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PostPosted: Thu Nov 13, 2014 2:35 am 
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So I just recently had ankle and knee surgery 6 days ago. I stopped taking the subs before the surgery and took Lortab 10mg the following day of my surgery. I have taken about 50 tabs in 6 days. I am all out of tabs now and want to start my suboxone again. When is it safe to do so? My last Lortab was last night at 2am and it's now been almost 21 hours since my last Lortab. I don't know if it helps, but my last day of tabs I only took 4 total the whole day. Thanks in advance. Just want to make sure I don't go into precipitated withdrawl.


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PostPosted: Thu Nov 13, 2014 6:51 am 
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Do you feel like you're having at least moderate withdrawal symptoms? At 21 hours since your last dose, probably, right? If not, wait until you are having pretty uncomfortable withdrawal symptoms, and start taking them again. If you're still unsure, you could use the COWS which is the Clinical Opiate Withdrawal Scale, a worksheetworksheet for you to rate the severity of withdrawal symptoms, and once you reach a level of moderate withdrawal on that scale, it's usually safe to begin taking buprenorphine again. The COWS is very easy to find online with Google.


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PostPosted: Thu Nov 13, 2014 2:04 pm 
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I tried to go by that scale before my post and no luck. I don't seem to be having too much withdrawal. Just the restless legs, headache and trouble sleeping. It's now been 32 hours since my last Lortab. I couldn't imagine it still being on my opiate receptors now, do you? When I first quit and started at sub I was a mess at this point before starting subs. But I was also taking way more than what I was the past 6 days. Let me know if you think it's safe for subs now! Thanks again!


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PostPosted: Thu Nov 13, 2014 2:17 pm 
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I'm no doctor, but since Lortab is a short acting opiate, I'd say 32 hours since your last dose seems like plenty of time, and you're having some moderate withdrawal , restless legs, trouble sleeping, etc. Just my opinion, but I think you'll be fine to start taking your sub again. If you're in doubt, start slowly with a small dose to gauge your reaction. Let us know what you decide, and how it goes please. Good luck:)


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PostPosted: Thu Nov 13, 2014 7:23 pm 
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It's now nearly 36 hours since your last lortabs so unless there is something you did not tell us, you will be fine. The level if opiates you were taking every 4 hours (10 mg) is not that much higher than the sub you will start back in.

What I'd really like to know is did you recieve pain relief from the Lortab? What dose of sub are you on?

Please let us know how your reinduction went


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PostPosted: Mon Dec 01, 2014 6:04 pm 
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I know its been a little while since you posted this but I was curious how your induction back to subs went?? I was just in the ICU for 2 weeks and was given IV Dilaudid the whole time because the Dr had seemingly never heard of "Suboxone, Subutex, Or Buprenorphine". So he gave me IV Hydromorphone til I left = and could get back to my Subutex. I basically just had to wait til I felt like complete garbage and take my Subutex and the transition back was easy. With IV Hydromorphan I only had to wait 24hrs because that particular opiate given by IV is in and out of you rather fast. I couldn't imagine after lortabs it would have taken more then 24-36hrs. Let us now ow you did.


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PostPosted: Sat Dec 06, 2014 2:11 am 
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You won't have any problem going back onto your Suboxone. I only waited 15-16 hours before taking it again. And no, the Lortabs did nothing, not for three weeks so I was glad to be back on my Sub again. You don't need to be in withdrawal like you had to do in the beginning. My guess is that the Buprenorphine is still in your system so going back is easy.

Others experience may vary. I can only say what happened with me.

May I assume you are back on Sub and stable again?

rule

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PostPosted: Sat Dec 06, 2014 7:25 pm 
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I'm guessing this OP is long gone given his post was 3 weeks ago. Too bad as it would have been nice to know. Rule you said you got no relief from hydrocodone over several weeks. You didn't say how much hydro you took at one time, how much Bup you were on and if to totally stopped the Bup while on the hydro. All of these things will make a large difference. I'd be really interested if you are willing to share. This seems to be a challenging and unknown ares of Bup treatment. I'm not at all surprised you got right back on. A bit more surprised at no relief even after several weeks. Again, the devil is often in the details.


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PostPosted: Sat Dec 06, 2014 8:45 pm 
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Since we are talking about this somewhat,this subject has more thsn just bothered me. More lately though.
In our clinic where there are a few people who have gone in for surgery, the post op pain relief
has been mixed to poor. Im concerned.
I do understand how this is supose to work. It is the drs treating you where the problem can begin.
On paper it seems to work fine. Just finding a Dr who is WILLING to give the xtra med needed is the problem.
I know a woman on 8 mgs who had her gallbladder removed, some pain afterwards but not to bad. She did it the right way. Taperd threes days before. But used over the counter products for relief later.
Idk, maybe because im getting older (56), and waiting for the shoe to drop. Ive never been admitted to
the hospital for anything.. This subject interests me greatly, and read everything dr j has written about it.
Maybe you could give us more info Rule on just what your numbers were..It is a private issue so i understand if you
decline bud....


Razor r....


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PostPosted: Sat Dec 06, 2014 9:45 pm 
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I have no problem going over my previous surgeries and pain relief. You may want to look up my posts from late 2011 to early 2012, that is when it all happened.

