with exactly the opposite outcomes. It is for this reason that I encourage all to write in whether they agree with my post or not because the bottom line for all of us is to help patients! Really, the whole purpose for posting this buprenorphine blog is to encourage dialogue from experts throughout the U.S. and around the world. As always, I truly appreciate your input!

      1. I see several posts about leaving patients on Suboxone during surgery.
        I would like to share my unfortunate and very traumatic experience to see if anyone here can offer feedback as to why I responded differently than others.
        In the past, for other surgeries, I have always stopped my Buprenorphine approximately 3 days before surgery. I’m given a few 5 mg doses of oxycodone to manage pain and “withdrawals”. I cannot recall ever having had any problems with anesthesia or pain control post-op, other than the fact that I require a bit more medication due to tolerance. I am currently in my 7th year of Suboxone therapy for long-term pain management.
        In June 2013 I had a routine, but necessary surgery. This time, my pain management dr suggested a “new protocol”. He told me to stay on my Suboxone (my daily dose is 16 mgs). He said I could safely be treated for post-op pain with hydromorphone, that it could “push through the buprenorphine” and I would get adequate pain relief without any problems. I was nervous about it, but I agreed to the plan. How I wish I had not!
        While I have several other medical conditions, from autoimmune disease to being on thyroid medication (suppression therapy, post-thyroidectomy), none of this should have had an effect on my ability to try out this protocol. Yes, my metabolism is a bit faster than most patients. That’s about it.
        The day of surgery, they had some trouble getting the anesthesia to work. It took a higher dose as expected. When I woke up in recovery they gave me my first dose of IV hydromorphone. Within 10 minutes I was vomiting, shaking and in a severe withdrawal state.
        None of the recovery nurses knew how to handle the situation and nothing could control my pain. They would not let me leave until I could manage my nausea. So I was stuck in recovery for almost 12 hours longer than I needed to be. One doctor suggested giving me Fentanyl (which I’m allergic to!). Another suggested I try taking Suboxone but there was no one to prescribe it and I didn’t bring my own meds with me as I was told to leave them at home. I eventually managed to get them to send me home and reluctantly tried an induction. When 2 mg alleviated symptoms I knew I was on the right track and within an hour or so, I was back on my prescribed dose.
        Why did I experience a very severe Precipitated Withdrawal from the hydromorphone?
        Should I ever try this route again or is it best to avoid it completely?
        I am actually schedule for a rib ressection w/brachial plexus repair this week and opted to discontinue my Suboxone this time. I am not willing to risk going through Precipitated Withdrawal again. It was hell. It was awful! Suggestions? Comments? Thoughts?
        Much appreciated!

        1. Ruby,
          Thanks for your comment. I’m sorry to hear about your recent issue post-operatively. Based on your comment, it seems like the best approach to treat your pain peri-operatively would be with intravenous buprenorphine. I do want to point out that a true allergy to fentanyl is very rare and in fact I have not seen one in my entire career. I’m curious to know what symptoms you had.

    2. I could not agree more that ‘it is a myth that mu agonists are ineffective’ when patients are also taking buprenorphine and that continuation of the drug seems to pose no problem at all in the clinical setting – even in doses up to 32 mg.

      However, problems can arise if the additional mu agonist opioid is not given in adequate doses – as with any significantly opioid-tolerant patient. While we would usually start with 1 mg morphine or 20 microgram fentanyl PCA bolus doses in opioid-naïve patients (and the nurses can double this if needed), our PCA doses in buprenorphine-maintained patients have often needed to be quite high. We tend to base the size of the bolus dose on the dose of Suboxone. For example, a patient on higher doses (above 20 mg daily) would often be started with a bolus dose of 100 microgram fentanyl (we use morphine less often but would start with 5 mg). As others would do, our assessment of adequacy of analgesia lies not just with pain scores but, often more importantly, with functional activity and pupil size.

