It is currently Fri Nov 24, 2017 1:22 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 17 posts ] 
Author Message
 Post subject: Surgery while tapering
PostPosted: Fri Dec 23, 2016 12:00 pm 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
Hello all, first post here. Let me begin by saying that I fully intend to spend hours of my time looking through these boards. I am thrilled something like this exists. I think my wife is on here somewhere too, not for her abuse-she's clean-but for mine.
At first I was hesitant to post a question that's already been asked and answered, but I seem to be having trouble with the search function. When I search for "taper schedule" or "liquid taper", the search doesn't seem to be able to search for exact phrase. I think I am just missing something because I am a newbie here. So that's my first question.

I was on high dose Subutex for 6+ years. That's behind me now and I am breaking little subutex tabs in eighths and taking on average 2mg/day. I am ready to go to 1mg daily. Once I can search properly I'll figure out a taper schedule. Looks like cutting the expensive 1mg strips is the way to go. Or Subzolv? Also $10 per unit. I'm in the US, and never heard of a liquid form until I saw it here.

Second question: I have to have cervical disc replacement. It is probably weeks or months in the future. My guess is that lowering the sub dose as much as possible in that time is the smart thing to do. I'm in terrible pain now, but dealing with it. I am drug free, except subs, for those 6+ years. Any thoughts? I should have the doctor give the post-op meds to my wife, I think. I just don't know what my tolerance would be like after going from 2mg/day to <1mg/day in a period of a month or two. I'm scared of post op pain being a trigger. The doc said with determination, I could posssibly be off post-op meds in 5-7 days. Anyone have a similar experience or have any advice?


Top
 Profile  
 
PostPosted: Fri Dec 23, 2016 11:11 pm 
Offline
Super Poster
Super Poster

Joined: Fri Jul 24, 2009 10:45 pm
Posts: 139
Hello EmBanks Best of luck with surgery.I am also on 2mg a day. I did have surgery while on 12mg a day.I stopped 6 days before surgery but had to have higher doses of pain meds after. I have tried decreasing from 2 to 1mg but, after a few days my digestive track rebelled. I have tried 1 1/2 mg without any problems. Some people keep taking suboxone and some people have taken full agonists for a few weeks before surgery.It definitely can be done.


Top
 Profile  
 
PostPosted: Sat Dec 24, 2016 12:56 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
Hi Em....

I think the best thing to do is to check out the Talk Zone section of this site. Dr. Junig has several blog posts on surgery and buprenorphine. What he recommends for patients currently on the medication is to lower daily dose to 4 mg's...if currently using more than that. .Then after surgery doctor can overcome the opiate block with higher than usual doses of whatever opiate is to be used. The trick is to find a physician willing to follow this advice as some doctors it should go without saying are ignorant.

You're on such a low dose, I'm sure you won't have any trouble. And if you taper off completely all to the good obviously.

Dr. Junig has much confidence it seems....based on long experience, with the aforementioned strategy. It has the advantage of eliminating any opiate induced euphoria, lowering the chances of relapse.

Best of luck

Godfrey

P.S. Of course don't rely on anything I've said. Go check those posts out for further details. Perhaps a doc will weigh in, they sometimes do...

P.P.S. I knew something was bothering me, it's that Dr. J also suggests for planned surgery that patient be off bupe for 3 days. So that's a bit more difficult, as there'll be some WD symptoms to deal with. Admittedly not an ideal way to get ready for the stress of surgery...but if it helps control severe post op pain then I'm sure well worth it


Top
 Profile  
 
Our Sponsors
PostPosted: Thu Jan 05, 2017 11:49 am 
Offline
Long Time Member
Long Time Member

Joined: Thu Aug 08, 2013 5:40 pm
Posts: 455
P.P.S. I knew something was bothering me, it's that Dr. J also suggests for planned surgery that patient be off bupe for 3 days. So that's a bit more difficult, as there'll be some WD symptoms to deal with. Admittedly not an ideal way to get ready for the stress of surgery...but if it helps control severe post op pain then I'm sure well worth it

Godfrey, you were correct in the body of your post.

Discontinuing Buprenorphine prior to surgery is one recommendation from the SAMSA guidelines. It has not been advocated by Dr Junig. If you stop Buprenorphine several days before surgery you go in to surgery exhausted (from the insomnia) anxious and possibly quite dehydrated.
I have found if you can taper to 2-4 mg (OP, of course you are already below that), take 2 mg the day of surgery then use enough oxycodone or hydromorphone to manage post op pain for a few days then go back to your regular dose. No need to do another induction which you have to do if you went the first route of being off the Buprenorphine.
As Godfrey mentioned, the hard part is getting a surgeon or his PA/NP to prescribe enough to cover your tolerance.
Being on a low dose of Suboxone going into surgery will be somewhat protective against escalating doses and using a full agonist for more than pain relief.


