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PostPosted: Thu Jul 23, 2015 8:04 pm 
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I'm quite the nervous wreck today. Next week I'll be having my tonsils and adenoids removed:(
(By the way, I'm new here. I've stumbled onto this forum before and was really impressed by the support that so many strangers provide each other!)

When I tell people how nervous I am about surgery, the common reaction is, "Oh you'll be fine- just get some good pain meds!" What they don't know is that I've been on suboxone for nearly 8 years now. It's been a life saver. Literally. Though now I'm dependent on this stuff- 24mg a day.

So my ENT and sub doc are all on the same page. The initial plan is that I should stop taking my subs between 24 and 36 hours before taking the morphine that the sub doc wrote for. This is happening several days PRIOR to surgery. I can't stop subs and get sick, as I have a job and children to care for (on my own). My doctor wrote a script for Morphine- 100mg 2-3x per day (the slow release kind). It's been over 8 years on subs and have not relapsed. Part of me is terrified I'll love the feeling of the pain meds, but I also have a rather large support system and know that if I ever "go back out" again, I will NOT get clean. It was the hardest thing I've ever done in my life. Here are my questions and concerns:

*How long before surgery should I stop taking my suboxone? How long after that should I wait to take the morphine?
*Can the suboxone effect the anesthesia?
*Will I feel anything from the morphine? (I have to be able to function- driving to work/working/at home, etc.
*Is the morphine dose ENOUGH to help with the pain? (I've heard this is a painful surgery- and I'm 33 years old. Also, as opiate addicts, we seem to be less tolerant of pain.

My doctor felt morphine was the best pain med to use. It was explained that he's treated other suboxone patients who needed surgery with morphine, but that "everyone is different".

Does anyone have experience with long-term suboxone use that had to be interrupted in order to take pain meds for surgery (or something similar)? Ahhh :shock: I'm so nervous...


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PostPosted: Thu Jul 23, 2015 11:31 pm 
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Hello Ilovelamp,
Welcome to the forum. Ive never had surgery on Buprenorphine, but though this forum and The SuboxTalkzone, Dr Junigs blog, there are helpful answers and experiences.

8 years without a relapse. You should be very proud. Congrats on this !!!!

I do have to say, with your upcoming surgery the very first thing you must do is drop your dose. Like tomarrow. 24mgs is very high dose Ilove. High as it gets really. If you understand the ceiling effect of Buprenorphine you should know 24mgs is about 20 mgs above the ceil. Most believe it to be between 4 to 8 mgs. Anything after these numbers and there is no more opiate effect. You may have a hard time getting pain relief if you dont start dropping your numbers asap. This needs to be done quickly imo. There are many great posts on this subject in the Talkzone. Use the seach box to fine them .

It is good your drs are both togather in this. But again im concerned about the blocking effect with so much sub in your system. When is this surgery to begin?? How many days do you have till then? You could start dropping by 2 to 4mgs right away and will feel No WD. Remember the ceiling is in the single digits.

I cant tell you about just how much pain relief you will get, it will depend on several things like just how much morphine they will be giving you overall..

Id would follow the drs orders, sounds like he has done this with others. Again, the Best thing you can do for yourself, the one thing you have control of is Your sub dose. Start dropping. ..

Hope this helps ..wish i had better answers for you tonght. Please read the information in the Talkzone Ilovelamp.



Razor


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PostPosted: Fri Jul 24, 2015 12:52 am 
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ilovelamp,

Why did you wait so long to tell us you have surgery next week? I suppose you recently found this site so you didn't know.

Like Razor said, 24 mg's is about the highest dose a person can be on. Six months ago would have been a better time frame to taper down to 1 mg. But's it's too late now so do the best you can to taper down.

You really need to make sure your doctors understand how Buprenorphine works. It raises the tolerance in your body so you'll need stronger pain medication to get any relief. Go look at our blogs and there might be something there you can print out for them to read. Search for Surgery on Suboxone and see what you find.

Sorry we don't have better answers for your problem. But at least I'd like to welcome you to the forum!

