Treatment Subutex question

I was wondering if anyone out there had any suggestions for me.
I just delivered my daughter on Monday Feb 20 2017. I take 24 mg of subutex (NOT SUBOXONE) once daily. I tore during delivery and am in an extreme amount of pain. The hospital hasn't offered me anything for my pain besides Tylenol which does absolutely nothing so I don't see the point in taking it. They wouldn't give me any narcotics which I totally understand given my history but I am so very uncomfortable I have no idea what to do. Any suggestions are welcome.

Congratulations ?!!!! Girl, I feel your pain. I was there before.

I don't know protocol for your situation. I can only think of sitting in tub when you can. I would be in the tub at 2am- floating was the only reli

Oops- floating gave me relief.

There has got to be some type of protocol for pain. Im sure others will know. Hang in there.

OP, would it be possible for you to get a second opinion on the appropriateness of a script for proper pain meds while you heal physically? I want to stress that I'm in no way expert about the suitability of narcotics post-partum. But I do know that it's very common for docs to Rx opioids even to addicted people after surgeries, which aren't so different from what you're going through. Obviously this requires care and assurances that the meds will be used responsibly. But these can often be worked out.

Again, I'm suggesting seeking a second opinion only...I'm not advocating doctor-shopping or anything like that. It just strikes me as surprising and somewhat cruel that you're not getting proper treatment for your pain.

Keep us posted.

first off thank you both very much for your replies.
I'm going to ask the doctor that is doing the rounds today what I should do. Trust me I also think it's very cruel they aren't doing much for me either. I also think it's because no one around here knows much about subutex to begin with. When I was in labor I asked for relief and they claimed anything they would give me would send me into withdrawl. Which I am almost certain isn't true. I was having contractions and was miserable with pain so I didn't want to argue the toss.
Last night I hid in my bathroom here at the hospital and just sobbed. I sobbed because I was in so much pain and overly frustrated. I'm also trying to breast feed and my daughter will not latch properly so I have super sore cracked nips. I am already overly emotional so add physical pain and you get a fully grown woman who can't keep her shit together long enough to even pee.
All in all I'd say I needed to ask more questions about this stuff before we got here but I'm here now and feeling really lost and really let down. I guess I dug myself into this mess so I shouldn't expect anything other than what's going on but it's still hard. I'm a human being who is in pain and no one seems to want to help.
Thanks again for your replies!

Well unfortunately the doctors may be right about sending you in to withdrawals. I am only speaking from personal experience. If some of the opiates were able to find a receptor to attach to (a big IF in a system flooded with bupe) they would certainly be ripped off the receptors at the next dose. It is violent on a level not measurable by the COWS scale. I didn't know what a true 10 was until I let a Butrans patch touch my skin with 1.5 grams of oxy as my daily base line. I ate 10 grams (yes that is right GRAMS not miligrams) of oxy over the next 3 days and it didn't even have any perceptible effect. I know this is the opposite situation that you are in being that you are flooded with partial opiate agonist, but it is the same premise. Bupe will not allow any opiates to take hold for long and when it unseats the rare few that do find a derelict receptor the results will be a very short and violent withdrawal. Meditation (yeah OMMMMMMM) might be your best bet. Toradol might work if it is acceptable with nursing babies. God it is good to be clean!

Narcotic pain relievers will not precipitate withdrawals for you, given how you described your situation with subutex. It's conceivable they might not have much effect until you metabolize the bupe in your system, but that should happen fairly quickly once you stop that (and start pain meds).

The danger (as jdfisse notes) is when you go the other direction--from full-agonist opioids back onto bupe when your pain lets up. That one you have to do very carefully.

But you should be able to transition onto opioid painkillers smoothly.

All this is, again, couched in my reminder that I'm not a doctor, so please do check with a doc you can trust.

American-

I am so sorry you are being troubled with this shit during this precious time. Im giving you a big hug.

I know you're in alot of pain- it hurts like hell. Try to get your bearings -and find out what protocol for pain management is while on sub.

As others said-you'll be ok going from sub to pain meds. But not pain meds to subs again due to prec w/d as Im sure you already know.

This is a precious time for you-remind the medical staff of that fact. And that you are in excruciating pain. Are you ok w waiting 24hrs after taking pain meds to re-start subs? Maybe they could work w you and come to a solution. Again, congratulations on your daughter.

jdfisse said:

Well unfortunately the doctors may be right about sending you in to withdrawals. I am only speaking from personal experience. If some of the opiates were able to find a receptor to attach to (a big IF in a system flooded with bupe) they would certainly be ripped off the receptors at the next dose. It is violent on a level not measurable by the COWS scale. I didn't know what a true 10 was until I let a Butrans patch touch my skin with 1.5 grams of oxy as my daily base line. I ate 10 grams (yes that is right GRAMS not miligrams) of oxy over the next 3 days and it didn't even have any perceptible effect. I know this is the opposite situation that you are in being that you are flooded with partial opiate agonist, but it is the same premise. Bupe will not allow any opiates to take hold for long and when it unseats the rare few that do find a derelict receptor the results will be a very short and violent withdrawal. Meditation (yeah OMMMMMMM) might be your best bet. Toradol might work if it is acceptable with nursing babies. God it is good to be clean!

