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PostPosted: Wed Aug 26, 2009 1:58 pm 
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My mother is going in for knee surgery today, specificaly having a high end tibial osteotomy. I should know the answer to this but just want to make sure. Can I give her a very low dose 2-4mg of suboxone for pain control post op. She's opiate naive so I doubt she'll have any precipitated withdrawal with the subox. Obviously she'll be loaded on fentanyl in the PACU and most likely will get a Rx for percocet. I feel the suboxone would be more advantagious as opposed to the percocet since it's analgesic properties are significantly more potent than morphine. Anyway, if there are any pain or other docs who can answer this or anyone else that's been through a similar situation, please let me know. I know it's unlikely, but if there's a chance this could cause precipitated withdrawal, then I won't consider it. My number one priority in regards to her post op is adequate pain management, and she's never had opioids before. Thanks in advance!


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PostPosted: Wed Aug 26, 2009 5:17 pm 
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I am not a doctor but I can tell you that I gave my opiate-naive husband 2mgs of Suboxone once - he has pain from an ankle injury - and he vomited for hours. 2mgs of Sub is a huge dose for a non-dependent person. Isn't buprenorphine usually measured in mcg when given as a painkiller?

Shouldn't your mother's surgeon be prescribing her post-op pain-control meds? If the percoset (or whatever she gets) doesn't control her pain, then she can let the doctor know. If you give her Suboxone and it doesn't control her pain, then what is she going to do? She'll have to hope she can get a strong enough painkiller to overcome the Suboxone she's already taken. I can tell you this isn't easy - I was on 4mgs of Suboxone when I had a kidney stone. The dilaudid they gave me worked but it wore off in like 45 minutes and they had to give me more.

If anything, I would think the only role Sub would have in this situation would be to help your mom taper off pain meds if she is on them long enough that she experiences withdrawal when she has to stop them. My husband's ankle surgery was very painful and he was on potent pain meds for about 6 weeks afterward. Then the doctor just cut him off, and it wasn't pretty. Suboxone for a few days might have helped in that situation.

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PostPosted: Wed Aug 26, 2009 5:23 pm 
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Doc,

I can also tell you that when I restarted suboxone after stopping opiates for about 4 months, I became wildly ill! I took about 4mg and about 3 hours later, I started vomiting. I vomited nearly continuously, and I had to visit the ER. Of course, they had no idea what it was but looked it up. My BP was 180/140, I was dehydrated, and quite intoxicated (I had pin pin pinpoint pupils too). They gave me some Zofran IV, and clonidine as well to lower my BP (They nearly freaked out when they saw it).

So, the moral of the story is that Suboxone is very very potent for the opiate naive.. Its very powerful and that may really make her quite ill. If she did become ill, its not like you could see the ER.

If she is given something else for pain, why would she need the suboxone anyway?

Jim

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PostPosted: Tue Oct 05, 2010 7:57 pm 
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I obviously know this is an old post but I guess I'm really curious after hearing about Jamez, Diary's husband, and a handful of others I've spoken with that had some major side effects when they started Suboxone after not having taken any opiates for more than a couple months. I spent around 4 months after I got out of treatment this last time without taking any opiods. In fact I was getting monthly naltrexone/Vivitrol injections to make sure I couldn't get high and yet when I started taking Suboxone I didn't experience any stomach problems, dizziness, or really any of the other side effects that occur from opiod intoxification. I'm really curious if it's possible for anyone to experience a kind of permanent or longer lasting opiod tolerance than normal. In reality the fact I had been on naltrexone for so long previous to starting Suboxone I would think that if anything I would have been more sensitive to opiods which obviously includes buprenorphine. I'm just curious if anyone has ever heard of a similiar situation. Because when I started Suboxone the best way to describe how I felt was very much like how I used to feel when I was coming down from an opiate high. I wasn't experiencing any kind of withdrawals but I also didn't feel high either. It was really just like all the PAWs symptoms went away.

