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suboxone and surgery?
  1. #1
    HicksvilleNY is offline Member
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    Default suboxone and surgery?

    whats going to happen when i go in for surgery in a couple weeks?

    I'm having a pretty invasive dental thing done and wonder whats going tp happen?

    how will it affect Anesthesia? general and local... also what if i need pain medication?

    i heard a horror story of a guy going in for emergency surgery and the pain med didn't work during and after surgery.

    I'm begining to think i better get off this asap

    been on 20 mg a day for a few months

    i'm getting scared and i can't really put this off any more than a week or 2 more.

    i'm starting to lose sleep over this... its not good
    Last edited by HicksvilleNY; 09-06-2008 at 06:13 PM.

  2. #2
    Robert_325 is offline Retired
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    Quote Originally Posted by HicksvilleNY View Post
    whats going to happen when i go in for surgery in a couple weeks?

    I'm having a pretty invasive dental thing done and wonder whats going tp happen?

    how will it affect Anesthesia? general and local... also what if i need pain medication?

    i heard a horror story of a guy going in for emergency surgery and the pain med didn't work during and after surgery.

    I'm begining to think i better get off this asap

    been on 20 mg a day for a few months

    i'm getting scared and i can't really put this off any more than a week or 2 more.

    i'm starting to lose sleep over this... its not good


    Hello my friend. Good to talk with you. Just wish it was under different circumstances. Got your email too and will respond.

    I hate to say this but at 20mg of suboxone for what ... about six months at least now you are going to have to get off the suboxone for a bit if you are going to take opiate pain meds. Opiates are not going to work after taking that high of a dose for six months unless you are off them for a good week at least possibly longer. You could get the dr to RX you a few percs or something and try them after a few days to see if they work or not so you will know for sure.

    Anesthesia should not be a problem. They won't use opiates for that. I will share one thing with you Ralph. I had dental surgery back before we began talking and the pain meds made me relapse. It was a very short relapse and I didn't go out doing crazy things but I started gobbling up lorcets like candy as soon as I took the first one. That was when I started on the subutex. Haven't ever touched another one since.

    Since I stopped the suboxone I have additional serious dental work done. They had to cut into the jaw bone to remove one tooth. The oral surgeon thought I was insane but I refused any opiates following the surgery. I gobbled up a lot of 800mg Ibuprofen but not one opiate. It hurt bad for a couple days but then it was over. I would not take opiates ever again unless they were cutting my belly open or something comparable. Thats just me.

    If you plan on taking opiates bottom line is the suboxone is going to have to be stopped for a while. Trying out some pills would be your best bet to see how long you have to go without the suboxone. We are all a little different.

    Stay in touch. Let me know how you are doing. I've wondered about you many times. God bless.

  3. #3
    HicksvilleNY is offline Member
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    well lets see i take 75 a month sooooo yep 20 a day, think i can put off the dental thing maybe an additional 2 weeks for a total of 4 weeks, so i guess i need to take some action stating right now, btw thats exactly what i need to have done, its a back tooth that has to come out and there is nothing above the gum line, its not going to be good and I'm afraid i really need to take some serious and careful steps here in the next couple weeks, i am well aware of the risks involved with getting back on the vics, but i'm kinda thinking this may have a silver lining..... if i can get switched back to the vics for the short term, then i can go back to the sub at a much lower level knowing what i know now, I'm scared to death at the thought of this but see no other options and i really don't want to be introduced to something different and new, I know what the vics do and do to me and i know what is involved with getting off them with the sub... so i feel i'm kinda ahead of the game knowledge wise.. i'm going to go back to the pain dr on mon or tues and see what he says, plus I do have some here that i didn't finish before the sub, about 15 of them.
    I was under the impression that the vics would work when i started feeling the sub wds 24 to 48 hours or i could just take vics after 24 hours and just keep taking them and i wouldn't get any WDs at all from the sub, this is what i need to know,,, what a friggin mess this is man..........

    now,,,,,,,see if you can figure this out........


    if i go without the sub untill i feel WDs then take a vic and it don't work with that vic prevent a sub from working ...hence nothing works and i go into complete wds?

    scarey huh?


    if anyone else out there has any info on coming off 6 months of sub and trying to switch over I would verymuch like to hear from you

    thanks

  4. #4
    Robert_325 is offline Retired
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    Default Ralph

    I really don't like to suggest doing vics instead of suboxone. But considering your situation and having the oral surgery it might be best for you. IF you will re-induct on the subs afterwards and start out at 8mg -12mg MAX and get off them in a month or so. I can help you with that. I have this tapering down thing figured out totally. Stay in touch. We can get you through this and off the subs when you start back in a reasonable time frame.

  5. #5
    HicksvilleNY is offline Member
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    i have been thinking about this nonstop for over a week and i know its not the norm,,,,

    this is my plan,,get the sub down and out... low as possible dose of vic till no longer needed then low as possible sub,,, its a very scary plan for me because i know where i was before,

    i plan on getting my sub now while i can so i have it,,,,,do you think I can do a complete sub program from vics to sub to no more anything with 75 8mg suboxone pills?I would love it if i could.

