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PostPosted: Mon Feb 24, 2014 10:49 pm 
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Hello all,

I have had to make an appointment for surgery removing all 4 of my wisdom teeth, but one of the had gotten REALLY bad and hurt more than anything. I have stayed clean of any pain killers and just stuck with my Suboxone from my doctor. I had people telling me that I need to get some, but I told them no, I don't want to and I didn't think it would do much because it was pain directly from the nerve.

I had a hard time taking Suboxone then and almost half the time it would cause it to act up and it would trigger some VERY bad nights of not being able to sleep for 36 hours a couple times. It was a nightmare and was losing my mind and crying in pain... and I have usually been pretty tolerant to pain. Suboxone barely helped and ibuprofen stopped working at a certain point too along with most everything else.

Well my doctor said to stop the Suboxone for 2 days prior to surgery because it would block the anesthesia which doesn't seem to be true. So I'd rather not stop if I will be avoiding painkillers. So hopefully there's no issue there. But one of my concerns was how am I supposed to take Suboxone in my mouth after having such surgery done? Am I gonna have to put it up my butt? Wouldn't it be really irritating and cause a lot of pain and conflict to the affected areas? I'm pretty sure it wont be as simple as it would be on a 16 year old as I have had them for a long time and they'll probably have to do a lot more cutting I think. One of them is like 75% broken away I swear.

I'm also on probation for drug related charges (not convicted of anything though) and I doubt it would even be possible to get painkillers, even with prescription, even though that's not really my intention anyways. I kinda worry what if they give me an opiate or something mixed in with something else like anesthesia? Can they do all this without giving me painkillers? I take urine tests with my doctor once a month, with probation officer (not sure the exact time frame as I just started), and with a facility (not mandated) I go to for hour groups once a week that can test me when they choose each week or not. Also, is there a possibility that I would NEED painkillers? I think what if I did somehow need them when I didn't stop the Suboxone? As you can see my mind is overactive and I don't deal well with piled on stress and anxiety. I have always been scared to go for surgery and I still am a bit especially with all this.

I will try to contact everyone I can but I only have a day or 2 to do so and I don't even know if I will be able to. My appointment is on Thursday 27th and the next chance would have been a month or so. Hopefully they talk to you before about being put under and any conflictions.


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PostPosted: Tue Feb 25, 2014 9:23 pm 
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Hi Agentx606,

How's the stress level? I see you're new here so a big Welcome goes out to you! Have you told your dentist or oral surgeon exactly what you told us?

When I had my wisdom teeth pulled, none of them were impacted or broken like yours seem to be. All I needed was some Ibuprofen and it reduced the swelling nicely. Aleve is my magic OTC drug. Take two, then one more 8 hours later. No more than 3 per day it says. It works really well for me, maybe it'll help with you too. The only tangible thing I can say is that it will be temporary. Your mouth will heal fairly fast so only a day or two may be rough. Or maybe not. Dental pain is a weird one. Opiates do nothing for the pain with me. Only an NSAID did the trick.

Let us know how you're doing, okay? It is still two days away from now. Read, run, or watch TV. Anything to take your mind off it. It will be okay.

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PostPosted: Wed Feb 26, 2014 12:03 am 
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Hi thanks for your comments! I have noticed nothing really helped my tooth when it was killing me besides Ibuprofen so hopefully that's all I will need. I guess I know myself that I overreact and worry too much, but I just get scared of surgery and if there would be complications with my medication. I will make sure to get there early and talk with them about things, but I have already mentioned about Suboxone and they really didn't seem to even know what it was and that always worries me a little. I'm sure the surgeon does though. It's really not a big operation I would think, but in my mind I just see it that way. lol. I was kinda being funny about having to put Sub up my butt, but I wonder how I could take the Sub with my mouth like that. That's one thing I'd like to know if anyone has experience with and if it wont be a problem.

