Comments on
Surgery on Suboxone


surgery on suboxoneI often receive emails from patients on buprenorphine (or Suboxone) who are preparing for surgery or other painful medical procedures.  Ideally in such cases, the surgeon would have a discussion with the person prescribing buprenorphine,

33 thoughts on “Surgery on Suboxone

  • April 23, 2013 at 8:04 pm

    Thank you, I cannot tell you what it meant to me to see your article. I am scheduled for surgery next week and I am on Subaxone. The thing is I’m afraid to tell my surgeon about it. I have needed to have this surgery for a while now but have put it off after the pain I experienced with the first surgery. It was an emergency procedure and I again was too afraid to tell anyone that I was on subaxone. I work in health care and know the stigma associated with addiction. To make matters worse I have professional relationships with some of the medical personal that will be involved with my care. I’m embarrassed and afraid of not being able to get adequate post op pain management. Any advise you could offer would help.

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    • April 24, 2013 at 1:18 pm

      I’ll send an article to your email…. some docs, in my opinion, should be ashamed for refusing to become educated in these areas…

      Reply
      • October 27, 2018 at 6:32 pm

        I just had open heart ♥️ surgery, 3 days ago. I’ve been on Suboxone now for nearly 6 years, and thank goodness because it saved my life. However, I’ve had to suffer in pain because the stigma that is associated with Suboxone. Rather than viewing my situation as a medical one, I’m viewed as an addict searching opioids.
        This little old fentanyl patch isn’t touching my pain and there’s word I’m being sent home with nothing for pain when other postoperative patients are sent home with Percocet. I can’t take Percocet, I need something strong and these doctors aren’t going to give me what I REQUIRE

        Reply
  • January 18, 2014 at 12:20 am

    I am scheduled for bunion surgery and was truthful about my situation to my doctor. I take 8mg of suboxone a day. He has never treated anyone on suboxone and I want to make sure I get adequate pain relief. My doctor thinks I can be on pain medication for a shorter period of time and have my psychiatrist manage my pain w suboxone. I’m not sure this makes sense because suboxone doesn’t stop severe pain. Likewise my psychiatrist who prescribes the sub thinks I can stop taking it 36 hours before surgery and I’ll be fine. In my experience opiates have had no effect unless I’ve been off suboxone for weeks. On top of this, I want to make sure the anesthesiologist is also aware of how to treat me. Do you have any advice or is there a paper I can give to all three clinicians so that they are all prepared to treat me? Thank you!

    Reply
    • January 18, 2014 at 1:21 pm

      On my personal blog I have a number of posts about surgery on buprenorphine, and you can search that blog, using the word ‘surgery’, at http://www.suboxsearch.com .

      You are correct– people stabilized on buprenorphine or Suboxone do NOT get surgical analgesia from the medication (buprenorphine is a very potent opioid, but not in people who have developed tolerance to the medication). NIH has a guide for treating acute pain in people on buprenorphine: http://www.suboxonetalkzone.com/bupe.postop.pain.pdf

      My problem with the NIH approach is that they suggest just ‘holding’ the buprenorphine. That is just not possible for most people– and even if held for a week, enough buprenorphine would remain in the body to block normal doses of opioid pain relievers. I have had many patients (over 50) go through surgery over the years, and have found that they do very well using the approach that I describe here: http://www.suboxonetalkzone.com/surgery.pdf

      Bottom line– you need higher amounts of an opioid agonist to out-compete buprenorphine at the receptor.

      For foot surgery, ELEVATION of the foot, after surgery, will be the biggest thing you can do to reduce pain– probably even more than the pain meds.

      Reply
  • March 26, 2014 at 11:57 pm

    I’m scheduled for surgery in 6 days and am taking subs.without a doctors rx. I’m afread to tell the doctor because I feel like they will not treat me post opt.with pain mess. But I’m also afread that it will effect with knocking me out! What should I do? After reading others storeys, I feel that stopping 36 hours before surgery is my best bet….what would u suggest?

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    • March 27, 2014 at 12:04 am

      Go to http://suboxsearch.com , and search the blog for ‘surgery’. You will find suggestions, and also links to articles from NIH about buprenorphine and surgery. I also have a form that you can download to give your doctor, to explain why higher doses of pain meds are needed.
      I do NOT recomment stopping it, because you will be sick and not eating— not the way to go into surgery. The drug lasts for weeks, and so stopping for a few days is not going to accomplish much… and you will have to do an induction to get back on Suboxone when the pain is done.

