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PostPosted: Tue Sep 11, 2012 3:45 pm 
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Hi Everyone this is my first post and I'm just hoping I can get some advice on how to eduacte the health care professionals taking care of me and my unborn daughter. First of all a little background on me, Ive been on 12 mg's of Suboxone since 2005 and have never been better. As far as I'm concerned Suboxone saved my life and is a miracle to me. I am 32 weeks pregnant with my fourth child (this is my first girl) and my first pregnancy while on sub. I guess I should throw in that my Dr. switched me to Subutex when I became pregant. I am a Kaiser patient and i get my Sub from their Checmical Dependancy Program, so I have CD/addiction Docs as well as an OB/GYN. My OB is great but uneducated on Sub and unfortunetly when you have Kaiser you have no way of telling who will deliver your baby or for that matter who will care for your baby after deliver while in the hospital. My last pregnancy was a C-section and i had planned on having another C-section this time around until my last appt with my OB when she kind of talked me out of it. I must say I will be pleased if I dont have to go through surgery again and am able to have a Vaginal birth but I want to be prepared just in case that doesnt happen. I had surgery two years ago and my surgeon and my CD/addiction docs had a plan for my post op pain i felt confident that I wouldnt be in severe pain or withdraw and everything would be ok, well it didnt work out that way. When it was time for me to discharge my surgeon wasnt around and it was whoever was on call, the whole plan went out the window and i was given liqued Norco instead of the fentanyl as planned. I went into terrible withdraw, had severe pain and ended up very depressed. I DO NOT WANT THIS TO HAPPEN AGAIN AND HAVE TO CARE FOR A NEWBORN AT THE SAME TIME. So im just looking for some advice on how to have a plan in place, for my post op pain (if i have surgery) and educating the dr.'s at the hospital about the effects of Sub on my newborn and get them to listen and take me seriously. Thanks in advance for taking the time to respond and sharing your experiences with me.


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PostPosted: Wed Sep 19, 2012 9:01 pm 
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Hi November's Mom and welcome to suboxforum.

First off I want to apologize that your post somehow slipped through the cracks and didn't get any responses. Sometimes that happens when a lot of new posts come in at around the same time. Anyway, better late than never.

The links below are to threads on this forum that include articles about how to best treat acute pain (or perioperative pain) in suboxone patients. I'd suggest you read them and perhaps print them out for your doctors.

http://suboxforum.com/viewtopic.php?t=1812

http://suboxforum.com/viewtopic.php?t=7344

Your situation is a bit more complex by being pregnant. Normally, I would suggest that someone having planned surgery who is on 12 mg spend a couple of weeks tapering their dosage down in the hopes that it will allow more of the full agonists to "get past" the suboxone tolerance and blocking effect. But in your case (especially third trimester), it's way too risky to do anything that will cause you or the fetus withdrawals.

As it sounds like you are already aware, you need to be administered a strong full agonist like fentanyl rather than something like vicodin or Norco - they just won't break through the suboxone.

There is another method that is listed in the first paper above and that Dr. Junig has written about as well. It's basically taking full agonist pain meds as discussed, but instead of discontinuing your suboxone, you'd D/C MOST of it and take about (in your case with you being on 12 mg) 2-3 mg ALONG WITH the full agonist. Dr. Junig has reported his experiences in treating his patients with this method and they have been very favorable in terms of good pain relief.

This is a link to his slide show (and you can also view it as a power point presentation) on that topic:
http://suboxforum.com/viewtopic.php?t=6527. (The first part is more of a history of opiates and how tolerance works, but stick with it and try to watch/read the whole thing. It will help you a lot. If I were you, I'd print out the power point and take that to your doctor.)

I hope some of this info is helpful to you. I wish you an uneventful and successful delivery. Come back and tell us how you and the baby are doing.

Again, I'm sorry about the delay in responding to your post.

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PostPosted: Wed Sep 19, 2012 11:30 pm 
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Hat gave you some great advice. The one thing I would add is find out if the hospital you'll be delivering at has a patient advocate. If they do, that person should be able to hear your concerns especially considering your last experience and help you so that doesn't happen again.

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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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