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PostPosted: Mon Jan 23, 2017 12:31 pm 
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I have not visited this site in forever and it's good to be back. Still on low dose (1/3 of 8 mg. strip daily) maintenance. Possible surgery on horizon and have been reading some of these posts. Although I usually consider myself a know it all (lol) I am not clear on why we have a higher tolerance to opiates for a considerable timer after weaning. If anyone can please help me with this, I would like to know why and for how long? My plan was obviously to stop the Subs a week or so before surgery and thought I would be golden.....guess not. I should mention I have been on maintenance on and off (mostly on) for about 6-7 years. Thank you for any help or suggestions you can give me.


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PostPosted: Mon Jan 23, 2017 1:38 pm 
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Hi Monica,

If you stop all subs 7 days before surgery your tolerance should be reduced quite a lot, but you're also letting in yourself in for likely significant WD symptoms which wouldn't be the best way to prepare for a stressful surgery. I think Dr. Junig mentions 2 weeks off subs for higher dose people, but maybe 7 days would be enough as you're under the ceiling effect I believe. But I don't think that's the best approach.

If you go to the talk zone section of this forum Dr. JUNig has several comprehensive blog posts on
surgery and bupe.

Here's a link to postoperative pain relief for bupe patients.

http://suboxonetalkzone.com/post-operat ... -patients/

Others will be along with more information, I'm sure.


Hope this helps!

Best wished,
Godfrey

P.S> I reviewed that article myself and Dr. J has this to say (below) about stopping subs before surgery. In other words if I'm reading it right, it's not going to be all that useful to completely stop sub use even up to a couple of weeks because of long half life.

"Holding Suboxone/buprenorphine does little or nothing beyond causing the patient significant
anxiety and discomfort; the long half-life of buprenorphine keeps the medication active for several weeks, and even if it could be removed, patients would still have a high tolerance to opioids."


Last edited by godfrey on Mon Jan 23, 2017 5:02 pm, edited 1 time in total.

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PostPosted: Mon Jan 23, 2017 1:50 pm 
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Thank u Godfrey!! If u follow that link to Dr. Junig's Talkzone posts concerning surgery while still taking buprenorphine, ur questions should be answered. Some ppl print out the info he gives concerning surgery, so that they can show their doctors who may not be so familiar with buprenorphine and surgery.

Welcome bk to the forum Monica!

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PostPosted: Tue Jan 24, 2017 1:13 am 
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Tolerance and withdrawal are part of the same process, where the difference between your dose, and your opioid tolerance, equals the severity of withdrawal. When withdrawal ends--- usually at 6-8 weeks-- that signals that your tolerance has returned to normal.

But since withdrawal symptoms don't peak until 7-10 days, I wouldn't expect tolerance to be much lower at that point. There are two aims when stopping before surgery-- 1. to reduce the blocking effects of buprenorphine and 2. to lower tolerance. Stopping for a week will be a step toward the first aim, but not so much the second.

I'm ALWAYS happy to talk wtih surgeons about handling post-op pain in patients on buprenorphine, so feel free to let me know if anyone ever finds him/herselif in such a situation!

I usually have people reduce to 4-8 mg, and then I give 15 mg of oxycodone every 3-4 hours... but for very painful operations it can take 30 mg to get pain under control. I suggest that surgeons and anesthesiologists focus on respiratory rate, NOT on the number of milligrams... and if they do that, things work out fine.
Good luck-- and thanks everyone for the plug! I'll also point out my site at http://www.suboxsearch.com - a site that doesn't get much use, but that really helps for these types of issues.

J


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PostPosted: Tue Jan 24, 2017 10:34 am 
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Quote:
'm ALWAYS happy to talk wtih surgeons about handling post-op pain in patients on buprenorphine, so feel free to let me know if anyone ever finds him/herselif in such a situation!


This is extremely comforting to me and I imagine to many, many others. Just saying "thank you"
feels inadequate.

G.


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PostPosted: Wed Jan 25, 2017 12:36 am 
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Our Dr. J is one of the kindest and best members of his profession. I have heard from a couple of his actual patients that he is caring and thoughtful. If I lived close by I would wait on his list however long it took to be one of his patients too.

And hey, Dr. Junig, I have a question! From what I understand the brain up-regulates the amount of receptors as tolerance to opioids grows. Is there any research that indicates how long it takes for the extra receptors to "die off"? With the receptors still in place, wouldn't the tolerance go right back up after only a couple weeks?

Thanks!
Amy

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PostPosted: Wed Jan 25, 2017 6:20 pm 
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Monica 65,

I had major surgery in 2008 when on 12 mg of suboxone. I was in the hospital for 6 days pre-op and did not take any suboxone during the 6 days. I had no pain meds the first 2 days pre op and 10 mg oxycodone every 8 hours day 3 to 6 pre op. I was not in much pain, just took the pills because I was concerned with going into withdrawal, fortunately I didn't. Post-op I was on a dilaudid pca pump for 24 hours in the I.C.U.. I was so doped up I felt no pain. I was transferred to a regular floor on day 2 post op. I was given 10 mg oxycodone which only worked for 2 hours, leaving me in terrible pain. I was switched to 20 mg hydrocodone every 4 hours, that worked okay. I was in the hospital one week post op. on this dose. I had no problems with the doctors who seemed to understand how to treat pain in suboxone patients, but nurses were always trying to taper my pain meds. Stopped pain meds day 12 and resumed suboxone without any problem.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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