Top
 Profile  
 
PostPosted: Thu Jan 05, 2017 5:36 pm 
Offline
Long Time Member
Long Time Member

Joined: Sat Oct 29, 2016 9:34 pm
Posts: 614
Thanks for that correction, doc.

G.


Top
 Profile  
 
PostPosted: Tue Jan 24, 2017 10:35 am 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
Thanks for the responses, and I'll look into all of that was mentioned above. I am also just about to see my pain mgmt doctor (First thing I said to him was no opiates, please) for a procedure that might prevent the disc replacement, or at least put it off. I am now just taking little tiny pieces of pill that I cut from an 8mg subutex..... I'd say .75 mg per day. I am thinking of jumping to zero from there. Or perhaps asking a doctor for the 2mg strips and cut them up into little strips to taper even more.

I do have another question to put to you all though: Is is possible/medically advisable to take a patient like me who is <1mg bup day, and switch them to low dose opiate like tramadol and then taper down on that medication? My fear is all the posts I see about the long long half life of buprenorphine. Which I know has been my savior for most of the past decade.... But I feel like if I have my wife and family involved dispensing and tapering low dose non-bup pain pills for me, it might be less of an ordeal? How the hell to non-addicts do it? Get off long term pain meds I mean? And is that an option for me?


Top
 Profile  
 
PostPosted: Tue Jan 24, 2017 4:14 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 658
Hey Em,

No worries on asking questions! Keeps your thread and this site alive.

'Is is possible/medically advisable to take a patient like me who is <1mg bup day, and switch them to low dose opiate like tramadol and then taper down on that medication?'
Imo, not advisable. Too risky. Reignites active addiction. Bup is still blocking some and it'll take more than normal. There's alot of weird laws, rules, state medical board guidelines on use of pain pills aka full agonists for addiction and its illegal for Drs to prescribe pain pills to taper a patient w addiction diagnosis. We read of it but its unusual. If you're going to continue to taper, hope you use bup.

'I'm in terrible pain now, but dealing with it.'
Is this pain from your cervical disc? Will this pain be resolved w the disc replacement surgery?
Just trying to see what your future pain coverage needs are.

'How the hell do non-addicts do it? Get off long term pain meds I mean?'
Perhaps Amy or other experts can speak to the non addict brain and help w this one.

'And is that an option for me?'
I assume you mean stopping. Prior to your 6 ys on bup were you a long term pain patient? For any reason, do you expect to have pain if you stop bup? Any recovery type work done to uncover issues leading to addiction?

See, I asked far more than you so you and your questions are welcome here! Some more info will help us better assist! Wishing you my best. P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
PostPosted: Wed Jan 25, 2017 1:16 am 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4265
I'd be happy to talk about what I know about how a long term chronic pain patient would make it off opiate medication.

First of all, this is an article by the head of NIDA that is a source of this info:

http://www.nejm.org/doi/full/10.1056/NE ... #t=article

Here is what I've learned. Any person who is taking opiates for a long enough period of time will develop tolerance and dependence. This includes chronic pain patients. However, a much smaller percentage of people taking opiates will end up addicted. The addiction, of course, includes craving and obsession, placing a disproportionate emphasis on getting the drug to the detriment of other areas of the addict's life, and a failure of inhibitory controls that would usually allow rational thinking to rule impulsivity.

These behaviors are caused by the addict's brain changing in certain ways. However, a non-addict's brain, which will develop tolerance and dependence for a few different reasons, will not change in the ways that reflect addiction. Non-addicts can feel uncomfortable withdrawal symptoms, but they are not psychologically tied to wanting to feel good or euphoric from their medication.

Because non-addicts don't undergo the same brain changes as addicts do, they are able to slowly taper off opiates without mental distress. As long as their pain is being taken care of they could taper off medication any time. Similarly, when opiate addicts take buprenorphine it puts the addictive behaviors into remission. Theoretically then, we addicts could react to tapering in the same way, and many do. Addicts need to work on the psychological portion of addiction though, to make sure that they do not become psychologically dependent on the buprenorphine.

I'm not sure if that explanation helped or made things more confusing. :?

