Bupe Suboxone and Surgery Concerns

Hey everyone! I love this site, its helped me out so many times in the past. So I recently (33 days ago) got on suboxone maintenance and I've been taking 2mg twice a day the entire time. I got on the suboxone after a few months of shooting dope everyday after getting out of prison. I found myself unable to stay stopped for even two days but with suboxone its been over a month since ive even thought of the needle. At first I only wanted to do a quick taper because I didnt want to get hooked on suboxone. But after seeing the dramatic difference NOT shooting dope caused in my life, I (and my family n friends n doctor) think I should stay the course for a few months and ween down more and more until I find myself skipping days and gradually moving out of the maintenance (rather than abruptly tapering from 2mg to nothing in a couple weeks).

So everything sounds good right? Well, this morning I wake up and get up the use the restroom and when I go to get up out of bed I immediatly am doubled over in pain. I woke up with an Inguinal Hernia and man its killing me. Im going to have to get surgery soon and it hurts way too much to be walking around and its fucking huge and its killing me

Im worried about going through the surgery on the suboxone because of any possible interactions it can have with the procedure and the drugs they use. Also the idea of taking an opiate blocker and not being able to use perscribed pain medication for legitamite post op pain kinda sucks to me as well. Im scared that this whole thing might trigger some bullshit out of me and I dont want any of it. I like the way things are going. Im not all about being 100% drug free (I currently smoke marijuana and might enjoy other recreational chemicals every once in a while ) I just dont want to be injecting drugs into me, I dont want to be taking opiates every day to function. I dont want to be labeled and removed from society because I can't get it together. Im doing good right now and am looking foward to the future.

So what does the forum think? Should I just stay on the suboxone and "tough it out" so to speak? Maybe they can give me some Ultrams and Ibuprofens and something to help me sleep and I can get through it with that and some medicinal herb

Or should I taper down over the next two or three weeks and then schedule the surgery for a time when Im sub free? Then I can get the surgery, use the meds as needed for pain, and once its over with and a few days have gone by I can analyze the situation and decided if I even need to get back on the sub. Like I said, Im not against taking pain medication if its prescribed for legit pain, I just dont wanna be slamming a needle into my vein morning noon and night.

Really my big concern is my recovery. Trust me, I dont wanna taper off the sub so I can get "rocked" on some vicodin (lol right) for a couple days. And I am fully aware how shaky it sounds to ween down, and Im actually leaning toward staying on the sub. Im just wondering if any of you have any insight or experience with a situation like this while on suboxone and if surgery while on sub led to relapse or problems with recovery. Any tips or insight is greatly appreciated. Its very painful and Ive also been having trouble with my insurance coverage (fucking COBRA) so Im just a mess. Sorry if I went on too long, thanks again guys,

-Jimmy

Definitely tell your doctor every drug you're taking (including Subxone) before you go into surgery. It could interfere with the anesthesia they give you and if anything goes wrong they need to know that naloxone won't reverse a Suboxone overdose. This is really a life or death situation when they put you under they need to know everything.

The one negative is that they can't really prescribe you any opiates because the Suboxone will just block it. Plus being on 4mgs a day, the typical post surgery stuff (vicodin, maybe percocet) probably won't do much for you anyway due to tolerance even if you were to temporarily stop taking the Suboxone.

I'd say just stay with what you're doing. I believe Suboxone does have some pain relieving properties, maybe not as much as a full agonist but better than nothing. Tell the doctor what you're taking and he'll probably give you some good NSAID or some muscle relaxers at least.

