Opioids Lots of Rare Opiate Related Questions..

[G_Chem]

Hey guys,

Damn I really wish I wasn’t here asking this right now but I am... I’m going to make a long story short in that I am likely looking at a pretty major surgery with some decent recovery time afterwards.

What scares me is that over 10yrs ago I was addicted to heroin, I quit by the time I was 20 and have been on low dose Suboxone ever since. At the moment I take roughly 1mg Suboxone a day.

In this day and age of opioid induced fear (rightfully so to some extent) im afraid that I may be flagged in their system and not treated appropriately with the proper medications. Im also afraid of how my Suboxone might interact with any medications they give me during anesthesia.

Due to my fears of not getting proper treatment, im also planning on procuring a reasonable amount of opiates myself to deal with this pain.

So here are my questions...

1.) Will low dose (1mg) of buprenorphine/Suboxone have any effect on the anesthesia I may receive? Is it possible to get through this without mentioning it? I have family that work in the hospital, me “coming out” about my past would add a whole nother layer to this shit pie. (I live in a completely different state now, and am hoping my medical past hasn’t followed me either.)

2.) Has anyone here tried Dibenzoylmorphine and/or dihydromorphine? @Limpet_Chicken? I saw limpet has tried the former but his bioassays were all over the place.

3.) If someone were to guess based on either experience or pharmacological knowledge, which would be the best choice for fighting pain while keeping drowsiness to a minimum?

Choices are; crude full spectrum poppy alkaloid extract, pure morphine, dibenzoylmorphine or dihydromorphine?

My guess is that dihydromorphine would likely be the best of the bunch but there’s almost no info out there on it. Extrapolating from codeine, it may be twice as potent as morphine.

That said a crude extract may be more beneficial with its extra alkaloids, although I’m not sure..

Any help on any of these questions would be appreciated. Especially those that have been on suboxone before and needed to get surgery done. I just worry the sub will block the more needed pain killers. Thanks.

-GC

 

[checktest]

To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine

Perioperative pain management suggestions for patients taking buprenorphine and presenting for elective and urgent/emergent surgery have been developed and are described here.

anesthesiology.pubs.asahq.org

Perioperative opioid requirements of patients receiving sublingual buprenorphine-naloxone: a case series - BMC Anesthesiology

Background Buprenorphine, a partial opioid agonist, displaces full opioid agonists from receptors and may impede surgical pain management. We report the effects of a sublingual formulation of buprenorphine-naloxone, Suboxone (SL-BUP), on perioperative pain management. Methods We identified all...

bmcanesthesiol.biomedcentral.com

The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes - PubMed

<p>The current understanding of the risks and benefits of continuing or stopping buprenorphine perioperatively is limited by a lack of high-quality evidence. Observational studies and case reports indicate no evidence against continuing buprenorphine perioperatively, especially when the dose is...

www.ncbi.nlm.nih.gov

Low/Lower doses of buprenorphine don't appear to significantly alter perioperative anesthesia and general pain control on the whole, but everyone differs. Your stability/history on 1 mg should be good in that regard.

With family that works in your health system, by HIPAA regulations they can't access your chart in regular situations. Not that people do not. You can ask for a private EMR status ('break-the-glass' and other terms) that requires extra logins, but some EMRs can be a hassle and some people ignore them. I have a lot of family and friends in health care, including where I go and where I work, so I can understand the reticence in revealing information. There was a LPN recently fired in my system for joking about someone's bipolar disorder (another nurse or someone) they looked up. Pretty sure other things were going on though....

I probably would want my anesthesiologist to know just in case, especially if complications arise in the course of surgery. Your level of comfort may differ, however.

Pain management depends on adjuncts available and the nature of your surgery. I.e. can't take some with high chances of bleeding, etc...

 

[cosmic charlie]

Just went under anesthesia recently and I'm on roughly 12mgs of Buprenorphine per day. Didn't have any issues with the surgery and it worked just fine. Really hope this works man and you feel better G_Chem I know it sucks having health problems I have some as well and its always a struggle but the Bupe helps cover the pain up for the most part.

