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PostPosted: Fri Feb 21, 2014 9:35 pm 
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I am a professional woman in my late 30's and have been on and off Suboxone for 5 years. I recently had surgery on my foot and was very worried about pain management as my doctors didn't seem to know how to treat a suboxone patient. My surgeon knew very little about the drug and my PCP didn't know much about surgery on suboxone. I was honest about my addiction issues and had both doctors touch base about my surgery. Besides pain management, my second concern was the judgement I knew I would face. My PCP said I would have nothing to worry about as did my surgeon but they were wrong.

Knowing that sub patients may need a higher dose of pain medication, my doctor did not prescribe enough percocet to make it to the post op appointment which was 5 days later. Over the weekend, my caregiver called the hotline to request more pain medication. We had enough to last me until 9:30 that night and stated this but the woman on the phone only heard that we were out of medication. She said that a doctor would call to follow up and conveniently that didn't happen. 5 hours later I called and again stated that I would be out of pills later this evening and again she said, You are already out of pills? No, I said, I will be out tonight. So about 5 minutes later the on call doctor called and asked how could I be out of pain pills already? Again I said I was not out but that I would be out before my post op appointment. Well, he said, didn't you see all the signs that said we do not prescribe narcotics on the weekends? No, I didn't. Nor did it say that on any of the paperwork that they gave me. I tried calling my surgeon who gave me his number for emergencies but he did not return my call. I also called my PCP but he was out of the country. He called in percocet to my pharmacy and my friend went across town just to find out that the pharmacy changed the the prescription to Tramadol because narcotics cannot be called in. I told her to forget it and that I would go to urgent care the next day.
So the next day I went to an urgent care clinic. After a painful night of tossing and turning, I was stressed out because I knew I was in for more judgement. Because of this I decided not to mention the suboxone unless he asked. Surprisingly, the doctor at the clinic was supportive and even said that I was way under prescribed (even for a non sub patient) and he gave me enough to make it to my post op appointment. At the appointment I decided not to ask for more drugs because I didn't want them to think I was being a typical addict. A day later though, a week after my surgery, I was in a lot of pain and called for some more. My doctor literally screamed at me and said that I wasn't listening to his instructions if I was still in so much pain. He had told me before the surgery that I would need pain pills for up to 2 weeks so I didn't understand where this coming from. I picked up the prescription that day and took it to the pharmacy which wouldn't fill it until the next day. They said that I had enough from the urgent care clinic and refused to fill until the next day. I don't understand if this was a state law or if it was coming from my insurance company or the pharmacy but I was shocked. This wasn't a refill. This was a new prescription. Since when do pharmacists and insurance companies decide over the doctor when I should receive pain medication?
I just wanted to share my experience with you all. Is there something I should have done differently? Do you think I should find a new surgeon for my next surgery (I have to do the other foot). I don't even know what to say to him when I see him in a week to get my sutures out. Should I tell him how I feel or should I just let it go? The crazy thing is, I cannot feel any euphoria from the percocet - just pain relief and I told him that.

Anyway, thanks for listening. If anyone is going through something similar and would like any advice, please don't hesitate to ask.

Banshee


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PostPosted: Sat Feb 22, 2014 9:11 am 
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Physics is a trip. For every action there is a positive or negative reaction, I was thinking out loud.
The next nail in our coffins besides the obvious, I will leave it at that to let you ponder. Anyway it's been about a year and a half since pharmacists now know more then our dr's, even for the normal folks that go to the pharmacies.

You could be giving yourself away. Being paranoid wondering if you'll suffer or get pain relief. It wouldn't be so bad if we could get that other part out of our heads so we don't get distracted when you see your dr post op.

What you described in you post about the dr's not giving enough pain relief is in my opinion because they don't care. Or in there own jaded minds, they still can not bring themselves to prescribe a few more milligrams because they are tainted just like us from the word addiction.

How do they know you take your Suboxone? How do they know how much is in your system or even tolerant to Suboxone? Would it matter? Maybe. So let's a drug test all the Suboxone surgery patients.

Just be honest don't be intimated, be yourself also may not hurt to learn about the pharmacology of both meds. An analogy could be for you in the office is like a cop is following you and you get yourself busted because you drew attention to yourself being paranoid when he wasn't paying any attention to you at all.

Good luck.

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PostPosted: Sat Feb 22, 2014 11:03 am 
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The ironic thing about a situation like this is that I couldn't even count on my fingers and toes people I know who are prescribed huge amounts of pain medication for complete BS. When I using, I had multiple scripts for multiple painkillers and other addictive medications. Constantly calling in for refills with the same excuse (I was going on vacation). All the signs of me being an addict were there. But no one cares until you actually say that you've got a problem and are in treatment for it, right? Makes NO SENSE.

I can't imagine going thru what you went thru. It sounds like you handled it very maturely and professionally, which I applaud. I agree with the the other poster....I think you should very clearly explain to your doctor how you felt about the ongoing situation and tell him exactly what you told us....that you couldn't possibly experience euphoria off the medication because of the Suboxone in your system. (If your doctor was more well-educated, he would have known that anyway....)

Best wishes. :)


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PostPosted: Sat Feb 22, 2014 1:39 pm 
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Thanks for your advice. My surgeon is concerned that I will overdose and almost delayed my surgery until I was completely off the sub. He thinks I could overdose on 5mg of Percocet which seems ridiculous to me. Anyway, I see him in a week and if he gives me any attitude I will let him have it. It really irritates me how little doctor's know about this drug.