Hey there Jimmy3. I just registered so I could reply to your post. I have been lurking on this site for the last few weeks.
First of all...Hi! I am about 4 weeks post-op from Hernia surgery. I am also a chronic pain patient and have been taking opiates for over 5 years. I actually would strongly advise against telling your surgeon about your drug use. I thought honesty was the best policy too. I was completely upfront with my meds (currently rx'd 40 mg Opana/day) I should also mention I am white 35 (but look much younger) professional-looking girl. Not the look one would expect to be discriminated against.
However...
At the hospital when I came out of antistesia the nurses were completly rude and mean. I was in excrusiating pain. More pain than I have ever known. I couldn't even cry because the surgery was in my stomach so any movement of my abs would just cause searing pain. As soon as I woke up I was yelled at. Told I had to get moving...
The forced me out of recovery early. They told me bs lines like "If I give you any more pain meds, I will have to strap you down and put you into ICU" I replied ok...fine..whatever you gotta do. I was hurting so bad I didnt care.
The nurse went on to say I would be charged because it would not be covered by my ins...blah...blah..blah..
She ignored my cries. I couldn't argue. My stomach/ab muscles could NOT move at all. I had to breathe thru my pain. Tears rolling down my cheeks. My chin quivered in disgust.
When I was discharged I was not prescribed ONE THING for pain! They expected me to simply use my existing rx for the surgical pain. That first night was unreal! I will never forget the pain I experienced. I had lots of opana and some percocet I saved.
It was incredible. I know the treatment I received was due to the fact that they did not understand why I was on such a strong med. I dont look crippled or hurt. My disease (Anklosing Spondylitis) is invisible.
I also ran into the same prob a year earlier when I had another procedure. This one was where they burned a few layers of my uterus to stop bleeding. Its called ablation. Anyway, its painful as hell! Same thing. I told my doc up front. Asked him to coordinate my post op care with my pain doc before the surgery. I was assured I would not have to worry . I was in good hands. It was not until I was done with surgery that he said..."No meds...not comfortable. At this time I was only taking 4 10/325 Percocet/day. He would not prescribe me A THING!
Needless to say, I would strongly encourage you to keep your mouth shut. You are better off being treated like everyone else. The medical community at large does not understand dependency, tolerance, and proper pain management. It is very widely misunderstood and many docs will simply shy away from any involvement.
I wish you the best of luck! Do not under estimate the recovery. Its a full month. The first week is unreal. I could not get up or lay down using my own muscles. I had to be placed. It is a lot of strain on those around you. Just be prepared.

Also, I am also going thru withdrawl now as that experience really made me realize how horrible life can get when people do not understand. So I am at the tail end of a week or so taper. I have been taking a few tramodol (prob 6 so far) as well as a few clodine (prob 2)
I have an appt w my doc tomorrow am and I have one pill left to get me by till then. Not sure what will happen but we are on the right track. Just gotta keep going....

IMO i wohld do some research on this site about rapid sub tapers and do one. I would most certainly want my pain killers aftet a surgery but of course that is my opinion

Oh also, I forgot to answer your questions...
I would try your HARDEST to be off of EVERYTHING at least a full week before your surgery. If you need pain meds go with trams or something else not an opiod. The reason I say this is because if your tolerance is up then the meds they give you wont work as well. And trust me! You will NEED every bit of pain relief. It is NO JOKE.
That is some serious pain and actually where these strong meds belong. Treating post-op pain and such.
Not as a daily pain reliever. Even though, I wish they could be taken that way without all the issues. It does make life much more palatable.

I mean no offense here as I know Simplgrl is just trying to help, but you need to disregard everything she said. I'm sorry she was discriminated against as a pain patient, but this has NOTHING to do with your circumstance.
You will be out under general anesthesia and are currently taking a drug that interacts with virtually every drug that is used to induce anesthesia. For instance, fentanyl is commonly used as an adjunct in anesthesia and the suboxone you are taking would block the effects of it to a very large degree. The anesthesiologist needs to know EVERY med you are taking so he can put you under and bring you back safely...that's his job. The idea that you would not disclose this crucial detail of your case would be dangerous and irresponsible beyond measure. Sorry friend, there are no two sides to this argument, they need to know.

Thanks romealone, you are correct! I was not considering the subs. I figured he would be well off them before the procedure.
Yes! If you are still on the subs definatly tell your docs. I was referring strictly to having other meds on hand or rx'ed
sorry for the confusion

Thanks for all the replies, I'm on my phone so this will b short. I'm not asking if I should keep my sub use a secret from my doctors, they already know. I'm just wondering if you guys would advise me to get off the sub for my surgery to avoid complications with my procedure and recovery. Thanks again for all the advise and feel free to keep it coming, peace!

If your doctors know, then ask them. They'll know how to answer your question best, as they know what they're going to administer to you.

i would stay off the bupe for a week before surgery

Some people here seem to think you can just kick bupe a week before surgery, with a painful hernia, just like that.

Um nope. Be completely honest with doctors, they will tell you how to manage and should help you best they can.