 

[GetMeOutOfThisCRAP]

Just letting you know what you probably already know, but even 3-5 days after discontinuing sub use I couldn't feel opioids (like literally at all). Even 3 days or so after those initial 5 days, the effects were still noticeably weaker than if I hadn't taken any subs prior to using opioids again. So they'll help with pain but because you won't feel much of the painkiller effects, it could be dangerous in a sense to self-medicate without being able to properly gauge how strong things are. Only you know where your tolerance is at--perhaps you can even talk to your doctor about temporarily increasing your sub dose for pain relief and foregoing the painkillers post op all-together? People more experienced than me will def help post how to handle this situation.

Sorry if you'd mentioned how you'd manage this dilemma already, just thought it might be important to state just in case. Good luck stay safe

 

[G_Chem]

Thank you guys for all these responses!

@Cosmic Charlie - Much appreciated man I’m assuming you told them beforehand?

@checktest - Thank you that was what I was worried about, based on my VERY limited experience trying to use other opiates on suboxone it seems you are correct that low doses don’t seem to block much of at all. Thing is I’ve only tried it twice in the last 10yrs both times with small amounts, so placebo could have been a factor. Last thing I wanted was to get in there and realize I was wrong haha.

@GetMeOutOfThisCRAP - Just curious man what dosage were you using? I’ve definitely noticed this effect with higher doses but I’ve heard once under 2mg it’s blocking effect is less strong.


In the end I’ll probably tell them cuz I’d rather have surgery go well and then I can manage my own opiates after. Obviously it will mean no opiate painkillers from them.

A little more on me, I don’t have a prescription for suboxone or any of these other drugs. 7-8yrs ago I decided enough was enough with my Suboxone doctor (who later was convicted of trading prescriptions for sex with hot junkies) and took my medications into my own hands.

While I’m still on suboxone I don’t think I would be where I am today if I hadn’t taken it into my own hands. The doctor didn’t want me to taper, whereas once o was on my own I tapered myself.

This opens up another can of worms, in that I have to procure and manage my use of drugs I’ve had problems with before. Without the accountability that comes with having a doc give it to you..

So you see why I’m on the fence a bit...

On one hand I keep my suboxone use to myself, risk complications during surgery but also have a chance at getting proper medications afterwards with the exact dosages and accountability needed to hopefully skirt another addiction.

The other hand, I tell them, surgery has less risk for complications but then once I’m out I’m probably looking at a “take some Tylenol and maybe Gabapentin” type situation. I then procure and use my own opiate painkillers with the potential risk of addiction and the only person that can stop me is me. I stopped myself before I suppose..

Sorry just kinda talking out loud right now. Thinking I’ll go with the second option as I said just cuz no matter what, if I have to take opioid painkillers there’s a risk of addiction either way. The way I’m sourcing these myself it won’t exactly be easy to do often (not like buying dope on the corner at least) but I’m obviously scared to go down this road again.

Appreciate you guys having a listen and being a sound board if nothing else

-GC

 

[GetMeOutOfThisCRAP]

I wouldn't overthink it too much. There's no telling what your pain situation will be like post surgery and if you go bonkers trying to plan it out it can just magnify the pain because you're so focused on it lol.

Let me think... it's been a while. A little scattered between 1-2 mgs.. not super consistent but not less or more.

However the opioids were only about 20-30 mg daily.. maybe you'd have a break through high with a larger dose of pain killers. It's just really hard to discern doses comparitively between subs and opioids because of how they affect a different number of receptors, duration of the two substances, etc.

This is just me... I'd figure out a way to manage my sub amount and arrange it so I have more for the post-operation period. Because I'm pretty sure the painkillers will work for pain relief but you won't feel the high. That wouldn't really be important if it's actually for pain maangement only. But in a way the high determines what my body is telling me and how much is too much versus too little. I wouldn't go past 80 mgs of opioids in a day total with your sub use though. That's HUGE estimation on my part however. I think you'll be better off than you're thinking no matter what you do. Gabapentin is indeed a good alternative to help.

