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BDD Moderators: Keif’ Richards
Subutex Question Please
- Thread starter bronson
- Start date
Just try to take your last dose 24 hours before your surgery as they will likely put you on a PCA pump with morphine, hydromorphone, or oxymorphone. If they don't put you on fentanyl, you will have issues getting pain relief if you take your dose the day of the surgery.
And to answer your other question...they added naloxone (an opioid antagonist - what they give patients who are ODing on opioids) in an attempt to prevent patients from administering their pills intravenously, but this was in vain as the buprenorphine (the active ingredient in Subutex/Suboxone) has a much stronger affinity to µ (opioid)-receptors than naloxone does. It's ill-effective in keeping the pills from working when being shot up, but it might diminish the effects slightly. Regardless though, naloxone will not have full effect on a buprenorphine overdose because of it's partial agonism.
And to answer your other question...they added naloxone (an opioid antagonist - what they give patients who are ODing on opioids) in an attempt to prevent patients from administering their pills intravenously, but this was in vain as the buprenorphine (the active ingredient in Subutex/Suboxone) has a much stronger affinity to µ (opioid)-receptors than naloxone does. It's ill-effective in keeping the pills from working when being shot up, but it might diminish the effects slightly. Regardless though, naloxone will not have full effect on a buprenorphine overdose because of it's partial agonism.
Swimmingdancer
Bluelight Crew
Actually both Subutex and Suboxone block other opioids. It's the buprenorphine in them, not the naloxone in Suboxone that does this. Basically buprenorphine is more strongly attracted to the opiate receptors than most other opioids and also more strongly than naloxone, plus when naloxone is taken orally in the small dose that's in Suboxone it doesn't do much anyway. So buprenorphine in a high enough dose prevents most other opioids from attaching to your receptors. It depends what opioid they are giving you for your surgery. If they give you one that binds to the receptors even more than buprenorphine (like fentanyl might possibly be able to overcome the blockade) or they give you a high enough dose of opioids in order to compensate you should be ok. Just let everyone involved with your medical care know that you are on buprenorphine and worried about the opioids not affecting you. I do think the best plan would probably be to try to go without your Subutex before the surgery, but see what your doctors say.
As far as worrying about getting sick, it depends how long you are going to be on other opioids for. If you are just stopping your Subutex and being given other opioids for one day then it won't make you sick to switch back to Subutex right away. If you are going to be given other opioids for, say, a week or more while you recover then you would have to wait until you are in withdrawals before taking the Subutex because it could cause precipitated withdrawals, (sudden very bad withdrawal symptoms).
Edit: ninja'ed by Jktm
As far as worrying about getting sick, it depends how long you are going to be on other opioids for. If you are just stopping your Subutex and being given other opioids for one day then it won't make you sick to switch back to Subutex right away. If you are going to be given other opioids for, say, a week or more while you recover then you would have to wait until you are in withdrawals before taking the Subutex because it could cause precipitated withdrawals, (sudden very bad withdrawal symptoms).
Edit: ninja'ed by Jktm
Mr Tee Blah
Greenlighter
- Joined
- Jun 16, 2011
- Messages
- 32
suboxone and subutex are essentially the same thing
the naltrexone ratio is so small as to be completely negligible.
the issue you will face if you stay on the subbies until your surgery is that they overpower most opiates (hence stopping you from feeling any pain relief effects)
there are some painkillers that will overcome subbies - high doses of fentanyl and other super potentate synthetic opiates
what you may need to do is stay off the subbies for a few days, until you start to get sick from withdrawal - that way after your surgery any pain meds your surgeon prescribes will atleast have some effect
i have no idea how subbies will effect anaesthetics
the bottom line is :
if your surgeon doesn't know much about subbies he can either look it up or ask a pain management specialist (whos prolly based in same hospital)
it should be no more than a email/phone call away for him
i find it unnerving how reluctant many health care professionals are to ask for help from their co-workers or specialists in the relevant feild
the naltrexone ratio is so small as to be completely negligible.