My doctor said to go without for 2 days, but he still said no pain pills so I don't understand why he would tell me to do that. I think I could get in trouble if I had painkillers either way so I am just going to tell them that I just can't have any and if I really will need them I'll have to make a later appointment and have to run this by everyone and investigate more, but thinking I will be okay. I really would have liked for my Dr. to give me one or two extra films in case since I am likely not at a dosage to keep above the ceiling effect (slightly under 4mg a day). I think I might have a little bit extra saved in case I need it, but I don't know if it'd really help much.

I'm just a scaredy cat in life I guess. :\ I would think they wouldn't even give me enough meds even if I came off for two days anyways, so I'd probably be in more hurt and have the pain of getting back on Subs again afterwards. Honestly, that seems more of a hassle.

Edit: Stress level is a little high, but I have been doing things to keep my mind off it and try to relax until the day comes. If I were to stop taking subs and get sick I'd likely be having anxiety/panic attacks and just feeling awful or constantly on the verge of one. I think that would be the hardest on me and the most detrimental and I'd be scared going under and getting all that done while in withdrawal.

Maybe I shouldn't have made the thread, but I'd like to become a member here either way. I think we can all benefit in sharing our situations.


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PostPosted: Wed Feb 26, 2014 1:17 am 
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Welcome to the forum!

The only reason I can think of that your doctor would like you to stop taking sub for 2 days before the procedure is that he thinks it will cause the anesthesia to work better if there are opiates in the mix. You will be IV sedated, right? Here's a quote from a dentistry practice about IV sedation:

"Medications are administered through an intravenous line (I.V.). The patient falls asleep and is completely unaware of the procedure being performed. Medications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient's vital signs are closely monitored."

So it is possible for there to be opiates used during your sedation. Of course, continuing with the sub wouldn't make you unable to be sedated and you would also have local anesthesia.

But you're right, unless he's concerned about your sedation I don't know why he would care about making sure you stopped the sub for a couple days. Maybe you could call your dentists office and find out what drugs they use during sedation. You could probably request no opiates.

In any case, let us know how it goes. I wish you lots of luck!

Amy

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PostPosted: Wed Feb 26, 2014 4:27 am 
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Hmmm.... I will report back!


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PostPosted: Wed Feb 26, 2014 4:44 am 
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I have just found this:


Studies have been done on the ability of bupenorphine to attenuate full agonist opioid subjective effects. Here are some of the results that may be of interest:

Bickel et al. 1988 found that 2 mg of bupenorphine failed to completely attenuate 6-18 mg of hydromorphone. Significant physical effects (pupil dilation) still occured and significant subjective opioid effects were reported. Subjects were treated with bupenorphine for 10-14 days before the hydromorphone challenge. Hydromorphone challenge was given 24 hours after last bupenorphine dose.

I have found that one can take full agonists if on doses of 3 mg of bupenorphine or lower per day. I am prescribed analgesics for my back pain and have switched between many of these drugs. It seems best to wait a few hours after the bupenorphine dose but one could probably take it immediatly although a higher dose would probably be required. 6-8 hours has been found to be plenty enough time. Of course the activity of the full agonist is still somewhat attenuated with 2 mg bupenorphine but not as much as one may think. Maybe 30% attenuation as a safe bet.

Higher doses of bupenorphine 8-16mg completely attenuate the effects of full agonists as the study reports and many bupenorphine users will attest too including myself. Some studies show this attenuation can last up to 72 hours following the last dose of bupenorphine [Rosen et al. 1993]. I believe I've seen a study that was able to overcome higher dose bupenorphine with a very high dose of a full agonist but am not sure on the specifics and don't have time to look now.