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PostPosted: Tue Oct 05, 2010 11:03 pm 
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Matt,

I will never forget when I first came here and I was SO stressed because I stopped my suboxone and thought I couldn't get back on it if I was opiate free. I thought I was so screwed. You were the first person who told me that it was possible to get back on sub even if you weren't on opiates. I was quite grateful for your comments, insight, and experience and in fact you were right. When I went back on sub, I had taken some opiates for surgery but I was essentially opiate free for 3 months. The 1st surgery was about 2 weeks post discontinuation of sub. It took 3 vicodin to stave off withdrawals and 3 didn't get me high, but it was acceptable for the pain for about 2 hours. It was definitely enough to get rid of the withdrawals/PAWS. Then, about 2.5 months later, I was given oxycodone for surgery and it only took 1-2 to get rid of withdrawal AND I was getting marginally buzzed off them. Prior to suboxone, it would take about 4 or 5 of those to really get rid of withdrawal and I never felt a buzz from them. So I think that I was able to take them as prescribed and they did the job would suggest a decreased opiate tolerance over time.

When I restarted suboxone about a week or two after I discontinued the oxycodone, I started by taking 4mg. It definitely got rid of the PAWS almost instantaneously. It didn't make me feel high or anything, but about 4 or 5 hours later I did start to feel kind of ill. I never threw up but wanted to off and on for days as I increased the dose to ensure I wasn't having neuropathy in my feet. I did feel a little goofy for a few days. Definitely not high really but I don't have a better way to describe it. I felt out of sorts I guess kind of like if you took cold medicine or something. Not high but not normal either. After a week or so this went away entirely. I had a hard time sleeping on it too I remember. But I really had to pace myself increasing the dose. the doctor suggested I start with 8mg and there was NO WAY I could have taken 8mg in a 24hr timeframe. The 4mg was enough and then I increased by like 2mg at a time very slowly each day or so.

Anyhow....I don't know what you were asking really. BUT....I will thank you again for helping me out early on. Some things you never forget, especially when you are vulnerable and scared and needy and someone steps in to help you out. It is a really big deal.

Cherie

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PostPosted: Wed Oct 06, 2010 9:42 am 
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Wow you really made my day Cherie :) I'm just so glad to know I may have actually helped someone, especially another opiate addict :) And yes you did answer my question. I was really just curious as to what has happened to others who started Suboxone after spending a month or so without taking any other opiates. I would assume that after I spent 4 months without taking any opiates combined with the fact that the entire time I was taking monthly naltrexone injections that my tolerance would have been greatly reduced or even return to the level of opiate tolerance I had before I started abusing opiates. Yet that wasn't my experience at all. Anywho thanks so much Cherie it really is a wonderful feeling to know I may have actually helped somone :D

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PostPosted: Wed Oct 20, 2010 11:58 am 
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The correct dose for the opiate naive is anywhere to 0.2-1.0 mg. I once gave my sister close to 1mg and she threw up about 6 times. She is 120 pound give or take. She was 26 at the time and she is about 5ft. 7in. Hope this helps.


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PostPosted: Wed Oct 20, 2010 11:59 am 
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Mike T wrote:
The correct dose for the opiate naive is anywhere to 0.2-1.0 mg. I once gave my sister close to 1mg and she threw up about 6 times. She is 120 pound give or take. She was 26 at the time and she is about 5ft. 7in. Hope this helps.


Damn, didn't realize how old this thread is.


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PostPosted: Wed Oct 20, 2010 2:02 pm 
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For whatever it's worth, I was opiate-free for 3 months prior to starting Sub. I didn't know very much about it and I purposely didn't look it up beforehand because I didn't want to fill my head with the possible side effects. I took 16 mg the first day and then 24 mg/day thereafter, and I didn't feel a thing except tons better! ~Rossma


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 Post subject: Giving out meds
PostPosted: Wed Oct 20, 2010 2:12 pm 
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Here is my advise....let the Doctors handle it. If your MOM has residule opiates in her system, & you give her Sub...could be trouble! stand clear & let the docs do it.

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PostPosted: Wed Oct 20, 2010 2:36 pm 
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yea 2mg of sub to the average person is like very strong. bup is a powerfull drug an can make people sick real quick. i understand you want to help her cause you know how habbit forming these drugs are and how strong they are but let the drs take care of her im sure everything will work out just fine. my mom had shoulder surgery an hated her painkillers wouldnt even take them unless she was in terriable pain. an only ended up takeing god lets see 6 out of 30 an flushed the rest so im sure everything will be just fine.


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