Had surgery or need for pain mgmt while on bupe?

[Suboxstitute]

I’m looking for input on people who've had surgery, planned or unplanned, while on bupe, or from anyone who needed serious pain management while on bupe. There's bits and pieces on the board, but I wanted to see if there was fresh input. Excuse the length please.

I’m facing oral surgery soon: bone graft, “lifting” of a sinus cavity, extraction of three teeth; it’s pretty major stuff for oral surgery. Implants and crowns to follow which I’ve had before.

I’m on 6mg bupe daily. When I stop pre-op, I’ll have 12mg in my system with the stacked up doses.

I’d rather not tell the oral surgeon about the bupe. When I discussed this with the bupe doctor, he wasn’t very knowledgeable. So the two doctors consulting together? It’s not happening.

For IV (“conscious”) anesthesia, they use 7.5mg Versed, 100micrograms Fentanyl, 40mg Ketamine. I’ve had this before and it was great – no recall and no pain (until that night). But I wasn’t on bupe then.

So pre-op I stop the bupe. After 144 hours (6 days!) I finally get down to < than 1mg (.74) left in my system.

At 3 days (more realistic to go w/o bupe and that’s a stretch), there’s still 3mg left. 3mg isn’t supposed to be a “blocking dose”…but the stories and even a post here, “1mg of bupe blocks everything” concern me.

My fear is I’ll feel what the guy is doing – incisions, drilling into my jaw, cutting - “exposing flaps of skin” etc. and wake up during it (I’ve read my op report from a similar procedure.) I don’t want to know what he’s doing in there while he’s doing it.

Anyone with info to share?

Ideas for how to manage 4-6 days with no bupe? All I have now is a 180mg bottle of cough syrup –with codeine, not even hydro. (It was taking up space in my dad’s medicine cabinet - he’s not coughing any more so I felt it best to remove it for his own safety.) I can't ask for pain meds pre-op, although the guy's pretty decent with the percs post-op.

[Vico-Dan]

You need to discuss this with your Dr. and with the Anesthesiologist and not with a bunch of dope heads like myself.

[clinton]

let all docs know asap what you are on, it may prevent very bad complications..
who cares about the oral surgeons opinion?
your health is more important.

[Suboxstitute]

You need to discuss this with your Dr. and with the Anesthesiologist and not with a bunch of dope heads like myself.


Yeah, I appreciate your response - but I was looking for some real-life experience. Believe me, I've "discussed" this upcoming surgery with my bupe doc and he didn't even believe me when I told him fent is used in IV sedation! Hell, my husband had just had a colonoscopy that day and they used fent for THAT.

So while I do understand what you're saying, I was looking for some real-life stuff to add in to the mix of doctor stuff. They don't always know all that much, believe me, especially about bupe.

Added for Clinton - yes, I know - it's my health. And that should rule.

But it's a long story about the surgeon, he's a friend, has to do with who I know and who he knows....and it's not GENERAL anesthesic. Actually, my goal is to be completely OFF well before the surgery (put it off this year as long as I can stand it) so it won't be an issue.

[zenpunk]

I used to mix bupe with some milder opiates but, believe me, this is higher risk behavior that will bite you in the ass later on...you need to talk to medical professionals, your health could be at risk if you mix this way with a script they unknowingly give you. And this doesn't even cover what they give you in during the procedure! The two doctors involved better start consulting on it!

[Nemesis1]

There are a few opioids that aren't blocked by buprenorphine... Tramadol is one... Ketobemidone is another... Would be nice to have them on a list...

[EleusisII]

Yeah, tell your docs...

There's nothing wrong with lying to doctors, but pre-surgery is definetly not the time. Lay it all out on the table, even if it means getting cut off somewhere.

