Hey I will be getting some oral surgery done this week. I thought that if you take suboxone (I currently am on 24mg a day), that you woulg not be able to be put to sleep. Could anyone tell me why my dr. told me to remain on the suboxone before, during, and after my surgery? Couldn't that precipitate withdrawal symptoms? Please someone HELP I don't want to go through withdrawals ever again.....
Here's info straight from NAABT (National Alliance of Advocate for Buprenophrone treatment). It's for doctors so it's got a lot of medical terminology.
What if I need pain medication for surgery, or acute pain?
You will still be able to be treated for pain with elective dental or surgical procedures. Your doctors should speak with each other about the plan. They will likely stop your Buprenorphine medication, at least 36 hours before the procedure, and then when you are ready to go back on Buprenorphine you will need to be re-induced, which means stopping your pain medicine, experiencing mild withdrawal (for a very short time) and restarting your Buprenorphine.
What the PCSS Mentors recommend (print and bring to your doctor)
Your doctor can contact The SAMHSA-funded Physician Clinical Support System (PCSS) and consult one of the buprenorphine mentors.
Recommendations for Patients Receiving Maintenance Buprenorphine Therapy (Ann Intern Med. 2006;144:127-134. Acute Pain Management for Patients Receiving Maintenance Methadone or buprenorphine Therapy) (print and bring to your doctor)
Treatment options are as follows:
1. Continue buprenorphine maintenance therapy and titrate a short-acting opioid analgesic to effect. Higher doses of full opioid agonist analgesics may be required to compete with buprenorphine.
2. Divide the daily dose of buprenorphine and administer it every 6 to 8 hours to take advantage of its analgesic properties. However, these low doses may not provide effective analgesia in patients with opioid tolerance who are receiving OAT. Therefore, in addition to divided dosing of buprenorphine, effective analgesia may require the use of additional opioid agonist analgesics (for example, morphine).
3. Discontinue buprenorphine therapy and treat the patient with full scheduled opioid agonist analgesics by titrating to effect to avoid withdrawal. With resolution of the acute pain, discontinue the full opioid agonist analgesic and resume maintenance therapy with buprenorphine, using an induction protocol.
I also went through oral surgery while on 32ms of suboxone, My pain management dr and the oral surgeon agreed that I could undergo the procedure. I was told to stop then suboxone 12hrs before the appointment, Suboxone is a partial opiate agonist it does not fill your receptors completely. What is is best know for is producing less euphoria and physical dependence. When compared to full opiate agonist such as Oxycontin, vicodin and heroin. Remember the only time you would go into withdrawal would be if you were to try and inject the suboxone, the naloxone would enter the blood stream and you would become ill within minutes, This is a diversion that was placed in the drug to keep people from misusing it. The naloxone when taken sublingually does not really get into your system at all. My surgery involved being put under anesthesia while they pulled 4 impacted wisdom teeth. I arrived and they started an IV and the Dentist come in and told me I had nothing to worry about he said to give me a sedative before that happened I asked what would they be giving me for pain control during the surgery, (Because Nell I had dreams that I was out but felt every painful part of the procedure and I could not wake up to tell them to stop) it was going to be dilaudid just a little extra than I normally use. He said don't worry count backwards from 100 well I think I made it to 73 and then I was out. Next thing I remember is the nurse waking me up and saying you did very well every thing went great, The dr came in a said the same thing, He said no smoking for 7 days as I could get a dry socket. I'll see you in 2 days there's a script at the front desk for you and your ride is here. I remember I snapped out of it very quickly. I went to the front and paid my $1400.00 and got a script for 10mg percocet. I was take 1-2 every 6hrs as needed #20. Well I felt no pain but filled them anyway because I knew all the opiate would wear off sooner or latter. I took the meds as directed. To make a long story short the 36 hours I started feel the withdrawal starting so I took a 16mg dose of suboxone, and felt fine 20 minutes later. You see I take 8mg every 6hrs for a total of 32mg of sub and lyrica for pain management. I didn't get a buzz on the percs other than pain relief, So it was back on with my life and suboxone. As I said suboxone is only a partial opioid antagonist. It takes obscene amounts of opiates to even get a 20 minute rush its just to dangerous to play games, Nobody loved the feeling of Oxycontin and norco than me even when taken as directed, But I was taking 120mg of oxy and 80mg of norco a day, Let me stop, Nelly your going to be all right dont worry yourself sick------God will see you through it--------------NOAH
Hey thanks for your much needed help with my question regarding the oral surgeon. You made me feel a little more comfortable about the procedure. I too was an oxy-norco person and have been on sub for about 8-9 months now. But what would a person do for emergency pain management? That is a question that has been bothering me. I have had kidney stones in the past and I wonder how they would kill the severe pain from those(if one were to occur), without getting off of the sub ahead of time??