      We do not use a 4-hour total dose limit – the dose is limited instead by onset of excessive sedation. A sedation score of 2 – easy to rouse but has difficulty staying awake – mandates a reduction in the size of the bolus dose. The nurses in the general wards have been happy to look after patients using daily PCA fentanyl amounts of up to 20,000 microgram/day (not all that common admittedly but in some patients even more is needed) with bolus doses up to 200 microgram. But we are fortunate in that our organisation allows all patients with PCA in our institution are managed by our 24-hour/7 days a week anaesthesiologist-based APS. Such high doses are, however, not allowed to continue unchecked and will be decreased relatively rapidly over ensuing days.

      Our patients are usually transitioned temporarily onto oral oxycodone (immediate-release) but the vast majority of cases are able to leave hospital on the same dose of Suboxone that they came in on. If additional opioid analgesia is needed for a short while after discharge (not common at all and most are fine with non-opioid analgesia including tramadol) the dose of Suboxone may be increased a little on a temporary basis – after discussion with the patient’s Suboxone prescriber – or arrangements made for a very limited number of oxycodone tablets to be dispensed (for a very limited period) at the time of their daily Suboxone pick up.

      I think the other myth that surrounds buprenorphine is that it should not be started in patients taking mu agonist opioids unless those opioids have been ceased and the patient is exhibiting mild signs and symptoms of opioid withdrawal. In patients with moderate to severe acute pain requiring opioid analgesia, ceasing the opioid is not appropriate. Where the buprenorphine has been withheld for some reason, of in those patients to be commenced on a Suboxone program, we have found that starting at low doses buprenorphine and increasing these daily has not been a problem in patients continuing to take even large doses of fentanyl, morphine and oxycodone.

      Pam Macintyre

  95. Interesting stuff. I always get giddy explaining the seeming pointlessness of bupe and naloxone in combination (like when I know an answer in Jeopardy and want to shout it out). I tend to agree with Dr. Leavitt’s comments above that it may be more for commercial or “mythic” deterrence of abuse. That said, I’ve also heard injection of Suboxone continues to be a public health scourge, particularly abroad in Southeast Asia, where it causes frequent amputations/gangrene from injection of fillers and other insoluble particles. I was particularly excited to see this topic as I recently stumbled across a study/info “nugget” while doing some research for work, and it seems to agree with your suggestions of using a very lipophilic pure mu-agonist with a short-half life. The company I work for, Basic Home Infusion, does compounding and clinical/patient support for patients with intrathecal infusion pumps. We have a number of patients with MS/CP receiving Lioresal for spasticity, but many more receiving various opioid combinations for chronic pain, often augmented with bupivacaine and/or clonidine. The narcotic component is usually morphine, hydromorphone, or fentanyl, but we have about 10 patients who receive sufentanil in their pumps (and one lonely person who, for whatever reason, gets meperidine). So while doing some reading about sufentanil (which admittedly, I’m not terribly familiar with) and receptor affinity in intrathecal administration, I’m sure I read that sufentanil is one (maybe the only) pure agonist with sufficient affinity at the mu-receptor to displace buprenorphine. More generally, sufentanil is approx. twice as lipophilic as fentanyl, and while either one can be used intrathecally to provide excellent analgesia, I wonder if sufentanil could just as easily be used epidurally or even intravenously to provide less invasive anesthesia. Its high lipid solubility would allow it to penetrate the BBB rapidly, its potency provides extended analgesia even at very low plasma levels (wide distribution), and its rapid metabolism gives it a greater margin for safety with dosing. And if its mu-receptor affinity was enough to overcome a buprenorphine blockade, it sounds like it would be a possible ringer for surgery in bupe-treated patients. And if that’s the case, I’ve heard that a sufentanil once-weekly transdermal patch is close to or in Phase III trials, which may provide an option for bupe patients needing extended pain relief post-op. Anyway, just my thoughts…a really interesting topic, and a great excuse for me to draw structures on my giant whiteboard! I’ll do my best to find that paper to share, I’m sure it’s in one of my random literature collections (read: “piles”) on my desk. Thanks for the discussion!