[mikells43]

DO NOT TELL UR DOCS. they will look at u like u have 4 heads popping out of ur neck. trust me people have suffered cause they were honest to the doctors. What you can do is ask ur bupe doc for some pain meds before surg when u go off of bupe, cause u can't manage pain on bupe, it just dont happen. if they give u shit about it then hmmm i donno. if u can get something to manage the sickness pre opp thats all ur worried about huh? also if u tel ur surgion thats doing ur operation cahnces are ur nto going to get shit cause they assoicate sub with "THIS PERSON IS AN ADDICT AND IM NOT GIVING THEM ANYTHING FOR PAIN CAUSE IM LIABLE" how did u get ur drugs before u went on bupe? didn't u order offline? the oxys right if i member right. but if i were u i wouldnt tell the other docs cause there going to treat u like an addict, theres horror stories about this on naabt. also FILL UR PAIN MEDS at A DIFF PHARM AND PAY CASH, NO INSURANCE . cause ur insurance will pop them back due to u being on bpue. theres horror stories about that too on naabt. dont use the same pharm not even the same chain, go to a mom and pops and pay cash to get ur pain killers.

as long as ur off the bupe in time for ur operation u should be good. so get something to go offof bupe and go back on. chances are if u tell the docs ur going to nto get anything for pain. ask nancy to show u the horror stories about the one lady that they wouldnt even give the post opp script after a big operaiton. they brought her in a tyelnol thats it. so dishonesty = pain releif. and its not even being dishonest. there is not enough info out ther eyet about bupe for it to be "accepted". u will be treated like an alien. im only saying this caus ei have alot of pity for those who are and have been.

[EleusisII]

Mikells, forgive me for doubting your judgement, but did you read the original post? We're talking surgery under anathesia here...

My fear is I’ll feel what the guy is doing – incisions, drilling into my jaw, cutting - “exposing flaps of skin” etc. and wake up during it

[Suboxstitute]

To be honest, I've experienced some of what Mikells is saying. I see both sides expressed on this thread, with the majority saying do NOT screw with my health no matter what/embarassment, being cut off, etc.

I'm not totally stupid here; truly I am not.

I was trying to get some real life info from real people - like someone was just told (on another board that it was OK to take sub the night before surgery. By her sub doctor. That is just crazy. That is NOT OK if you're going to need any kind of pain relief.

The last thing I need right now is to be labeled once again, at the LAST place where I'm not labeled, and where I've been an "upstanding" patient for years. Now I know - that's the price you pay for ever being on bupe - you need pain management? Forget it. That big red mark "addict" is on your chart. It's not right, it's not fair, but it's reality.

For now, let's just hope that I can successfully get off the bupe and put it way behind me by the time of surgery so that it won't be an issue.

I still want to pick up some info from people who had been there/done that and had some tips on how they got through it. It could be useful to others, too. There have to be others in this situation.

[Inspektahdek]

you had better make sure they know you have a tolerance or you'll wake up with your intestines hanging out like I did screaming and crying not knowing what was going on.

This little exercise created a maxed out morphine sulphate pump for me afterwards though, ahem :D

I'd ask the bupe doc for some temp opiates since sometimes they will wean you on oxys before the bupe, etc. I've heard some people getting regular opiates before starting on bupe to get them to the system like Heroin users getting oxy or short acting opiates to be in their system to transition to a high dose of bupe for people with monster tolerances. If I told any doctor, it would be the bupe doc, not the reg doc, they'll prob fuck you over opiate wise. Or you can cop some shit on the street to keep you free from w/d until surgery. ? Anything is possible, there's alot of possible choices.

[Suboxstitute]

you had better make sure they know you have a tolerance or you'll wake up with your intestines hanging out like I did screaming and crying not knowing what was going on.

This little exercise created a maxed out morphine sulphate pump for me afterwards though, ahem :D

Yeah, totally get what you're saying - when I had back surgery in Feb 2007 I took the anesthesiologist aside and told him exactly how much I was taking, and he did the right thing, and I did fine. Well, pretty fine except it took some arguing with the nurses on the floor to get what I needed.

But it wasn't bupe, and I still wasn't completely labeled, since I had legit MRI results which showed a badly herniated disk. And I wasn't in tretment. You can do the right thing, and sometimes you get screwed.