      Find the articles at suboxsearch.com — and in the meantime, here is what I give my own patients: http://www.suboxonetalkzone.com/surgery.pdf

      Reply
  • October 18, 2014 at 10:21 pm

    I have been on 8 mg subs for 15 months taking one to two a day. I am scheduled to have oral surgery in a few days. I already had one surgeon refuse to operate due to me being on subs. So I went to a new surgeon and didn’t tell him I was on them. Now I’m scared that the anesthesia won’t have the right effect and that the pain meds won’t work post-op. The plan was to stop taking subs three days before surgery, take the pain meds for five days, wait another two days with no meds at all and then begin my suboxone again. Will this work? I am terrified! Any help is so very much appreciated!

    Reply
    • October 19, 2014 at 5:15 pm

      I’ve found that it doesn’t pay to stop buprenorphine before surgery, because it takes more than a week for blood levels of buprenorphine to get low enough to allow opioids to work– and you are still tolerant to opioids, even in that case. So I keep my patients on buprenorphine, at about half their normal dose, taking it every day without interruption… and then I treat their surgical pain using 15 mg of oxycodone every 4 hours. Patients report good pain relief, but no ‘euphoria’ from the narcotic. When they stop the pain meds, I change them back to their regular dose of buprenorphine. That approach as worked well for a number of my patients.

      Reply
    • October 19, 2014 at 11:27 pm

      I posted above about bunion surgery. I told my doctor about my suboxone and he and his staff made me feel like a drug addict. I felt ashamed and frustrated. The good thing is that I still felt pain relief without euphoria. I was not given an adequate dosage even for someone not on suboxone. I had to take about 15mg of oxycodone like Dr. Junig suggests but I was only given 5-10mg every 6 hours. My suboxone doctor was out of the country so I had to go to urgent care. I did not disclose the fact that I was on sub and they doubled the dose. The pain was very manageable when I didn’t have to worry about running out. When I get my other foot done I am not telling the doctor because honesty got me nowhere. Don’t worry about anesthesia. They monitor it closely and sub will not block the effects.

      Reply
  • December 16, 2014 at 11:16 am

    I just wanted to share that I had surgery to have all four wisdom teeth extracted. I was given full anesthesia, not twilight sedation. I take 8mg Subutex each day, in 2mg doses. I took 2mg that morning before surgery, as usual. The surgery went fine; there was no problem with anesthesia. I asked for Tramadol for pain, after explaining my situation with opiates. I had read online that Tramadol works for Sub patients. Luckily, Tramadol and ibuprofin worked fine for me. Mainly, I wanted to share that you can be given full anesthesia without major concerns. I was pretty worried about it before surgery.

    Thanks for all your great articles and YouTube videos, doctor. I’ve been reading/watching them for days. I’m a 10-year buprenorphine patient (DOC was hydrocodone).

    Reply
  • October 7, 2015 at 8:55 pm

    I am scheduled for surgery on the 22nd of this month. ERCP gall stone removal from my common bile duct. I hated telling the nurse and dr I was on subs, but I was more afraid of what would happen if I didn’t. The Dr didn’t know what to tell me about what to do before surgery. I called my sub Dr but haven’t heard back yet. The surgeon gave me a paper saying not to take Tylenol, aspirin etc. 5 days before surgery. Does that mean stop my subs for 5 days before? I don’t know if I can. They said I will be sedated during this upper endoscopy. Please help, I have two weeks to figure out how to deal with this.

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    • October 8, 2015 at 2:17 pm

      Unfortunately, I can’t give you instructions on how to manage your medications, as that has to come from someone who knows your personal situation. What SHOULD happen is for your buprenorphine prescriber to speak with your surgeon, to plan how things should go. When my patients have surgery, I typically speak with the surgeon, and take over handling the post-op pain. That won’t be an issue for an endoscopy, as people are not typically on narcotics afterward.

      I usually have my own patients stay on Suboxone continuously, including the morning of the procedure. But you need to clarify things with your doc… one thing that may or may not be an issue is that opioids cause constriction of a valve that opens into the common bile duct, and it is possible that your surgeon wants you off opioids in order to reduce spasm of that valve.

      It is unreasonable, in my opinion, to expect a patient to go 5 days before surgery with no buprenorphine. Your doc should take your call, and provide some answers.

      Reply
  • August 23, 2016 at 1:03 pm

    I am scheduled for rotator cuff surgery on September 8 and I am afraid they will not give me anything for my pain as I am on 12 mg of Suboxone what should I do ?