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PostPosted: Sat Feb 22, 2014 2:36 pm 
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Hi Banshee and welcome to the forum! I am sorry that you were met with so much ignorance in your post-op care! I had a laproscopic surgery recently and only met with some slight ignorance, but no visible judgment when I woke up from the anesthesia. (The nurse started trying to control my pain with morphine instead of going straight to dilaudid, so I was in a lot of pain until she made it to the right medication.)

My suboxone doctor is educated on the extra pain relief needed by suboxone patients, so he prescribed me extra sub and a opiate drug called Nucynta before my surgery. He also said that if I needed more short acting pain meds like oxycodone besides what I was prescribed by the surgeon, he would give me a script. I brought an article with me to the surgery. I showed it to my surgeon and to the anesthesiologist. I said to them, "It's very likely that you already know what is detailed in this article, but since being on suboxone does make my situation different, I wanted to share this article with you." I also told my surgeon when he came to see me pre-op, "My biggest concern today is that I've been on suboxone, which makes me tolerant to opiates. I need you to know that it will take more pain medication to bring down my pain than it would for a person naive to opiates." He promised that he would write an appropriate script for my post-op pain. He ended up writing a script for 20 hydrocodone 10/325. I think he wrote it for hydrocodone so that he could call in more to the pharmacy if I needed it. Between the Nucynta, the extra sub, and the hydrocodone, I was able to keep ahead of the pain. (And you should also know that I am on only 2mg of sub per day, so an extra sub did a lot for pain management.)

Please know that I recognize that your ankle surgery was much more major than my laproscopic surgery and you needed more pain relief than I did. I just wanted you to know that there can be success stories while having surgery on suboxone. I also want to give you a link to the article I brought in to show my surgeon and the anesthesiologist.

http://www.suboxonetalkzone.com/bupe.postop.pain.pdf

My advice for you: When you next see the surgeon for either post-op check up or for your next surgery, bring this article. Also, write down some bullet points about your previous experience detailing how you were treated and what didn't work. Be prepared to ask how the surgeon would handle post-op care differently for your next surgery given the information you are giving him. If you don't feel that he or she is taking you seriously, be prepared to switch to a different surgeon.

Also, in regards to your PCP (if that is who prescribes your suboxone), bring this article to him/her as well. Tell your PCP how it went last time. See if your doctor would be willing to prescribe some pain meds to back up what you receive from the surgeon. Make sure you know if the doc will be on vacation during your recovery.

I really hope that the article will help make your next surgery more bearable. Just because you are an addict doesn't mean that you don't deserve to have your pain managed!!!

Let us know how it goes.

Amy

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PostPosted: Sat Feb 22, 2014 10:59 pm 
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This subject is a sore spot for me. When I had my surgery two years ago to remove part of my tongue, the pain was through the roof. My surgeon would not listen to reason and I found out he under prescribes pain meds to all his patients. My Sub PCP agreed that I needed very strong meds but still never did talk to my surgeon. Even the nurses were pissed off because my blood pressure was high and calling the doctor did no good. I seriously considered suing. Thing is, I'm just not one of those who sue for every little reason. Why are we meant to suffer?

Sooner or later I'll need to have another surgery. I'll be fully prepared for that one before they put me under. Considering we don't even feel the euphoric effects of opiates, what is the big deal? Most doctors just don't know anything about Suboxone and we end up suffering. Eventually they will all know about the effects of Buprenorphine on the tolerance level. A man can hope, yes?

This subject gets me so damn mad I see red so I'll end it here.

Be proactive and demand to see someone who knows what they are doing.

Best of luck,

rule

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PostPosted: Mon Feb 24, 2014 12:35 am 
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I get angry when I hear about these types of stories. Buprenorphine is not that complicated of a medication, so the docs who prescribe it have no excuse for leaving people hanging.

The only thing that will get doctors' attentions is if people complain to their state boards. I have had board issues myself, as part of my addiction-- so I don't wish that on anyone.... but at the same time, it is not right to do surgery, collect large payments that are assumed to cover ENTIRE management of the case... and then just skip out on the post-op care.

The truth is that it is very difficult to overdose when buprenorphine is in a person's system-- unless the person takes very, very large doses of an agonist. As the original writer described, people taking agonists, who are on buprenorphine, do not feel any euphoria--- but they will get pain relief if they take enough of the agonist.

The article linked above is a good one, except for the fact that the people who wrote it suggested that people on buprenorphine just 'hold' their buprenorphine for a couple weeks. Few patients can simply 'hold buprenorphine'! It takes weeks for the buprenorphine to leave the system, so I believe that a much better approach is to have patients REDUCE their dose of buprenorphine to about 4-8 mg per day, starting a few days before surgery-- and then continue that dose of buprenorphine through surgery and post-op. I find that people on 4 mg of buprenorphine get pain relief from about 15 mg of oxycodone every 4 hours. DO NOT TREAT YOURSELF WITH THAT DOSE; YOU NEED A DOCTOR TO ASSESS ALL OF THE VARIABLES--- BODY SIZE, AGE, PRESENCE OF OTHER RESPIRATORY DEPRESSANTS, ETC--- TO DETERMINE THE PROPER DOSE.

People having surgery--- print out the NIH article above, and also print out this sheet that I prepared for my own patients: http://www.suboxonetalkzone.com/surgery.pdf

It is NOT necessary to go through pain, just because you are taking buprenorphine. To the original writer of the post--- give BOTH papers to your surgeon, and if you have any other options in surgeons, let him/her know that you need a referral elsewhere if the same thing will happen again. If it does happen again, google the licensing board for your state-- and let them know about your misery.


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PostPosted: Tue Feb 25, 2014 1:57 am 
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What are you supposed to do though when you print out all the proper information for the doctor/surgeon and they just give you that "Im the doctor not you why are you waving those papers in my face you little pissant" type of attitude and then just blow you off.


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