I was trying to pull off this lesser surgery, but it seems I'll have to come clean is the consensus. Unless I get off he bupe by then.

Thanks for your post.

[Inspektahdek]

what meds are they giving/did give you?

[roxi*stardust]

I haven't had any personal experiences with this but I did read a great article about Bupe, that had an entire section dedicated to this very dilema. I will see if I can find it again. It was all about Bupe pharmacology; very good stuff in it.

Anyway, the article listed several options for doctor and patient to discuss. All of them involved tapering in Bupe several days to a week before surgery. One option was switching to a low dose of methadone for maintenance the week or so before surgery, and then treating pain with normal pain relievers (oxy, hydro, Fent, etc). Another was to maintain on methadone prior to surgery and then take only methadone for pain and only have a standing order for a very short acting pain reliever like hydromorph or fent for pain not relieved by the methadone. Another was to taper on the Bupe right up until surgery then use pain relievers as needed. All those otions alos had a plan for continuing Bupe treatment after the need for pain meds had passed. I will try to find it it for you. Well off to google............................

[Suboxstitute]

I will see if I can find it again. It was all about Bupe pharmacology; very good stuff in it.


Roxi, thanks - very kind of you.

I think I may have stumbled onto the same article, since I've been looking around too... and there just isn't a lot of good info out there.

So again, my point was to see if there are any opi folks here who had found themselves in the same dilemma.

The official line on naabt.org and other "bupe" sites, of course, is to have the doctors consult with each other and decide on the best course.

Ideal, in principle - except that when one sub doc called a surgeon to "consult", the surgeon backed off from even DOING the procedure, since he didn't know anything about sub (it's not such a big deal, the method you just outlined above is a reasonable course). And the anecdotes like that are all over the "bupe" boards, hence mikells comment above.

I could just switch oral surgeons, but I've got a complicated thing goin' here with lots of prior history with my oral surgeon, no need to go into the gory details - my teeth LOOK beeee-u-ti-ful though!

[Suboxstitute]

what meds are they giving/did give you?

Do you mean for this upcoming surgery? Versed, fent and ketamine for the sedation (it's IV sedation, not completely put to sleep like general).

For the back surgery in Feb 2007 it was a traditional "general, put to sleep" anesthesia for several hours, and I have no idea what they use for that, although I could probably look it up.

At that time, I was doing a lot of hydro and some oxy (but nothing strong like fent or anything) and had a healthy tolerance for pain meds. Both since I was in a hell of a lot of pain, plus I was doing it recreationally.

so I talked to the anesthesiologist about tolerance and he made sure I stayed asleep AND had fairly adequate pain management afterwards. I say "fairly" adequate since after the first day, they took me off the morphine pump and it was just oral meds (so I had to supplement from my purse LOL)

Post-op from back surgery, I had just oxycodone (plain, not percs) for about a month, then they said "no more drugs for you!" so I sorta went back to illicit sources until I went on bupe in August.

Edited to say: I really have no access to other LEGIT pain meds any more (due to bupe treatment). EXCEPT for the dentist/oral surgeon who are in a separate "place" from my bupe doc and primary (who are in the same health care system). It sucks, I should have thought this all thru before I went on bupe. If you're on it, and need adequate pain mgmt, even for a short time, you are SUPPOSED to get it - but believe me, it's difficult.

If I were to do it over again, I'd go to a nearby city and find a way to pay cash for the bupe treatment. BIG mistake to go through my same health care system. Big mistake. But too late now. I had just lost my job, and I was worried about $$$ but I could have afforded it somehow. Now I'm flagged in a pretty big system in my town, the University health system, as an addict.

[EleusisII]

I'd bring that paper along, that another member mentioned, and show the docs.

Obviously it's your choice, and too little anasthesia isn't going to kill you. But fuck, experiencing a surgery like that while semi-awake and with the anasthetics not working properly? There isn't a script that worth that, imho.