See:
Bickel et al. 1988. Buprenorphine: dose-related blockade of opioid challenge effects in opioid dependent humans.
http://jpet.aspetjournals.org/content/247/1/47.short

Rosen et al. 1993. Buprenorphine: duration of blockade of effects of intramuscular hydromorphone
http://www.sciencedirect.com/science/ar ... 169490121X


Sooo... I take about 2mg when I wake and about 1.5 later on (in the habit of taking a tiny extra sliver before bed, I know it's probably pointless but I have hard time falling asleep if I don't) so if they really needed to involve the fentanyl then it would probably break through. Or if they gave more it should have better chance and 4 days should be out of me. But concern I then have is getting back on Sub if I would get precip. w/d. Probably not too bad since I am always on Sub. This is all hypothetical as of now, but will discuss with them. One good thing is that I have tried to abuse Fentanyl and found absolutely no enjoyment or high from it on all 3 occasions. Just a highly sedated feeling like I was about to get surgery. (lol)


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PostPosted: Wed Feb 26, 2014 7:39 am 
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Wow that was a trigger! Can you say euphoric recall??? Lol

Anyways dude don't worry so much. You won't feel any pain during the procedure and any pain after the procedure can be well controlled with ibuprofen.

You don't have to worry about precipitated withdrawal because you aren't stopping suboxone so it will still be in your system. So no worries there.

Just keep telling yourself "I'm not afraid of a little pain. Bring it on!". You have no idea how much of a difference a positive attitude makes.

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PostPosted: Wed Feb 26, 2014 8:18 pm 
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Lol, I'm sorry.

Ok so I should have stopped for 2 days I guess as it doesn't seem like they were even thinking of giving me anesthesia without opiates (fentanyl I would assume). But they told me if I don't take anymore after around noon when I talked to them and the next day then it should still work fine. I think you're probably right. I have some Ibu 800's ready and I'm sure they'll give me stuff to help. I just find it annoying to stop sub, get sick, try to take something else, get sick and go back on Sub. I don't care to do any of these things, but I know how annoying it is since I have done it in the past. If I did get any precip. w/d I would ease my way back on by taking small pieces every hour until good. Just hopefully it gets out of my system fast and will not fail any tests. Also that they will give me enough knowing my Sub will still block some, but yeah I don't think at 2mg twice a day that my opiate receptors would be fully occupied, but I have been on Sub for years. So if I don't take anymore it will be roughly 22-23 hours since I took 2mg. Hopefully it all works out well and their anesthesia will be effective.


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PostPosted: Wed Feb 26, 2014 8:21 pm 
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And on those tests they said they were only tested on people who were treated for a couple weeks. That's probably a key thing there and I think someone on it for 6 months to a couple years or more it would be way harder to get any medicinal or especially recreational effects.


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PostPosted: Wed Feb 26, 2014 9:08 pm 
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I am really uneasy right now. Reading stories of people saying that it just doesn't override the Sub. They sometimes double their doses, but some say that they might not even do that. I am getting really nervous and scared and especially uneasy when I know I can't take anymore of my normal dose of Sub. So hopefully it will be something they can be aware of whether or not I am sedated enough cause I have a feeling I wont be unless they actually learned about Suboxone and what it is. I definitely say more people need to know about it.

Even though I know you don't W/D so easy or quickly, the way my mind works I stress myself into feeling clammy, uneasy, and almost like I am actually getting into W/D. This must be the type of mental thing that cause people to say they feel W/D mid day and need more when it's just a mental thing that can translate into a physical thing.

I am ok right now I guess, but I think as the night goes on I will have trouble sleeping. I just dread this. I have read too much about people being honest and then being treated like scumbags and let suffer. But this purely sedation so I would think any of that should be overrided. It's when it comes down to prescription painkillers afterwords where they should really be concerned.


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PostPosted: Thu Feb 27, 2014 4:20 pm 
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Okay so I am sitting home pouring blood into some gauze pads. Things went well. I thought they were just going to give me laughing gas + local, but they still did give me the IV juice. Shortly after sticking me with a needle and mask over my face I must have faded pretty quickly because I don't remember anything, but when I came to it felt like maybe 5 minutes went by and was like damn are you sure we are done? Didn't feel any pain and now I am packing and repacking my mouth with gauze that gets all bloody. Only the top right has a little stinging and that was where my busted up one was.