Do you carry a ID card identifying you as a suboxone user? On the back it tells the physicians how to treat you for pain management, Mine which I got free from www.suboxone.com, they will send you a kit which contains the card. It is very important that you carry this card with you in case of such emergency, Or if you should be brought into the ER unconscious, They would no how to treat you should you have the card is an easy accessible place in your wallet like in plain view near your license. Or you can go to supper Walmart they have a machine located near customer service that allows you to make ID tags on chains or as a bracelet, I wear a chain that is about the size of a military dog tag. You operate the machine which has a key pad like your computer, You type what to show on the tag, mine says name and alert suboxone 32mg, It cost me $7.00 with the chain, it takes about 5 min and well worth it, Getting back to your ? as the sub is only a partial opiate antagonist. Not every receptor is occupied. The card states on the back that the average dose needs to be adjusted and anaesthesiologist know what to do. Other options are to hold you and give you something non narcotic like toradol no its not ultram a lot of people get the two confused. If your injury is not serious they will treat you with non narcotics, Kidney stones they would just need to adjust the amount of Demerol. You wont feel very euphoric but you will get pain relief, But I would first call my sub DR and tell them your going to the ER for rescue medication for stones, that's what my Dr wrote on the script of 90 norco if my back should go out on me to the point I cant stand the pain the insurance does not question it because they know what a rescue script is, Just make sure the pharmacy enters it as a rescue dose, Tell wellruthie1965, to go to www.suboxone,com they have a physician fined based on zip codes, You always best to go to a pain management as I do to get the suboxone who ever they all do not have the suboxone waiver to prescribe the medication, but they are usually more reasonable and except insurance, where as many of the sub dr that dont deal in pain management or accept insurance is in it for the money, average price for 1st visit should be $175.00 to $250.00, My dr even gives me 2 refills so I go every 3 months as it is 150 mile round trip. She is really good to me if you lived in Florida I'd refer you to her my copay is about $10.25 nelly you can email me anytime, I will get back to you as I get a lot of emails from this forum--------NOAH
Hey thanks again for the advice. I did know that Toradol and Tramadol are separate meds. I happen to be in Nursing School and I currently have a night job doing nothing but passing pills to the elderly. Funny Huh? See the one bad thing with the Toradol is the fact that I am allergic to most NSAIDS. The only one that I am not allergic to is Naproxen. I just am so scared still about this extraction business. I already am having tremendous amounts of pain.. for the last 6 days. I went to my DDS yesterday and was told that I have an absess in one of the teeth that is to be extracted. The infection has also spread into my jawbone. The Dentist gave me a script for Vicodin ES and antibiotics, but unfortunatly, I can't have any pain relief... I told the Dentist about me taking Sub, but I don't think he knows anything about it. I tried to get a hold of my Sub Dr. but no response as of yet. I have been taking large amounts of Aleve and Tylenol. I know that too much of either of those can do harm to the stomach and the liver, but what am I to do? I don't want to quit taking the Sub until I hear something from the doc. If you have any advice for me at all, please let me know... you have been very helpful regarding my past concerns. I'll check back later, gotta get some sleep, just got off work.----------Janell
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