I guess switching to another med prior to the surgery, and telling the docs that you have a higher tolerance then usual patients might be an option? You'll avoid the bupe label, and hopefully they'll give you enough to break through to bupe.
Still, it's dicy...

[mikells43]

the bupe only interferes with the pain killers, u still can be put asleep and have successful sedation under anest. they give you a pain killer, a paralydic, and a seditive/hypnotic for the anestisa coctail, ive been put asleep before without opiates so its not a big deal. and if u want pain releif dont ttell ur docs. just get off the bupe days before and ull be fine. i got ur pm. u dont want to become a horror story do u?

and anest. can work even if ur on a full dose of sub. ud ont have ot have opiates to be put under, u can be put under with propothol, and a benzo. ive been put under with plain old versed and didn't recall a thing. they make anestisa up to be a big thing but its not. it pays alot to do as a profession tho btu its just giving people drugs and giving the drugs a fancy name for no reason lol. if u break it down u can have successful sedation and everything even if taking 32mg a day . but if u want pain releif then its good to get off of the bupe. u still can be put under and will not recall anything without opiates.

[SpecialGuy69]

two things:
1- ask bupe doc for pre-op meds. Methadone comes to mind- its most similar to bupe in that its got a big long halflife, docs are more comfortable prescribing it than say, oc or dilaudid, and as long as your dose isnt over 40mg, your pain meds would work just fine

2- just ASK the surgeon whats up. Meaning "In the past, i've always had a high tolerance to pain medicine. What happens if the medicine you give me is not controlling my pain?" or something like that. Then at least you know whats gonna happen, and surgeons hear this ? all the time so its not suspicious

Hey-- theres a 1 in a million chance that IF your sub doc switches you to done before surgery you might be able to convince him/her to keep you one done after surgery. Wouldn't that be nice...

[Suboxstitute]

OK, some great ideas here. Thanks a whole bunch to all who responded. Responses still welcome!

I see the oral surgeon tomorrow afternoon to discuss and go over x-rays etc. I'll mention my tolerance, etc. ...he knows I've had back surgery and also knows I've had trouble once w/pain relief with him.

Post-op pain I can get through w/o opiates if I have to (although it would be nice to not be cut-off there due to being an A D D I C T) ....more concerned about the fent in the anesthesia being blocked if bupe is still in the sysem.

If I can get meds to hold me for 6 days pre-op (as AO said above) I can make this work.

I mentioned pre-op meds to ease off bupe to sub doc, he wasn't enthused about prescribing. Guess he just thinks I can jump off for a week at 6mg. More likely, he wants to defer to the guy dong the procedure. But he's probably forgotten that conversation by now. He;s got a busy practice.

I hope to be off bupe in the next few months.... but one of the teeth is giving me pain so I don't think I can wait too long.

When it all "goes down" in the mouth I'll post the results.

thnx again.
Sue

[mikells43]

if i were u , i wouldnt bring up the tolerence thing with the oral surg. chances are ur going to be labeled if u go "oh and yea i have a tolerence and i need more than others" doc will think, " tolerence=addiction". so keep ti cool with him. if percs will get u thru then why not just ask for 10mg percs the day of the operation, wait till he does the surg to bring that up. dont blow it before it comes up. be in pain to ask for stronger pain killers. if he thinks ur trying to minuplulate him before he even cuts u then he might even back out of the opeartion if he thinks ur a risk to him if u kno what i mean. i had one doc refuse to do a surg on me cause i was hooked on painkillers at the time. so play it cool. dont give urself a way. and even if u have to suffer for a few days before hand ull be allright when its all done.....

[RobOC]

According to my old bupe doc fent will knock the bupe off of your receptors and seeing as that is the only opiate in your sedation cocktail and that your gonna lower the amount in your system you should not have much to worry about. Still, you should consult your oral surgeon on this.

[mikells43]

fent has a lower binding affinity than bupe i beleive. bupe might not block it. fent is short acting so i doubt it will take charge of the receptors like bupe does.