the issue you will face if you stay on the subbies until your surgery is that they overpower most opiates (hence stopping you from feeling any pain relief effects)
there are some painkillers that will overcome subbies - high doses of fentanyl and other super potentate synthetic opiates
what you may need to do is stay off the subbies for a few days, until you start to get sick from withdrawal - that way after your surgery any pain meds your surgeon prescribes will atleast have some effect
i have no idea how subbies will effect anaesthetics
the bottom line is :
if your surgeon doesn't know much about subbies he can either look it up or ask a pain management specialist (whos prolly based in same hospital)
it should be no more than a email/phone call away for him
i find it unnerving how reluctant many health care professionals are to ask for help from their co-workers or specialists in the relevant feild
thesameoldfears
Bluelighter
If you take your normal dose the morning of the surgery, assuming your dose is at least 2-4mg, then you're going to have a hard time getting any relief from your pain meds due to the high binding affinity of bupe. I've had to wait 5 days before I got effects from a full agonist after being on high doses of bupe before, but if I keep my dose really low I can have success from as little as 18-24 hours. And as others said suboxone/subutex act in the exact same way as the naloxone does not out compete the bupe at the ratio in the pill. Personally I would wait as long as possible before surgery without taking bupe, but don't set yourself up with an unrealistic amount of time so you end up caving and taking it too close to surgery. Like if you know you can make it three days without bupe prior to surgery, don't try and wait 5 and end up taking it the night before surgery. You could also try to taper your bupe for the time period before surgery to get your tolerance lower.
This is just my personal suggestion based on my experience with switching from subs back to a full agonist. If you're being honest with all of your doctos then they should be able to tell you what to do.
Another thing I wanted to touch briefly on is this: I've heard of people who are on bupe or methadone maintenance who have surgical procedures where the surgeon assumes they won't be in pain afterwards because they're already on high doses of opioids. Make it clear you are not immune to pain and in fact have a tolerance that will make it difficult to get relief from the normal medicines and dosages they would prescribe to a non-tolerant individual. It is hard for people (especially those unfamiliar with how bupe works) to know how to dose someone who has developed such a tolerance since a dose that for you will only provide pain relief could have another non tolerant individual very sick.
This is just my personal suggestion based on my experience with switching from subs back to a full agonist. If you're being honest with all of your doctos then they should be able to tell you what to do.
Another thing I wanted to touch briefly on is this: I've heard of people who are on bupe or methadone maintenance who have surgical procedures where the surgeon assumes they won't be in pain afterwards because they're already on high doses of opioids. Make it clear you are not immune to pain and in fact have a tolerance that will make it difficult to get relief from the normal medicines and dosages they would prescribe to a non-tolerant individual. It is hard for people (especially those unfamiliar with how bupe works) to know how to dose someone who has developed such a tolerance since a dose that for you will only provide pain relief could have another non tolerant individual very sick.
I'm quick like that.
I tend to look for threads with no or very few replies, as replying to threads with more than 6 or 7 replies in BDD tends to get redundant lol. Though the reinforcement is good.
But ya, I would drop the Subutex 24-36 hours before surgery to avoid this. And also, buprenorphine, while having an extremely high affinity for µ-receptors, isn't very good for pain. I know this from personal experience. You might need to stay on regular opioids until you've recovered so as to keep from being in agony.
I've IV'd 4mg of Suboxone before, and it might have dropped my pain level down from a 7 to a 6... I DO NOT ADVISE DOING THIS; IT'S VERY UNSAFE AND RECKLESS.
I this doesnt exactly answer your question but it is good to remember anyways:
I have been told by numerous methadone/suboxone doctors that when dealing with regular doctors they sometimes assume you are going to need less then or zero painkillers, since you are already on opiates. I have experienced this first had with a dentist and it is not fun. Good luck with the surgery !
I have been told by numerous methadone/suboxone doctors that when dealing with regular doctors they sometimes assume you are going to need less then or zero painkillers, since you are already on opiates. I have experienced this first had with a dentist and it is not fun. Good luck with the surgery !
how much subutex are you taking? if you are taking bupre for pain you probably are taking below 2mgs, and below 2mgs the subutex or suboxone does not block other opiates..
0.5mg subutex compliments other opiates quite well, kind of ULD naloxone potentiation
0.5mg subutex compliments other opiates quite well, kind of ULD naloxone potentiation
hatrix
Bluelighter
I'm sure the daily dose surpasses that since he/she said they have been using for an extended period of time.
I would say you should stop taking a couple days before the surgery. You'll probably go into withdrawal, but it's better than the opiates they give you having no effect and experiencing terrible pain.