They gave me Amoxicilin 500mg 1 every 8 hours for 7 days and they still gave me Oxycodone/Acetaminophen 5-325. Says take one tablet every 4-6 hours and there's 20 of them. I told them all about the Subs and they all seem to know what it is or that it's an opiate blocker at least, but the oral surgeon still felt it was necessary I guess I'm sure the surgeon actually knew a good amount about it because he must run into it a lot and he's good. Now it's not to the point where I can take any meds yet, but kinda confused on what I am supposed to do here. Whether they talked to my doctor and instructed to give me these or what. I only stopped my Sub 22 hours before the surgery and things went perfectly it seems.


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PostPosted: Thu Feb 27, 2014 4:54 pm 
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I'm so happy things went very well for you! Now you have your own story to tell others how it REALLY was, and keep them from freaking out. :D

I believe the surgeon routinely hands out the Oxy to his patients that have a procedure close to yours. He may have spoke with your doctor? I won't tell you not to take the pain meds, only you know how bad it's really hurting, but I would try EVERYTHING else first before you do. As was mentioned in another post by Rule, try some OTC meds first and I bet you will be surprised how well they do work. I know I when I twisted my ankle a while back I was shocked they took the pain away! Ibuprofin and Aleve work great!

Glad it's over for you. It will take a couple days for your mouth to heal. Did the surgeon suggest gargling with warm salt water? I know that helps heal it quicker than just about anything else. Takes the soreness away too! Don't do it unless he told you to. The antibiotic will heal you also, and prevent infection from creeping in.

You can probably go back to the subs when your ready. That is unless you decide to take some of the Oxy, then you might have to wait a little bit. I hope you heal quickly. Keep us updated how your doing. Take care and all the best.

Karen


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PostPosted: Thu Feb 27, 2014 6:09 pm 
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So yeah some thoughts ran through my mind about the 20 perk 5's sitting in front of me, but I am just going to try to dose onto my Sub in a few minutes starting at .75 mg it looks like then if there are no interactions then will take the rest. I would not be able to take those Percs as directed because 4+ mg of sub keeps your tolerance to about 50-60mgs according to Dr. J so even if it was strictly for pain it would look like I was abusing them. And the amount of Acetaminophen is just too much. Figured my two options were to call my Doctor and ask what to do and that they gave me opiates, take them for a night and hope they were out of my system by Monday (if I even go monday or have a test then) So at most it would be 1-2 days of taking the Percs. For the hassle and the worry I just say no. Sub should do me just fine and can supplement that with Ibuprofen 800s. Thanks all for your input! The numbing is going away very slowly and starting to feel the hurt, but yeah I don't think it will be anything I can't handle. Maybe it's just cause I am biting down hard right now on the gauze.


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PostPosted: Fri Feb 28, 2014 12:25 am 
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Lol, the pain is literally just about nothing. I do not feel any. I took about half my dose of Sub, kicked in after an hour or so and didn't feel so uneasy, the Ibuprofen I think really did the most (even more then Sub could have), and took a single antibiotic. Doing great! I feel noooooooooooooo pain. Just imagine if I took Percs when I could have avoided them and felt no pain anyways. Man that would have been a shame. Also because of the fact it's been probably 4-5 years since I've even had any painkiller pill. I know everyone's situation and operation is different, but man I honestly don't feel any pain. Just a little uncomfortable feeling a little mucus-y and having a little blood come out. I managed to get some chicken noodle soup even with the small chicken chunks, but I was basically swallowing all of it. lol. Also managed to take a few puffs on an e-cig with no issues and get a coffee down by curling my tongue like a U and funneling it down with the least contact as possible. LOL Crafty. :D

Don't know why I was worried. But yeah I forget if I already said this, but they gave me the gas mask, IV, and also local which must have been after I went to sleep. So I believe that's all 3 of the sedation methods put together? Either way, they did it right because I was OUT instantly. I remember taking 4-5 breathes with the mask on and no more until I woke up. I was breathing into my nose and out my mouth so that stuff got through me fast apparently. But now I wonder what really did it. If it was when he plunged that stuff in me or the gas or both.

I still find it funny that I was prescribed painkillers after talking and explaining my Sub to everyone and their mother. LOL well for one thing I am happy they didn't immediately look down on me and actually nothing about their attitudes changed.


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