  6. #6
    Robert_325 is offline Retired
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    Quote Originally Posted by HicksvilleNY View Post
    i have been thinking about this nonstop for over a week and i know its not the norm,,,,

    this is my plan,,get the sub down and out... low as possible dose of vic till no longer needed then low as possible sub,,, its a very scary plan for me because i know where i was before,

    i plan on getting my sub now while i can so i have it,,,,,do you think I can do a complete sub program from vics to sub to no more anything with 75 8mg suboxone pills?I would love it if i could.


    You can definitely do this with 75 8mg pills. Hell yes. If you will just trust me when you start back on the subs you will have no trouble I promise you. There won't be anymore 20mg doses, not even any 16mg doses. That was crazy man. Some of these drs are nuts I swear. It just doesn't take that much to do this. I know.

    The most it will take to re-induct might be 12mg. You just don't need anymore than that. Probably less. Most everyone inducts at 8mg, a few at 12mg. But no one does suboxone like your dr has you taking it. Anyone that has come to this site taking large doses I have talked them down to a reasonable dose and they are now done with it totally or almost there. One girl on here who posts a lot was at 40mg when she first posted. That is insane! She was down to 12mg I think in about a week following instructions. I promise you can do this Ralph. It's not that hard if you begin properly. That is the whole thing. Your dr had you all screwed up before you realized it. Then you were hung out to dry kind of.

    Just relax. We will get you back on track. Just please don't let the vics get the best of you. I hate that you are going into this backwards kind of. But whatever it takes I guess. Main thing is to get you through this surgery and then on and off the suboxone properly this time.

  7. #7
    HicksvilleNY is offline Member
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    lets just see how low i can go with the subs for now......hows that for a start

    i'm ready

  8. #8
    HicksvilleNY is offline Member
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    was thinking,,, i shouldn't be too deep into the vics if i go that route,,, it really should be easier ,,, much easier then,,,, this just might be happening for a reason.......but i need to get it down to a better level right away
    whats a good cut back from a 20 average?

    also was thinking maybe i won't need the pain meds if its not too bad....

    i think too much, I better try and sleep some, talk tomorrow if you are around

    thanks

  9. #9
    HicksvilleNY is offline Member
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    ok shooting for 16 today

    its noon and i'm at 8

  10. #10
    HicksvilleNY is offline Member
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    Default Treatment of acute pain in patients receiving buprenorphine/naloxone

    http://naabt.org/documents/PCSSAcutePainGuidance.pdf


    Topic: Treatment of acute pain in patients receiving buprenorphine/naloxone
    Author: David Fiellin, M.D.
    Last Updated: 11/10/05
    Guideline coverage:
    This topic is also addressed in Clinical Guidelines for the Use of Buprenorphine
    in the Treatment of Opioid Addiction (TIP 40), page 7576.
    http://www.pcssmentor.org/pcss/docum...20Guidelines%2
    0(TIP%2040).pdf
    Clinical question:
    How do I manage acute pain in a patient receiving buprenorphine/naloxone
    (bup/nx) for the treatment of opioid dependence?
    Background:
    Buprenorphine is a partial agonist at the mu opioid receptor. As such,
    buprenorphine can provide analgesia, although the doses used generally for
    analgesia in other countries ranges from 0.2 to 0.6 mg., sublingually and the
    duration of effect is limited to 68
    hours. No peerreviewed
    published data is
    available to advise the appropriate dose of bup/nx for the management of acute
    or chronic pain. As a mu agonist, buprenorphine effectively blocks the analgesic
    properties of other opioids that could be use to treat acute pain. In addition,
    providing buprenorphine after a full mu agonist can result in precipitated
    withdrawal in a patient who has already taken an agonist opioid medication to
    treat acute pain.
    General principles: Inform patient of your awareness of their addiction and
    provide reassurance that their addiction will not be an obstacle to pain
    management. Include the patient in the decisionmaking
    process to allay anxiety
    about relapse. Offer addiction counseling as needed. Patients who are opioid
    dependent should not be denied pain treatment with opioids when indicated.
    Maintenance opioids should not be expected to adequately treat new onset acute
    pain. Patient controlled anesthesia (PCA) can be used in opioid dependent
    patients with acute pain.
    Recommendations:
    Level of evidence: Very low – expert opinion/clinical experience