    Reply
    • August 23, 2016 at 1:35 pm

      You will want to gather information. Rotator cuff surgery is one of the more painful operations, and there are right and wrong ways to do it. I get frustrated…. right now I have a patient in the hospital; his surgeon didn’t speak with me for the two months before his hip replacement, and yesterday his treatment team called frantically from the recovery room, saying they cannot get his pain under control. That situation happens OFTEN.

      At SuboxForum you will find information about surgery while on buprenorphine. You will also find many of my comments about the issue at SuboxSearch , if you search the BLOG (i.e. SuboxoneTalkZone) for ‘surgery’ or ‘post-op pain’.

      The two general approaches are to 1. stop Suboxone for two weeks then do surgery, or 2. continue Suboxone and treat with opioid agonists on top of the Suboxone/buprenorphine. I greatly prefer the latter for a number of reasons that I explain in detail at SuboxoneTalkZone.

      Reply
  • September 12, 2016 at 6:40 pm

    I’m scheduled for breast revision surgery after a 10 year old implant deflated. It has been deflated for over a year while I saved for the surgery and now has significant capsular contracture and is extremely painful. My surgery is next week and is a 3 hour procedure. I just went to my pre-op appointment and was given my scripts, and I did explain to the doctor that I am on the Butrans patch, 15 mcg. My patch use is due to severe bag and leg pain, not addiction. I was prescribed lortab 5mcg. I am freaking out about the post-op pain, but the surgeon seems very “whatever” about it, like I should be fine. Since I’ve had breast surgery before, albeit way less invasive, I know this isn’t going to manage my pain adequately. What should I do besides print out your form on the sub page? Can I talk to the anesthesiologist ahead of time? I would direct the surgeon to my prescribing Doctor, but honestly he doesn’t know much about Butrans either.

    Reply
    • September 13, 2016 at 1:54 pm

      Your daily dose of buprenorphine is much lower than the average ‘addiction’ dose of buprenorphine (your on about 0.3 mg per day, vs. the 8-16 mg of Suboxone used). But as you suspect, lortab is not going to do anything, as it will be blocked by buprenorphine— plus your tolerance is higher on Butrans than the effect from 5 mg of hydrocodone. You are correct in being concerned. But I don’t know what you can do, other than keep complaining and relaying your conerns. I don’t know how to word this exactly… but there are some docs out there who are constantly concerned about their patients, and some who are less concerned. I am frequently annoyed by doctors who ignore my calls about my own patients having surgery. I’ll often try for weeks to get a surgeon to call me back without success, and then I’ll get a frantic call from the recovery room from the surgeon’s assitant, unable to get the patient to stop crying out in pain. Or sometimes the surgeon will call only after being up all night after doing the surgery, when the hospital kept calling about pain in his/her patient. I would contact the anesthesiologist, just out of hope that he/she will be someone who cares and is willing to go to bat for you. The most important advocate for you should be the doc who prescribes the Butrans. In my practice, I usually provide post-op pain for my patients, simply because surgeons refuse to learn about buprenorphine.

      Reply
  • September 26, 2016 at 12:10 pm

    I’m so glad I found this site. I’m 59 and had open heart surgery in 2013, but had been useing opiates since a bad right wrist compound fracture in 2008 that took four surgeries from June 2008 until April 2009 to get it where I could turn my palm up again. I just went on suboxone on August 8th, but am always terrified of what would happen if I had heart attack or needed more surgery due to my coronary artery disease and peripheral vascular disease and any other accidents. Wish you were in North Carolina. But this site has given me some very good advice and tools to use. I’ve been up front with all my Dr.about my taking the suboxone,I told my PVP, in case he wanted to drop me. I’ve informed my heart Dr.through his nurse to make sure it wouldn’t hurt my blood thinners or blood pressure meds. Because if they can’t understand I was fixing to loose my car, everything and I’m trying to make what time I have left better then I needed another Dr. But my question is that isn’t it the naloxen that makes you sick when you do an opioid with the suboxone. I’m prescribed one and a 1/4a day, but most days I don’t take that much. Cause if I’m able to function and not sick I don’t take it. What’s the best way to have something in case of emergency so the hospital will know and hopefully treat you right and with respect if I can’t respond and there’s no one there to respond for me. Thank you very much.