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simco said:

Narcotic pain relievers will not precipitate withdrawals for you, given how you described your situation with subutex. It's conceivable they might not have much effect until you metabolize the bupe in your system, but that should happen fairly quickly once you stop that (and start pain meds).

The danger (as jdfisse notes) is when you go the other direction--from full-agonist opioids back onto bupe when your pain lets up. That one you have to do very carefully.

But you should be able to transition onto opioid painkillers smoothly.

All this is, again, couched in my reminder that I'm not a doctor, so please do check with a doc you can trust.

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simco is correct, taking opioid pain medication when buprenorphine is already in your system won't do anything in terms of precipitating withdrawals. It will however help to your pain level. There is ABSOLUTELY no legitimate or medical reason for them refusing your pain medication as is appropriate to any other woman in your condition.

It's very frustrating how this kind of unprofessional, horrible bedside manner is so common when it comes to treating patients on opioid replacement therapy or who have an admitted history of substance use disorder. There is just no fucking reason for it other than moralistic narrow minded attitude on the part of the staff.

I hope you find a way to advocate for yourself to get the kind of care you deserve OP! Please show this document from the National Alliance of Advocates for Buprenorphine Treatment: http://www.naabt.org/documents/PCSSAcutePainGuidance.pdf and visit their website for more info: http://www.naabt.org/faq_answers.cfm?ID=51

Hopefully your doctors are simply uneducated as opposed to bigoted when it comes to people they see as drug addicts.

Thank you everyone for responding!
I'm actually being discharged as I type this. Tried to get the doctors attention but she was never sent to my room. I have a sinking feeling they think I just want to get high. Which I don't. I have over a year clean and I just want to enjoy my newborn. This is fucked up beyond belief. I'm usually more of a loud mouth about stuff when it pisses me off but I think I'm going to find myself in the bathroom sobbing again. I have no idea how I'm going to make it through.

You really need to talk with someone on staff at the hospital before you get discharged about this issue if it is still a problem. I mean, if you are resigned to dealing with it on your own that is one thing, but if you need additional help you need additional help.

You are in the right here, so if you need to please don't hesitate to stand up for yourself. What they are doing is unethical and unprofessional, although I probably wouldn't actually put it in those words to them. Just get them to see that document about talking with your doctors about how pain medication should be used as a buprenorphine patient.

Like, just refuse to leave until they have someone, ideally a doctor or manager, come over and talk to you about this. And not before showing them the document I linked to you about talking to your doctor in my previous post, like actually going through it along with them to make sure they actually read it.

Please let us know what you do and how it works out regardless of whether you decide to fight for yourself or just go home. I hope you feel better ASAP

BTW congrats on your daughter! Other than the horrible pain, it must feel pretty amazing to be a parent

If it gets out of hand I will call my OBGYN. For now I really don't feel like fighting them.I'm tired I'm dizzy my nipples hurt and I can't sit down without wincing. I don't want to look at these people's faces anymore. I'm just done. I just want to go home and forget about all of this️

But thank you so much for those two links! I'm very grateful you replied toothpastedog!

Americanfloosie said:

If it gets out of hand I will call my OBGYN. For now I really don't feel like fighting them.I'm tired I'm dizzy my nipples hurt and I can't sit down without wincing. I don't want to look at these people's faces anymore. I'm just done. I just want to go home and forget about all of this️

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Americanfloosie said:

But thank you so much for those two links! I'm very grateful you replied toothpastedog!

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No problem, it's why we're hear I totally understand where you're at in terms of just wanting to get home and relax. You definitely deserve your rest. Hope you have a safe and healthy transition home and with the baby.

Let me tell the forum about a little hell scenario that I personally witnessed. My wife was on sub and roxy at the same time. Yeah for 2 years. Throw in some adderal and some valium and she was having a grand old time. Every single night WITHOUT fail for 2 years she would go into a massive terrorizing 20 minute withdrawal period. YOU CAN SUFFER PRECIPITATED WITHDRAWAL IN A SYSTEM THAT IS ALREADY FLOODED BY BUPE. It is pretty simple. A little bupe falls off...a little opiate attaches...here comes the bupe again and RIP! If that wasn't your experience then I am very glad for you, but that experience can and does happen. Now I will say that with 24mg of bupe as your daily dose that scenario would seem pretty unlikely because although that is within therapeutic limits it is an irresponsible and unnecessarily large dose of bupe. [edit **as long as new bupe isn't introduced into the system the withdrawal could be avoided but responsible docs would be shocked by seeing a 24 mg daily dose of bupe] Pretty standard for bupe doctors who are trying to keep cash cows in the stable.