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PostPosted: Fri Jul 24, 2015 2:42 pm 
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Just confirming what others have said. 24 mg of sub is an awful lot. I was on sixteen mg and tapered down to 8 very easily. I felt more alert, happier and just better overall with each drop. Going down to six was doable for me as well. I think that the lower you can go without feeling awful the better for surgery. I doubt that you will feel euphoric from the morphine, it will help to prevent withdrawal and with pain.
I had a thoracotomy(lung surgery ) in 2008 while on sub. (12 mg). Took 2 oxycodone every 6 hours on days 3-6 before surgery. Surgery on day 7. I was in ICU on a dilaudid drip for 24 hours after surgery and was totally snowed. Back to reality on the day after surgery when I was switched to oral pain meds. I got back on sub as soon as I could. I was scared to go off the pain meds but actually felt so much better back on suboxone. Good luck


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PostPosted: Mon Jul 27, 2015 1:34 pm 
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Thank you everyone for your replies. After getting comfortable for 8 years on sub, this is difficult. I took 16mg on Friday and then nothing until Sunday evening. Took one 100mg morphine which did nothing much besides make me sleepy. Though I'm thinking that wd would be worse at this point without it. I'm sure much of it is psychological, but I do feel pretty crummy. The morphine 100mg ER pills are prescribed 2-3 times/day. I took one more a few hours ago, but wondering if maybe I could take another.
I feel pretty foggy mentally right now... And from everything I'm reading- I think the effects from any pain meds could take WEEKS to feel after being on such a high dose of suboxone for so long. I plan on switching back to subs as soon as I can, maybe 4-7 days after surgery. Depends on pain levels, etc. Maybe switching back I will be able to cut my dose right off the bat?


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PostPosted: Thu Aug 27, 2015 6:13 pm 
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jeandianne wrote:
Just confirming what others have said. 24 mg of sub is an awful lot. I was on sixteen mg and tapered down to 8 very easily. I felt more alert, happier and just better overall with each drop. Going down to six was doable for me as well. I think that the lower you can go without feeling awful the better for surgery. I doubt that you will feel euphoric from the morphine, it will help to prevent withdrawal and with pain.
I had a thoracotomy(lung surgery ) in 2008 while on sub. (12 mg). Took 2 oxycodone every 6 hours on days 3-6 before surgery. Surgery on day 7. I was in ICU on a dilaudid drip for 24 hours after surgery and was totally snowed. Back to reality on the day after surgery when I was switched to oral pain meds. I got back on sub as soon as I could. I was scared to go off the pain meds but actually felt so much better back on suboxone. Good luck


This was really helpful. You know how sometimes you just need to see/read/hear something enough times for it to stick? I've been creeping up to 12mg+ per day (I was closer to 6mg lately) and I hate it. I know all about the ceiling stats (and to correct a post above, the true ceiling is more like 12mg, not 4-8mg but it is true that there are hugely diminishing returns around 8mg) but for some reason I haven't been taking less.

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PostPosted: Thu Aug 27, 2015 6:17 pm 
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ilovelamp wrote:
Thank you everyone for your replies. After getting comfortable for 8 years on sub, this is difficult. I took 16mg on Friday and then nothing until Sunday evening. Took one 100mg morphine which did nothing much besides make me sleepy. Though I'm thinking that wd would be worse at this point without it. I'm sure much of it is psychological, but I do feel pretty crummy. The morphine 100mg ER pills are prescribed 2-3 times/day. I took one more a few hours ago, but wondering if maybe I could take another.
I feel pretty foggy mentally right now... And from everything I'm reading- I think the effects from any pain meds could take WEEKS to feel after being on such a high dose of suboxone for so long. I plan on switching back to subs as soon as I can, maybe 4-7 days after surgery. Depends on pain levels, etc. Maybe switching back I will be able to cut my dose right off the bat?


That's a really good idea - using this transition as a means to taper.

And I feel for you. My friend made the 'mistake' of starting off on 24mg and a year later, she can't think straight if she doesn't have all 24mg. Like you said, a lot of it is psychological.

Just trying to be of assistance, but one made you feel sleepy, two made you feel foggy...why would you consider taking your third at that point? :lol:

Personally I would save as many as I could for aftercare, but like you, I'm very much afraid of not being able to manage pain due to suboxone maintenance.

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