Good luck

just tell your surgeon and anesthesiologist that you are on sub at whatever dosage and they will figure it out and let you know what you'll have to do prior to surgery. each anesthesiologist is different; when my girlfriend had her gallbladder out while on subs, they told her to just keep on taking the suboxone as she normally did, and they compensated for it by using more fentanyl or whatever during the procedure. what will actually knock you out is maybe a benzo plus a non-opiate agent like sevoflurane or propofol... the opiates are just for pain... anyway, the surgery went great for her, no problems at all. but this really is a scenario where you want full disclosure, if you are taking any opiates or benzos on the regular, they need to know so they can knock you out both thoroughly and safely.

you will definitely have a harder time getting medication for post-op pain, though, particularly if they know that the sub is prescribed to you for opiate dependence. often they will just suggest that you use the sub for pain control at an increased dosing regimen vs what you normally take for maintenance... my girlfriend found this to be ineffective, she just ended up using powder dope on top of the sub for pain relief... or perhaps you will get scripted vicodin or something that will be ineffective when sub is in your system... but in whatever case i very much doubt that they'll give you stronger post-op pain meds to compensate for the fact that you're taking sub. so be prepared to lean on e.g. pot, naproxen and your subs for post-op pain.

OP, if your doctors know then you should be fine. Think about it... they've performed countless procedures. There are many people on buprenorphine who also end up needing surgery. They will know how to treat you.. if they don't then they need to go back to medical school.

My dad was on bupe and is now on methadone for opiate addiction. He had knee surgery while on Subutex and I believe he elected for local anesthetic instead of general anesthesia. They also gave him a lot of benzos and apparently he chatted with the surgeon for most of the surgery and was very interested in whatever they were doing with his knee... He didn't remember any of it though. Post-surgery he used iboprofen and icing for pain and was fine. It's mostly swelling that causes pain and he said opiates really just make you out of it so you don't notice the pain and make you rest and allow your body to heal.

He had major stomach surgery while on methadone which they put him under for. When he got out of surgery he was MISERABLE from the pain. I think he had some really incompetent nurses at first... but finally they got enough morphine in him to get him comfortable. They just had to keep pumping it into him till it broke through the methadone. But he said the most effective thing for his pain was the Adivan they gave him. It potentiated his methadone and made it strong enough to help with the pain.

I'm kind of just related what he told me here.. but he's always happy to relate his experiences to other people so I can give you his email if you want and you can ask him any questions or concerns you have

Speak with your docs about a taper plan to take advantage of full agonists during the acute pain. Ideally, as someone else mentioned, you might be Rx'ed tramadol to bridge the gap to the day of the surgery.

Off topic, but to respond to slim girl, Im sorry to hear her experience, but honesty SAVED me during my last kidney stone. Iam Rx'ed 50mcg/fent patches every 48 hrs. As a result, the Doc put me on 100mcg fent patches and 10mg percs. Had I not told him, I would have been up shit creek. During my stay at the hospital, I was also given a generous dose of morphine on a regular basis on top of the 100mcg fent patch.

Hey @ReversiblePulpitis - That is good to hear. After 2 surgeries and having multiple docs tell me it was not a surprise that post-op pain is not treated properly if you are already on pain meds, I just felt this may be a more common problem. Something most people (at least I didnt) even consider would be an issue.
I thought by being honest, I would be prescribed something stronger to compensate but every time I was expected to use my regular meds for the new pain. It was a joke.
I even spoke to my pain managemnent doc before my first surgery to ask how this is handled and he said the surgern should treat the new pain seperate. He would not be responsible. That made sense to me so I told the surgern and staff. I guess I just was unlucky to have a complete ass of a gyno cuz he played it off like all was good until I was out of surgery. I was literally pushed out the door. Did not even go into recovery (which I think is criminal negligence material) and was barely even out of the antesthia. He told me "im not comfortable with that" when I asked what about any rx?
Sorry if this is not common. I hope its not and I was just unlucky. I just have feeling it will get worse with this new war on drugs. My docs keep telling me they are feeling the pressure from the DEA and more and more docs wont want to get involved with writing for these kinds of meds.
I just think its something to consider. Be honest and risk not getting anything, or keep your mouth shut and get treated like any other patient.
I would have been better off if I kept my mouth shut. thats all im sayin

I just had surgery Friday on my ankle and they put me asleep and all that... I stopped taking my suboxone 2 days before surgery and am on pain meds until they run out then back on subs. They need to know about the suboxone and u can't taken it or your iv pain med they give u thru ur I'v won't work

The simplest answer to your question is rooted in neuropharmacology. Buprenorphine has a high affinity for the mu (opioid) receptor. If you notify the physician he/she should be able to treat your post operative pain with parenteral fentanyl which has a higher affinity for said receptor and should more rapidly remove the buprenorphine from the site. I would however discuss this with your doctor and see about beginning to taper before the surgery to avoid post op concerns about proper analgesia.