Suboxone + surgery + post op pain meds

[ndts]

Hi,

I am currently taking 24mg of buprenorphine a day as Suboxone.

My wisdom teeth are coming in incorrectly, therefore I will most likely have to have them removed.

I know that I have to tell the practitioner in advance that I am on suboxone so there will be no problems with anesthesia, etc.  My question requires some pretext.  After the sugery I will obviously be in a lot of pain.  My opioid tolerance is substantial because I am on buprenorphine at a moderately high dose, so the routine painkillers that are prescribed post op in most circumstances (e.g. vicodin) would not be strong enough to alleviate my pain.  What do practitioners most often do in these situations?  Do they prescribe stronger pain killers to suit the patient's tolerance level?  Or do they play it safe and prescribe the routine, weak pain killers, even at the distress of the patient?

One reason I ask this is because during a recent stay in a hospital (before I was on suboxone), a nurse reported to my attending doctor that I had scars or "track marks" on my arms, and that I was a possible drug user (used to do IV heroin).  During one of his visits, he asked me if I was an IV drug user.  Feeling as though I was caught, and also putting myself out there hoping he would not judge me, I told him the truth about my drug use.  I was on 3mg morphine IV every 2 hours at this time.  The next day, a psychiatrist came in and interviewed me further about my drug use.  I was also totally honest with him.  He prescribed me Celexa and left.  Shortly after, I requested more morphine as I was in legitimate pain.  The nurse came in with the morphine, but after checking a computer she told me she could not administer it because it was no longer prescribed to me, but said I had some percocets prescribed.  I asked for the percocets, and after a couple hours of waiting, the nurse finally brought me a 37mg tramadol/325 APAP pill which is DEFINITELY not adequate pain relief.  At this point, I was in serious pain, descending into opiate withdrawal rapidly and losing my wits.  I sensed a change in all the nurses and doctors who were attending me, they were less compassionate and looked at me differently; as though they didn't fully believe anything I said.  This made me extremely angry and upset.  I was apparently being denied adequate pain relief just because of my past drug use.  I repeatedly told the nurses I was in pain and that the tramadol wasn't working, but the most they would do is give me a warm pad to lie on which, in my opinion, is a big slap in the face.  They would not prescribe me anything else, so I had to wait in pain for another couple days before being discharged with a lousy, useless bottle of tramadol and a referral.

That was a very negative experience for me.  I put myself out there and was totally honest with the doctors about my drug use hoping I would not be judged and discriminated against, but that is exactly what happened.  I hope the prejudices and discrimination I experienced is not the norm for other hospitals/practitioners... If I have to get my wisdom teeth removed, I do not want to suffer immensely while it heals.

[peanuts136]

I had knee surgery and I done the right thing and tapered off suboxone like my doc told me. He reassured me that I would get adequate post surgery pain relief. Well, after I got released my sub doc did not call and approved any type of pain meds. Needless to my leg felt like it was on fire all night. They told me to take Tylenol. How in humane and cruel these doctors are, I believed my sub doc and in the end he did not even call me back. I was crying in pain and they treat me like a street junkie looking for a fix. This was a hard lesson to learn, and how can they send a patient home without adequate or rather no pain relief at all. Every doctor should know there is a better recovery from surgery with adequate post op pain relief. I will not be able to go to rehab for my knee because the pain would be even more intolerable. Needless to say, I will not return to the suboxone program because I can not go thru this again if I need more surgery in the future and I don't want to be treated like dirt from nurses and doctors when they know you are on suboxone. They don't see us a recovering addicts, but the treat us like we are looking for drugs even after we have surgery and any other patient receives post op meds, we excluded and punished by the medical establishment for the rest of our life. They don't see us being clean for years no matter how long it's been . We we always be treated like junkies, we are human beings and everybody deserves a pain free recovery from a surgery. I'm a upstanding citizen, I work everyday pay taxes and pay all my bills. Do I not deserve the same respect as any other patient in the hospital. They don't mind charging my insurances and asking for payments. This was my biggest fear and it came thru. This is how we get treated, trying to live a productive full life drug free, thinking suboxone is a great way to achieve this. But I found out it is a high price to pay. I feel like I'm not worthy enough or that I must not be a good enough person in their eyes to not have to suffer thru this agonizing post op pain.

[Tuckamore]

I am very sorry for the way you were treated on your last hospitalization. You ask a very complicated question in my opinion. I never advise someone to withhold facts from their medical practitioner. You will not be able to hide the tracks if you are in a similar situation and being caught in a lie will do you more harm than good. I would be upfront with the medical provider before I was ever is a situation of needing pain releif. I would discuss how your pain will be managed prior to any procedure..

Remember that buprenorphine remains effective in the body for up to 48 hours, This is a discussion you must also address with the oral surgeon. If he is not willing to work with you to your satisfaction than I would find another surgeon.

Best of luck to you. Please let us know how you are doing. Others will post with their suggestions. Take Care, Tuck