    -Randy

    1. Randy,

      Thank you for your insightful and exciting comments! I wholeheartedly agree; all the fentanyl family drugs should be useful, and the more potent, probably the better. Remifentanil, sufentanil, and alfentanil as you know all are more potent compared to fentanyl. Keep me posted on your work! Best, Jeff

    2. Sufentanil is the answer. It has a higher affinty for the Mu receptor and is highly lipophillic. It now comes in a sublingual tablet available in a pca format for inpantient use only. I can’t believe that so many doctors are ignorant of this and are criminally neglient at worst and should lose their linscence at best.

  96. Hi Dr. Fudin,
    Glad to see a commentary on this topic! Boy, do I ever have an experience with this.

    It was near the beginning of my career as a pain specialist when I had a patient who was admitted for elective breast reconstructive surgery (she had had problems stemming from a fire, involving multiple skin grafts). She was also taking Suboxone and was told to (self?) wean prior to surgery. I had discussed the patient’s analgesia plan in advance of her admission with both her surgeon and her Suboxone clinic, and had recommended adjuvants and morphine PCA doses at higher demand doses and a higher 4-hour lockout than our opioid naive patients, with the plan to titrate her aggressively as needed. I wrote those PCA orders alongside the surgeon prior to her procedure, along with a detailed progress note explaining the rationale and plan.

    After that, it quickly turned into a debacle. The patient had not titrated her dose downwards at all (are we surprised, honestly? How many patients would be able to do this?). Upon her arrival in the recovery room, the anesthesiologist on the case DC’d our order and started his standard PCA (1 mg/10 min lockout/24 mg 4-hour limit). Naturally, she reached that pretty quickly and had absolutely no pain relief, and was dropped off on the postop unit in an incredibly distressed state.

    I called the surgeon and explained the situation. He approved the reinstated initial order for our PCA with a loading dose to try to get her pain under control. It wasn’t a crazy order; I don’t recall the exact dose but I do remember the demand which we had estimated earlier was exactly half of her hourly requirement. We had also increased the lockout to 15 minutes to allow for a wider margin in between doses, and of course increased the 4 hour limit and wrote for the concentrated version of morphine PCA (10 mg/mL). I wrote the order and tried for twenty minutes to locate the nurse to discuss the case, but couldn’t get ahold of her. Finally she returned my call and I summarized the situation, and asked her to call me with any questions or if she needed me. I left the unit to see my next patient and told her I would check back a little later to see how the patient was doing.

    Ten minutes later I got a call from the charge nurse that the patient’s nurse was refusing to start the PCA. I showed up on the unit and before I could say anything the nurse threw the PCA key at me. (No really, she did.) She went on a tirade regarding my and the surgeon’s fueling this patient’s “habit” and that she refused to be a part of it. The charge nurse and everyone else on the unit refused to take over the case. At that point I called the surgeon again to explain the situation but couldn’t get a hold of him either; his partner came to the unit and broke down crying because “no one would listen to her.” If memory serves, the CNO got involved at that point. There was a lot of concern over my advisement that the buprenorphine would eventually wear off and we would need to down-titrate the morphine. They wanted to transfer the patient to the ICU, but I argued against it because 1) I felt oversedation and signs of toxicity could be managed with the frequency of monitoring required during PCA administration, 2) the patient was not in a critical enough state to require intensive care, and 3) (lastly but I believe still important) the patient was self-pay and gratituitous monitoring in the ICU because no one was willing to take her on seemed a bit unreasonable.

    Eventually the floor’s charge nurse took over and they started our PCA order. I checked in that night and spoke with the surgeon by phone. The next morning, she was doing very well and her pain control was excellent; she was so appreciative. Eventually we were able to titrate her PCA off and she returned home (though I confess I don’t recall what her discharge plan was, as I think the Suboxone physician took over at that point).

    All that said, I am very skeptical of routine use of buprenorphine for that reason–what happens if the patient needs increased pain control in the acute setting? This scenario was a total nightmare and stands out in my memory as one of the worst cases in my career.