 

[Tryptamite]

Dihydromorphine is about 1.5x the potency of morphine. Similar to the relative strength of codeine and dihydrocodeine.

It is different to di(acetyl/benzyl/propionyl)morphine which all have a relative strength about twice as strong as morphine.
You can have dihydrodibenzylmorphine if you wish. It sounds tasty.
Starting from clean pod extract the dibenzylmorphine full spectrum would be best. Probably will have trace amount's of benzylcodeine probably as toxic as acetylcodeine.
If starting from pure codeine I would go to morphine and then to Dihydromorphine (not necessarily in that order) and then on further if one wished.

The best you will get from pod extract is a kind of clean tar heroin.
Limpet was fond of referring to his dipropionylmorphine as "prope-dope" and sounded for all intensive purposes like good heroin.
I doubt hydrogenation wI'll work with anything but the cleanest of reagents.

 

[Wilson Wilson]

It's best to be on the safe side and let the anaesthesiologist know the meds you are on so they can plan accordingly.

Last time I was put under I was scripted diazepam and they even gave me some just before the operation for preop anxiety so I thought hey not a problem. I told them about it anyway knowing that being on a benzo could cause complications with general anaesthetic. I didn't tell them about my use non-prescribed alprazolam and etizolam use because they have a short half-life so I figured it wouldn't be a problem and didn't wanna get into any trouble.

When I woke up from the operation I couldn't breathe and they had to do some shit to make me breathe again before I passed out. When I came to afterwards, I didn't even remember that happening. But they didn't give me any morphine because they were concerned about CNS depression. As you can imagine waking up from surgery without any painkillers FUCKING HURTS.

I have no idea exactly why that happened but I can't really believe that using potent benzos didn't play at least some part in it.

Since bupe has a very long half-life and knocks other opioids off their receptors, and for general anaesthesia they tend to use fentanyl for analgesia, they probably should know about the bupe in your system.

Assuming they can't see your medical records (which going by @checktest's informative comment they shouldn't) you can just tell them you have bupe scripted for pain relief if you are worried they'll deny you postop analgesia for marking you as an addict.

 

[Hylight]

It's best to be on the safe side and let the anaesthesiologist know the meds you are on so they can plan accordingly.

Last time I was put under I was scripted diazepam and they even gave me some just before the operation for preop anxiety so I thought hey not a problem. I told them about it anyway knowing that being on a benzo could cause complications with general anaesthetic. I didn't tell them about my use non-prescribed alprazolam and etizolam use because they have a short half-life so I figured it wouldn't be a problem and didn't wanna get into any trouble.

When I woke up from the operation I couldn't breathe and they had to do some shit to make me breathe again before I passed out. When I came to afterwards, I didn't even remember that happening. But they didn't give me any morphine because they were concerned about CNS depression. As you can imagine waking up from surgery without any painkillers FUCKING HURTS.

I have no idea exactly why that happened but I can't really believe that using potent benzos didn't play at least some part in it.

Since bupe has a very long half-life and knocks other opioids off their receptors, and for general anaesthesia they tend to use fentanyl for analgesia, they probably should know about the bupe in your system.

Assuming they can't see your medical records (which going by @checktest's informative comment they shouldn't) you can just tell them you have bupe scripted for pain relief if you are worried they'll deny you postop an algesia for marking you as an addict.

I am so happy you made it !
I just wanted to take a chance and say.
Thank you for your amazing strength.
And deep and sincerely atonishing information.
Thank you, please be well and stay safe now !
alright !

 

[Wilson Wilson]

I am so happy you made it !
I just wanted to take a chance and say.
Thank you for your amazing strength.
And deep and sincerely atonishing information.
Thank you, please be well and stay safe now !
alright !

Thanks for the kind words. I've been in tougher spots than that, I once felt myself almost unable to breathe as my whole body turned white from a very close call on an oxy and benzo combo, and I managed to save myself by taking amphetamine. Very fucking stupid of me to mix oxy and benzos especially when I had no naloxone and no one with me. That's the closest I ever came to death.