    Reply
    • September 26, 2016 at 5:57 pm

      That is a common misunderstanding. Naloxone is not absorbed in any significant amount unless injected, and is ONLY present to deter IV injection of Suboxone-related drugs. Buprenorphine itself precipitates withdrawal, if given to someone who has opioid agonists in their system. But you CAN give opioid agonists to a person on Suboxone… as long as the buprenorphine or Suboxone is on board first. So if a person on buprenorphine or Suboxone needed emergency surgery, the proper approach would be to give large doses of an opioid agonist, enough to out-compete buprenorphine. I use that approach for ALL surgeries in patients on buprenorphine products; some docs out there approach it differently and ‘hold’ the buprenorphine for a few days before surgery. I find that approach to be misguided because 1. many patients can’t simply ‘hold’ their buprenorphine med for a few days, and even if they did, they would enter surgery sick, dehydrated, and depressed, and 2. opioid tolerance would still be high and still require high doses of an agonist. I discuss the combination in detail at my blog– if you like reading about Suboxone, check it out: http://suboxonetalkzone.com/taking-buprenorphine-having-surgery/
      Also check out the Suboxone Forum.

      Reply
  • November 4, 2016 at 8:47 am

    Thanks Junig for sharing this post. I fully agree with you that Buprenorphine is a partial opioid agonist that is used for several indications.

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  • January 26, 2017 at 10:05 pm

    Talking with your doctor about post-op treatment as a bupronorphine user is critical to being able to effectively manage pain without aggravating addiction triggers.

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  • February 18, 2017 at 11:54 pm

    I was mugged and robbed and beaten severely last week. I am on 16mg Suboxone daily part of my opiate treatment. I required emergency surgery for a dislocated, broken mandible. The medical team seamed clueless on how to treat my pain. I suffered greatly. No Suboxone was given to myself for the two days in the hospital. I was given minimal narcotics that did nothing,along with toradol that helped some. I Left the hospital with scripts for liquid ibuprofen, Tylenol and 5mg oxycodone to take every 4 hours as needed. My Suboxone doctor was furious. I am very glad I came apon this site so I can educate my surgeon which is pretty sad given the opiate crisis in my area (Western Massachusetts). More surgery’s are in my future because of this assualt,and I pray my pain can be better managed. Thanks much

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    • February 19, 2017 at 12:17 am

      Crazy– buprenorphine meds have been used in the US for 13 years now, and it is so irresponsible that ANY doctor would be remiss in self-education on this issue== let alone surgeons! I have materials available to provide to surgeons if you ask at my forum; the basic idea is to reduce (but continue) buprenorphine or Suboxone, and use enough oxycodone to out-compete at the mu receptor. People get pain relief, but no euphoria or sedation, but the dose has to be high enough to get there. Doctors just have to remember to treat the patient, rather than focusing on a number.

      Hope to see you stop by– just post what your wrote here, and ask!

      Reply
  • April 7, 2017 at 10:52 am

    I’m in the hospital right now. 2nd day post-op from gallbladder removal. I’ve taken suboxone for 6 years. On 8mg /day. I take one mg every 4-6 hrs.
    My pain the last 24 hrs has been excruciating. They’re giving me 4mg of Morphine every 6 hours. I haven’t slept one single second in a day & a half.
    The doctors don’t know what kind of meds to send me home with. They want me to get right back on Suboxone.
    I believe I’d have to wait at least 24 hrs between an opiate & Suboxone dose. I’ll be in withdrawal after 6 hrs. I had withdrawals last night with morphine in my system.
    4 years ago I took Norco for a pulled tooth, waited 12 hrs between last Norco & Suboxone dose & dove into the Hell of precipitated withdrawals.
    The discovery of needing this procedure & getting it happened within days. I was not prepared. The doctors are CLUELESS.
    They want to send me home today. I don’t know what to do. I am terrified.
    If you have advice- please speak up ASAP. Please. I’m so scared.

    Reply
  • August 31, 2017 at 10:27 pm

    I take about 1mg suboxone film a day (I say ‘about 1mg’ bcos i take an 8mg film, cut in half/cut in half again/and again 1 more time) and my very painful post op surgery is on the 13th Sept. If i stopped 48 hrs before surgery, would i still need higher doses of opiates postop? What about full 5 days before surgery, stopping 1mg subox?
    Thank u dr.