    1. Wow Anne, that is quite a story! I think that at the very least, if several clinicians wrote in and ackowledged these issues, perhaps it could fuel a fire to encourage education in this area, especially in colleges and CE programs. Perhaps equally important is for some published works on this, as I have seen very little in the literature on our to handle this other than case studies. A well thought out prospective study is much needed. Thank you for sharing!

      1. Doc, I’ve been freaking out. I’m 30 yro M . Avn unknown ediopothy. THR schedule for July 6. I’ve been taking suboxone 8×2 daily. I’ve bbeen honest with both ortho surgeon angle pain doc. I had crushed calcaneouse reconstruct sergury 2012 and same situation. When the nerve block wore off I discovered a whole new, ’10’ on the front face/smile face scale. I was given .2 delaudid iv over 15 min pump + 10mg hydrocodone by 4 hr… I was crying!!! And the docs said too bad.The suboxone never has acted the same for 5he pain as aot treatment. I was a former medical student. Nothing that almost counts for anything… but I’m petrified.. I can’t see it being anything other than a repeat. Btw pre op plan states they only plan on titration to 10 mg oxycodone. What would You do “hypothetically” if you had this patient? j0eld@aol.com

  97. Good points, Jeff. My understanding is that the naloxone in sublingually administered Suboxone is expected to be poorly absorbed. The purpose of naloxone in this combination product was intended to prevent IV administration by drug abusers of the pure buprenorphine in Subutex; ie, the IV naloxone was expected to block IV buprenorphine effects and discourage abuse. As I recall, this actually didn’t do the trick, and folks were still injecting Suboxone to an alarming extent. However, since Suboxone is more expensive, there was a commercial interest in promoting that instead of Subutex — and regulators, like the FDA and DEA, favored the semblance (myth?) of an abuse-deterrent formulation.

    1. Hey all, great article btw! I just wanted to share my experience with an elective shoulder surgery while being on Suboxone nearly 8 years. First and foremost do not be embarrassed or afraid to share with the surgeon and surgical staff that you are on Suboxone. In fact it is best they know and here is why. I, myself hid the Suboxone from them and when my primary doctor ( also my Suboxone doctor) gave my surgical clearance, the surgeon found out about the Suboxone and post poned my surgery because of it. So please make sure they know about the subs. Shortly after the postponement the surgeon set me up with a pain management doctor for pre and post surgery pain maintenance. I saw the pain management doctor one time and set up a plan. Currently I take 8mg suboxone daily, so her pre plan was she had me stop the Suboxone 5 days prior and gave me a 21 day supply of oxycodone 10mg 3x a day. About 36 hours after stopping the subs is when the modeterate withdrawal began. I took one 10mg oxycodone and it completely stopped all withdrawal symptoms. I then took a half before bed and woke up feeling fine. I kept the same routine going, when I felt withdrawal, I took only one oxycodone and it worked. Post surgery she gave me a 2 week supply of oxycodone 10mg 4x a day as well as a non narcotic muscle relaxer. I only used the oxy AS NEEDED and the muscle relaxer helped tremendously as well. After about 8-10 days I didn’t need the oxy anymore as the ibuprofen was enough to handle the pain. After about 32 hours of no oxy, I took a half of 8mg sub ( 4mg ) and felt no precipitated withdrawal whatsoever. The next morning returned to my normal 8mg suboxone dose and everything went flawlessly!!!!! I hope this bit of information was able to help some of you out and also show this method is highly recommended and effective. Please remember to set up a Pre and Post surgery pain management plan for they will keep dependency risks low as well as make the post surgery pain tolerable. Good luck everyone and wish you all the best!!

  98. YES! I’m old 🙂 and I could have a heart attack so I REFUSED antagonists as pain meds for cp!!! Its still narcotic…so no benefit to docs wanting you to use it! AND WHAT IF I HAVE A HEART ATTACK and NO PAIN RELIEF???? NO thanks! Not a chance!!! Docs don’t know this…well alot of docs don’t!!! They need to understand medicine better. Some do…some don’t! Please keep educating people! Thanks.

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