Luckily in the case with the general anaesthesia I was obviously being monitored by professionals in a hospital so they could do what was necessary to save me instantly. If you're gonna almost die anywhere a hospital is the best place for it to happen! I think they gave me naloxone then too, but I can't be sure because I seriously just do not remember, I was totally blacked out. The first thing I remember was screaming in pain from waking up the second time without any analgesia.

 

[Hylight]

Thanks for the kind words. I've been in tougher spots than that, I once felt myself almost unable to breathe as my whole body turned white from a very close call on an oxy and benzo combo, and I managed to save myself by taking amphetamine. Very fucking stupid of me to mix oxy and benzos especially when I had no naloxone and no one with me. That's the closest I ever came to death.

Luckily in the case with the general anaesthesia I was obviously being monitored by professionals in a hospital so they could do what was necessary to save me instantly. If you're gonna almost die anywhere a hospital is the best place for it to happen! I think they gave me naloxone then too, but I can't be sure because I seriously just do not remember, I was totally blacked out. The first thing I remember was screaming in pain from waking up the second time without any analgesia.

really

 

[Hodor]

Just went under anesthesia recently and I'm on roughly 12mgs of Buprenorphine per day. Didn't have any issues with the surgery and it worked just fine.

The problem with this statement is that there are different types of anaesthetics.

Buprenorphine isn't going to interfere with ketamine (an NMDA antagonist) or propofol (generally assumed to be primarily GABAergic), but it might decrease the effectiveness of fentanyl and its analogues (ex.: remifentanil) which are sometimes used to induce anaesthesia in combination with midazolam.

Therefore, if you are on a suboxone maintenance treatment and possibly taking the occasional benzo, it might be worth mentioning to the doctors.

 

[Zonxx]

Hydromorphone IV is the best alone,but throw some morphine into that solution and ughh i gotta stop this post now.

 

[cosmic charlie]

Yes that's probably what they did I told them and the stuffed burned BADLY as it went in my veins and then zonked I wake up. I'm not really aware of what that gave I didn't wanna look funny asking but was curious. Thanks for your knowledge honor what do you think it could have been what burns badly when IVed to that degree. I don't remember it being that brutal when I went under 5 years ago before that and I also felt high for like 10-15mins after the procedure when this time I was pretty much baseline within minutes and it wasn't euphoric in anyway. Sound like propofol?

 

[Zonxx]

Yes that's probably what they did I told them and the stuffed burned BADLY as it went in my veins and then zonked I wake up. I'm not really aware of what that gave I didn't wanna look funny asking but was curious. Thanks for your knowledge honor what do you think it could have been what burns badly when IVed to that degree. I don't remember it being that brutal when I went under 5 years ago before that and I also felt high for like 10-15mins after the procedure when this time I was pretty much baseline within minutes and it wasn't euphoric in anyway. Sound like propofol?

Hydromorphone likely, if the solution is pushed in too quick it burns like a motherfucker, BUT on the plus... you can get upwards of 80mg into 1ml of sodium chloride

 

[Keif' Richards]

I know I'm late to this, but what I would say to the anesthesiologist is the truth. They certainly can monitor your vital signs and stuff, but there's not a ton of information regarding doing this sort of thing on the sly. I really would just tell the anesthesiologist so you can end up with the most appropriate level of pain control. Either way, they are right there waiting and watching to make sure your alive and breathing so you can expect them to simply compensate with more sedatives, opioids or whatever. The post-op pain control is one that you don't want to go wrong. A lot of docs will prescribe the same level of pain control based upon the operation. This might leave you without adequate pain control and that would suck.

 

[G_Chem]

Thanks to everyone who posted

I decided to tell them after all to hopefully avoid any complications. And will be taking my post operative care into my own hands. I feel this is the best way to go.

-GC

 

[LucidSDreamr]

^ very sad state of affiars that someone on suboxone for 10 years that hasn't abused opioids can't have their pain managed legally. That pain is going to get managed one way or another though. thats what these stupid fucks (the government, not doctors) don't understand.