    For patients receiving bup/nx who develop or are anticipated to have acute and
    limited (e.g. 2 hours to 2 weeks) pain that will not be adequately treated with nonopioid
    analgesia, the following steps are recommended:
    1. Anticipated pain (e.g. elective surgery, tooth extraction)
    · Temporarily discontinue bup/nx 2436
    hours prior to anticipated
    need for analgesia
    · Provide adequate opioid analgesia, titrate to effect. It is good
    practice to know the usual doses needed for patients undergoing
    the planned procedure. Discuss with your colleagues and
    remember that patients who are opioid dependent and who have
    recently received bup/nx will likely need higher than usual doses of
    opioid analgesics due to their physical tolerance and/or narcotic
    blockade from recent doses of bup/nx.
    · Do not provide bup/nx while patient is receiving opioid analgesia
    · Discontinue opioid analgesia once pain has remitted or can be
    managed with nonopioid
    analgesia.
    · Allow patient to experience mild to moderate opioid withdrawal.
    · Reinduce
    patient onto bup/nx as per usual.
    · Note: single doses of opioid analgesics (e.g. post dental extraction)
    may be effective even if bup/nx has not been discontinued.
    However, patients should be cautioned to avoid bup/nx dosing
    during period that opioid analgesic is likely to be occupying
    receptors.
    2. Unanticipated pain (e.g. major trauma, renal colic, acute fracture)
    · Determine when the last dose of bup/nx was ingested and
    temporarily stop bup/nx.
    · Options to consider: regional anesthesia, increased dose of
    buprenorphine, high potency opioid such as fentanyl, providing
    alternate opioid agonist treatment such as methadone during
    period of pain management
    · Provide adequate opioid analgesia, titrate to effect. It is good
    practice to know the usual doses needed for patients who
    experience this event. Discuss with your colleagues and remember
    that patients who are opioid dependent and who have recently
    received bup/nx will likely need higher than usual doses of opioid
    analgesics due to their physical tolerance and/or narcotic blockade
    from recent doses of bup/nx. Monitor/caution patients regarding the
    potential for oversedation
    during the first 72 hours after the last
    bup/nx dose. While the initial effect of a full agonist may be
    blocked by buprenorphine, as this blockade fades, the full agonist
    effect may become clinically evident.
    · Do not provide bup/nx while patient is receiving opioid analgesia

    · Discontinue opioid analgesia once pain has remitted or can be
    managed with nonopioid
    analgesia.
    · Allow patient to experience mild to moderate opioid withdrawal.
    · Reinduce
    patient onto bup/nx as per usual.
    References
    Kogel B. Christoph T. Strassburger W. Friderichs E. Interaction of muopioid
    receptor agonists and antagonists with the analgesic effect of buprenorphine in
    mice. [Journal Article] European Journal of Pain: Ejp. 9(5):599611,
    2005 Oct.
    Sporer KA. Buprenorphine: a primer for emergency physicians. [Review] [46 refs]
    [Journal Article. Review. Review, Tutorial] Annals of Emergency Medicine.
    43(5):5804,
    2004 May
    Savage, S. R. (1998). Principles of Pain Treatment in the Addicted Patient.
    Principles of Addiction Medicine, Second Edition. A. W. Graham and T. K.
    Schultz. Chevy Chase, MD, American Society of Addiction Medicine: 919944.
    MedicationAssisted
    Treatment for Opioid Addiction in Opioid Treatment
    Programs. CSATSAMHSA,
    DHHS, Rockville, MD. Treatment Improvement
    Protocol (TIP) Series 43.
    PCSS Guidances use the following levels of evidence*:
    High = Further research is very unlikely to change our confidence in the estimate
    of effect.
    Moderate = Further research is likely to have an important impact on our
    confidence in the estimate of effect and may change the estimate.
    Low = Further research is very likely to have an important impact on our
    confidence in the estimate of effect and is likely to change the estimate.
    Very low = Any estimate of effect is very uncertain.
    Type of evidence:
    Randomised trial = high
    Observational study = low
    Any other evidence = very low
    * Grading quality of evidence and strength of recommendations
    British Medical Journal, 2004;328;1490Provided
    by: Physician Clinical Support System, (877) 6308812;
    PCSSproject@asam.org; www.PCSSmentor.org

  11. #11
    scully006 is offline New Member
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    Default suboxone and surgery

    I am with you there on this issue with the surgery. I started taking suboxone less than a year ago because a friend told me about it. At the time I was badly addicted to pain killers and needed something to change. I didn't have the money or the insurance to go see a doctor so I been getting them from a friend. I managed to get myself down to like a sliver every day. Im thinking probably about 1mg. I can't seem to get over the hump to just quit but from what I know. Taking over 20mg a day of the sub is a LOT stronger than a few vics. It would be best for you to ween down as much as possible. Don't take any for a few days before the surgery. don't take any subs after. Use your prescription pain meds to get yourself off of the suboxone. A script of pain meds shouldn't be enough to get you physically addicted. All I know is that I am kicking myself in the ass for ever getting addicted to the suboxone. Seems as though it is harder to stop taking those than it would have been to just stop taking the pain killers in the first place. Even if after the surgery you still need to take them, take much less. I could not imagine having to take even a HALF of a suboxone. it would make me sick! Good luck!

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