jdfisse said:

Let me tell the forum about a little hell scenario that I personally witnessed. My wife was on sub and roxy at the same time. Yeah for 2 years. Throw in some adderal and some valium and she was having a grand old time. Every single night WITHOUT fail for 2 years she would go into a massive terrorizing 20 minute withdrawal period. YOU CAN SUFFER PRECIPITATED WITHDRAWAL IN A SYSTEM THAT IS ALREADY FLOODED BY BUPE. It is pretty simple. A little bupe falls off...a little opiate attaches...here comes the bupe again and RIP! If that wasn't your experience then I am very glad for you, but that experience can and does happen. Now I will say that with 24mg of bupe as your daily dose that scenario would seem pretty unlikely because although that is within therapeutic limits it is an irresponsible and unnecessarily large dose of bupe. [edit **as long as new bupe isn't introduced into the system the withdrawal could be avoided but responsible docs would be shocked by seeing a 24 mg daily dose of bupe] Pretty standard for bupe doctors who are trying to keep cash cows in the stable.

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Perhaps I should have been clearer: taking buprenorphine and a full agonist opioid medication at the same time is problematic. But as long as one has waited 24-48hrs after the last dose of buprenorphine and not reducing buprenorphine until 24hrs after the last dose of full agonist opioid medication was consumed, it is highly unlikely that there will be any interaction. See http://www.naabt.org/documents/PCSSAcutePainGuidance.pdf

IME I have had no problem taking significant doses of full agonists less than 24hrs after taking buprenorphine, although I've always waited at least 12-24hrs before taking a dose of buprenorphine after taking a full agonist opioid. I don't know anyone who has had any issues whatsoever taking full agonist opioids while on a course of buprenorphine.

IME the complications that rarely seem to come when administering a full agonist while undergoing buprenorphine treatment can avoided entirely by waiting a day or two before taking any full agonists, often less of a wait before the full agonist can be safely administered.

We are home and I'm feeling a lot less anxious about it all. I think just being in my own home has a calming and pain killing affect.
As for my dose of 24 mg. That is not the first time I've heard that it sounds like I very high dose. I'm definitely going to be weaning lower here sooner rather than later but my question is though why is 24 mg a reckless dose? What is a good dose to be at? And as for the cash cow thing my doctor actually doesn't really make any money off of me. I have a special contract with my clinic. I don't want to get into details but they basically make zero money off of me other than my counseling sessions. But I don't disagree 24 mg seems high and I'm not saying there aren't crazy doctors out there but I just wouldn't consider my doctor to be that kind of an asshole.
Thanks guys. I haven't posted on Bluelight in forever. I've missed my bluelight family!

American-

Glad you're feeling less stressed. And breastfeeding can be difficult. I chose not to-and omg my boobs hurt sooo bad. I looked like Miss December lol. I had to wait for my breast milk to come out on iits own-and it did at a horrible moment.

It gets better- and I know you'll figure this out

Americanfloosie said:

We are home and I'm feeling a lot less anxious about it all. I think just being in my own home has a calming and pain killing affect.
As for my dose of 24 mg. That is not the first time I've heard that it sounds like I very high dose. I'm definitely going to be weaning lower here sooner rather than later but my question is though why is 24 mg a reckless dose? What is a good dose to be at? And as for the cash cow thing my doctor actually doesn't really make any money off of me. I have a special contract with my clinic. I don't want to get into details but they basically make zero money off of me other than my counseling sessions. But I don't disagree 24 mg seems high and I'm not saying there aren't crazy doctors out there but I just wouldn't consider my doctor to be that kind of an asshole.
Thanks guys. I haven't posted on Bluelight in forever. I've missed my bluelight family!

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Just for some additional context--I was on 24mg of bupe for about four months. They kept hiking my dose because I kept craving enough that I'd frequently hold back my meds so I could get high. So:
a) 24mg is definitely a high dose. But not unheard of. FWIW, I don't think it was particularly therapeutic though.
b) For six months (my whole tenure on subs) I danced back and forth between bupe and heroin. It was shitty in a million ways. But not
once did I wind up in pWDs. (I had to wait until I started on naltrexone for that ).

You are in the right place AF. It isn't some ridiculously high dose, it is just above what I have experienced ever needing to form an adequate blockade and subvert withdrawal. Bupe is a weird animal with such a long half-life that serum levels stay pretty high for days even after abstinence. In my experience Bupe is one of those less is more chemicals (it works better over the long haul in smaller doses). My comment wasn't meant to inspire fear. For all intents and purposes Bupe is pretty benign when taken alone. If it wasn't, there would already be a field of scattered bodies because of the irresponsible prescribing. I just get my ire enflamed when I see it being marketed as a panacea for the long run. If a person is not an addict and merely dependent on an opiate it is a subversive way of continuing to generate revenue for doctors and pharmaceutical companies.