Just because you are taking Suboxone to treat an opioid addiction doesn’t mean that you have to suffer needlessly after surgery or injury.
There are medications you can take to manage acute pain while on medication-assisted treatment (like Suboxone or other forms of buprenorphine) for opioid addiction.
Life is unpredictable and sometimes an injury, illness, or surgery can cause us acute pain. This pain is different from chronic pain and will go away within a short period of time. Even though we are trying to break our addiction to heroin or pills, we can still get the pain relief we need to lead a comfortable, productive life.
For surgical or dental procedures, your health care provider may choose one of four recommended courses of action. If the operation is to address a medical or dental emergency, be sure to let all health care providers know that you are taking Suboxone, including paramedics, ER staff, anesthesiologists, and dentists.
Here are four recommended courses of action for managing acute pain when on Suboxone:
1). Continue Suboxone maintenance therapy and adjust the dosage of a short-acting opioid medication (e.g. morphine or oxycodone).
You may need a higher dose of opioid to outcompete the binding of buprenorphine (one of the two active drugs in Suboxone) to your body’s opioid receptors.
2). Divide Suboxone dose and take it more frequently.
Suboxone has pain-killing properties and has been used to manage pain in many countries. However, your provider may also need to add a second medication such as morphine.
3). Discontinue Suboxone slowly to avoid withdrawal and start an opioid medication.
Restart Suboxone once acute pain is resolved.
4). Switch from Suboxone to methadone at a dose of 30-40 mg per day to avoid acute withdrawal.
Dana Forman, one of Workit Health's Nurse Practitioners, has this advice for Suboxone patients worried about taking pain pills after elective surgery: “Many patients that are being treated for opioid dependence feel they need to put off having elective surgery because they are on Suboxone, but that is simply not the case! The surgery can be performed and acute pain can be adequately managed. Here at Workit, we generally ween the patient off of their Suboxone over a course of a few weeks, and then 3-4 days prior to the procedure, we take them off completely and start them on Norco or Percocet. We want the patient to restart Suboxone soon after their procedure, usually about 2-3 days post-op.”
Whether your acute pain is anticipated (e.g. from surgery) or unanticipated (e.g. from injury), your provider may take you off of your Suboxone. Don’t worry, you can restart once your pain has been managed successfully.
Adding a pain pill or switching from Suboxone may seem risky. After all, we are trying to get off of opioids. What might seem particularly concerning is the potential need to take higher doses of opioid medications than normal. This is because the buprenorphine in Suboxone binds very strongly to opioid receptors and a higher dose may be needed to compensate for this. Your provider may also consider putting you on hydromorphone which also binds opioid receptors strongly.
Remember buprenorphine partially binds to opioid receptors. This makes it an effective painkiller for those with opioid addiction and means you may not need to add another pain pill to manage your post-injury/operation pain. Like pain pills, buprenorphine binds and stimulates opioid receptors but only partially (whereas pain pills and methadone stimulate them fully). Depending on the specifics of your acute pain, taking Suboxone more frequently and at lower doses may be all you need. Only you and your care team can make the best decision for you.
But what about the naloxone in Suboxone? Many of us know that naloxone competes with opioids for binding to the opioid receptors. Once naloxone binds to the receptor, it turns it off. These properties, at the right dose, induce a sudden opioid withdrawal in patients which is why it was added to Suboxone to deter people from misusing the buprenorphine in Subuxone. While this may worry people about to be put on pain pills, the naloxone in your normal dose of Suboxone won't affect you if taken as prescribed.
Finally, in addition to opioid pain pills, your provider may prescribe other medications to alleviate your acute pain such as NSAIDs (e.g. naproxen, celecoxib, ibuprofen) and/or gabapentin. Unlike opioids, which change our perception of pain, NSAIDs and gabapentin treat the root-causes of acute pain such as inflammation and over-active nerves.
Regardless of which method you and your provider choose, know that it is possible to manage acute pain while still taking Suboxone for opioid addiction.
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Ali Safawi is a humble intern with big dreams of connecting communities and institutions to tackle addiction.