Let me try to make this short. In Sept. of 2011 I was diagnosed with a base of tongue tumor which happened to be cancerous. It had spread to my right lymph nodes on my neck too. At the time, I had planned to taper and be off Suboxone in the near future so my daily dose was only 1 mg., and had been for several months.

Knowing I was going under the knife, and being at such a low dose (IMO), I saw no reason to stop the Sub early and suffer through any w/d's, so I just took my regular dose the day before surgery and none the day of. My surgeon was aware of my Suboxone use but said nothing. Same with the Anesthesiologist. What a mistake that was.

Never in my life had I experienced so much pain. You know how much it hurts to bite your tongue, try having a large part removed. My doctor only prescribed 7.5/500 Lortab, 1 tab every 4-6 hours. Of course I took two every 4 hours, it did nothing. After begging for something stronger, he upped it to 10/500. When I told him I was taking 2 every 4, he reeled back in shock and told me not to do that. BTW, this surgeon is well known for not prescribing adequate pain relief but what was done was done.

I took 2 every 4 hours for almost two weeks and begged for a refill. He wouldn't do it but his surgical nurse approved it. Bless her heart. Not feeling any pain relief for so long was too much to handle so I took about 4-5 of them and still felt nothing. So I took 4-5 more......nothing. The next day I went back on to my Suboxone (6 mg's) and finally felt better. I considered suing but knew it wouldn't do any good. Had another surgery on my right neck but the pain wasn't too bad so I only took the Lortab for a short time before going back on my Sub again. And yes, I tapered back down to 1 mg before the 2nd surgery.

Bottom line. Buprenorphine raised my tolerance level so friggin' high that Hydrocodone did not work at any dosage. After much research it seems like I would have been okay with Fentynal or something strong like that for at least two weeks. Then bringing the dosage down or switching to another strong opiate like Oxycodone or similar might have worked.

Razor, I'm sorry if this scares you. It scares me too, but next time I'll be better prepared to get pain relief. I'll print out papers written by Dr. Junig on the subject. Back in 2011, most all the nurses never heard of Bupe and the Dr.'s knowledge was also not there. Today I think it would be better. At least I hope so. Donh, I hope this answers your questions too. I hated to even type this again. Very unpleasant memories.

The good part. I'm alive and well and able to talk. My tongue is a bit shorter but no one notices. I can't whistle anymore nor hit some high notes with my voice because of the radiation. I'm missing a large section of my right neck but no one notices unless I point it out. To me, it looks like my head is on crooked.

So that my friends, is my story in a shortened version.

Tom

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PostPosted: Sun Dec 07, 2014 7:29 pm 
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Thanks for taking the time to provide the details. I certainly didn't want to put you through any trauma reliving this! I have to say that if you were taking 30 mg of hydro at one time and still not getting any relief I'm not sure what else could be safely done. I get that you did this on your own and not the doc but from the doc point of view that's a solid amount while only on a mg or two if Bup followed by no Bup.

Sadly I've heard things like this in the past. Fentanyl is said to work better with Bup. Thing is I've heard reports that doesn't work well either and has to be either IV or the IR sticks or pops. Bottom line big pain is really hard to treat while on Bup. It's often best to try non-narcotic like tordal, ibuprofen, etc. the other thing that seems to help is getting pain mgmnt from your sub doc if that is possible. They tend to understand much more. The knee jerk reaction of most docs who don't understand is to do nothing different. Or nothing that can get them a lawsuit. Or nothing at all!

Very sorry you had to go through this. And here I thought I was safer on 1.5 mg if I ever needed pain mgmnt. Guess that may not be the case.


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PostPosted: Mon Dec 08, 2014 9:11 pm 
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Thank you so much rule for sharing the details of your ordeal for the benefit of others who may need surgery while taking buorenorphine, I'm sure those are very difficult memories to relive. This has actually also been a concern of mine recently. In the two year period before starting my buprenorphine treatment, I had 4 minor surgeries, and then a major hysterectomy, so 5 times under the knife in 2 years! In the next year depending on a few things, (kinda personal), I may need one more procedure. In the end it'll likely be up to me, but I've been putting it off due to fear of being in horrifying pain. When I had the abdominal hysterectomy, cut hip to hip OUCH BTW! I didn't tell the dr. I was an addict with a monster tolerance and did not receive adequate pain relief at all! It was awful. I Never would admit my problem, so they were afraid to give me much of anything. Needless to say, I don't ever want to go through that again!

Unless my sub doctor will handle my pain mgmt following surgery, (since he understands) I think I'll put it off as long as possible!


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PostPosted: Tue Dec 09, 2014 2:32 am 
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It seems we hijacked this thread but the OP is long gone I think.

donh, keep in mind that was only MY experience and others may vary. Members here have posted that they received pain relief on a high Bupe dose with only taking Norco or similar. I may have been the exception to the rule.

My Suboxone doctor means well but knows very little about it. We here know 10 times more than he does. He actually told me last month that if I took any pain pill that I'd get sick because of the naloxone in it. I said nothing and just nodded my head. My belief is that he took the class years ago and has read nothing about it since. A lot of well meaning physicians are like that.

Thanks if you read my story from beginning to end. I did try to make it short!

rule

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