    Reply
  • February 24, 2018 at 2:03 pm

    I have had more then 8 back surgeries from 1980 to 2006. In 2007 I broke my back and was then treated with long and high doses of opiates from 2008 to 2017. I have been on methadone (40mg a day) at first,then transitioned to suboxone. Began at 12mg strip(s) and have found half a strip to be the best dose. While on the opiates long term I lost most of my teeth due to dry mouth and high stomach acide from GERD. I am facing multiple oral surgeries and possible implant surgery. I am concerned about the sedation as well as the pain during the procedure and post operative pain.I never took the opiates as a “recreational drug”.I don’t have cravings for the opiates. I only take the suboxone so I don’t go through withdrawl. I still have severe back pain and get no pain relief from the suboxone,so to treat my surgical pain with the suboxone is not a viable solution. My suboxone Dr. is wavering about any opiate pain management ,I don’t want to deal with more pain or withdrawls,what are my best options and how do I relate this to my sub Dr. without them thinking I am “seeking out opiates” Thank you for your information.

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  • July 12, 2018 at 1:40 pm

    I need oral surgery soon. I am on 5.7 zubsolv twice a day.
    I can not stop taking the suboxone because of my job and children.
    I am terrified. Also, I am 52 years old. At my age anything can happen. I have been having horrible anxiety constantly worrying about this. My sub dr. Has had me on this dose for 3 years. What do I do? I feel so lost right now.

    Reply
  • July 18, 2018 at 7:34 pm

    I’m 58 years old and a cancer survivor. 7 years ago I had a thoracotomy at the VA hospital. This surgery is considered to be the most painful operation you can have. Before surgery I was taking a low dose of Percocet for the cancer/radiation treatment pain.
    My post op pain was not controlled and it was a horrible experience. For about 4 years afterward I was taking opiates for the post thoracotomy pain I have. 2 years ago the VA decided it was giving too many pain med prescriptions and sent many vets to pain management. That doctor switched me to morphine and rapidly decreased my dose. I was constantly withdrawing and I made the decision to go on Suboxone. I started out on 24 mg per day, and I’ve weaned down to 4 mg per day. Now I’m facing open heart surgery in a few weeks and I’m terrified. My subs doctor doesn’t seem to think it’s a big deal, and says I should just stop the Suboxone the day before surgery. I’m worried that after surgery they won’t control my pain again and because I may need a higher dose they’ll see it as “drug seeking” behavior. After my past experience I’m already having a lot of anxiety about this, and I worry about going into such a serious surgery in withdrawal and anxious. Any advice you can give me would be much appreciated, and I could pass it along to my doctor.

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  • August 24, 2018 at 12:20 pm

    I’m having a hysterectomy on wed the 29th of August . I send medicate with Suboxone , I’m worried about it messing with the general anesthesia. I’m too scared to tell my Dr because of the stigma attached . Can somebody give me good news. It will be 5 days since I have taken anything and I don’t take them constantly. Help please , I know I’m an idiot

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  • March 8, 2019 at 10:06 am

    Heres your problem, your acting like a dummy and need to see a different physician in a different hospital whom you do not know so that you can be properly treated.

    This is the most ridiculous thing I’ve read on the internet in a while…

    Reply
  • April 20, 2019 at 11:35 am

    I’m having a knee replacement I’m a few weeks and I’m very worried about getting appropriate pain relief. Reading everyone’s comments doesn’t give me much hope and I’m going to go into surgery afraid. Also when I’m released and start up the sub’s again will I go into PW. Believe me you don’t want to go into PW. When I was started on sub’s I was off opiodes for 4 days and my sub doctor told me I had no worries about going into PW. I took a dose of 16 mg and drove home. As I was driving I started to feel really weird. By the time I got into my house I was in the beginning of PW and in the deepest level of hell you could reach. Freezing cold but sweating bullets, restless leg syndrome, I was rolling around on the ground unable to get a grip on reality. I thought I was dying. All I could do was roll on the ground and cry out for help.. Well I landed up in hospital with nobody able to treat me as they didn’t know what was wrong with me because I couldn’t communicate because my mind was gone it was experiencing something very weird and strange something I couldn’t control. I felt so embarrassed but I couldn’t help myself. This went on for hour after hour when in the blink of an eye it was over and I got up out of the hospital bed and walked out and jumped in a uber and went home the whole time very upset that I wasn’t warned about this PW. I wouldn’t wish that on my worst enemy. And when I found online all the warning about PW I was furious nobody warned me. I told my wife I’ll never put myself in that position again and here I am about to go into surgery and I could be setting myself up for withdrawals again when they release me and I go back on sub’s. Please help me and give me some advice for pre-op pain management and post op pain management and transioning back onto sub’s. Thank you

    Reply
 

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