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Wed Jan 25, 2017 1:34 pm 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2840
Location: Southwest
Too bad I didn't have this information heading into my surgery back in '11. It may have been here and I just plain missed it.

Before my surgery to remove a cancerous tumor off the base of my tongue, I had already tapered down to 1 mg several months prior to diagnosis and took my last dose the day before the surgery thinking the pain meds would work. Talking to my surgeon about being on Suboxone had the opposite effect like our good Dr. Junig stated in his blog. My doctors mind set was "bad addict, bad addict" and he actually prescribed LOWER doses of pain meds for pain that was the worst I've ever dealt with. He first gave me 7.5 Hydrocodone which of course did nothing. I begged for a larger dose so he upped it to 10 mgs. When I told him I was taking two at a time he flipped out and yelled at me. When I tried to explain the tolerance problem he said he didn't want to discuss it and left my hospital room. My suffering went on for 3 weeks until I got back on my Suboxone. Even the nurses were trying to help but had their hands tied with me having only one doctor and not a team. Live and learn.

Knowing what I do now will affect me if I ever need surgery again. I won't stop the Suboxone but take it along with the pain meds. Plus, I will print out all the necessary blogs for my Dr. to read. If we can't agree on a pain relief plan then I'll find another doctor. Plain and simple.

Hopefully, my experience wasn't in vain and others may learn from it. Never, never, again.

rule

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
   
PostPosted: Wed Jan 25, 2017 2:51 pm 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
Thank you Pelican, Amy, and Rule. I love this site and the fact you all care and take the time to respond. I haven't read the link Amy posted, but I certainly will... just wanted to get some thoughts down first and answer some of Pelicans' questions.

P: Will cervical disc replacement surgery resolve pain? What is your future pain coverage needs?

Me: I can live with the other pains in my life (blown out L5-S1 <--started this whole mess)
I cannot live with a numb ear, shoulder, hands at times, and horrible neck pain 24/7. No sleep. If epidurals don't work, I am for sure getting a disc replacement. Doc said with luck I can be off post-op meds in 7-10 days. Wife would be in charge. If I am still on bup at that time, so be it. I'll go back to 1mg a day until I'm ready to jump off again.

P: Were you a long-term pain patient before 6 yrs of bup?
Me: Kind of... 1 year in Pain Mgmt (abusing) then 1 year on the street drugs. I will for sure have pain after stopping subutex. I have pain now and I'll probably deal with it forever. My mindset now is different, though. I don't want pain meds to kill pain. I want them because they seem easier to taper off of. I get it- A professional like Amy is screaming NO NO NO! that's too risky. I'm just asking theoretically..... Will 50mg of tramadol stop someone who is <1mg subutex per day from getting sick? Forget equianalgesic charts for pain control for a moment..... I am just wondering if its possible. Not medically advisable, check. Probably not legal, check. But possible?

Gonna go read up Amy's article now...


Top
 Profile  
 
PostPosted: Thu Jan 26, 2017 11:14 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 658
Amy, good article. Helpful!

Em, I don't know the answer to your question - is it possible ? Just don't know...

Sometimes folks stop bup but then start to experience pain no longer covered by bup, which is why I asked what pain issues might be present after healing or in spite of surgery - your answer sounds like the surgery could take care of the major pain problems and you'll live w the rest. I asked bc Bup is a strange drug -- at lower doses, even for those that started on it for addiction, at low doses, it is effective for pain and is utilized as a pain mngt tool, Low dose Suboxone or Belbuca and Butrans are micro bup doses for those w a pain diagnosis. My point is to say bup for mild to moderate pain avoids restarting full opiates for pain.

I've said here before, imo, we've seen many people come off buprenorphine but the ones that stay off are the ones who used their time on bup to prepare for the things that happen to us all, that can trigger relapses: medical/surgical issues, strong & overwhelming emotion, and craving/being around opioids in any way. We need to have plans in place to manage all these possible events, because chances are good one or all three will happen at some point.

Appreciate all the hard work on your part to best prepare for possible surgery and am pleased you have family support which can be crucial and make all the difference. Best, P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
PostPosted: Fri Jan 27, 2017 11:02 am 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
P,
I had a bup doctor say to me a few months ago. "Some people just can't get off buprenorphine ever, they need very small doses for the rest of their lives, and as long as they are stable, that is ok." I didn't understand what he meant at the time, but I guess I do now after reading your comment. I had several docs tell me that bup does nothing for pain. My own experience confirms that, too. But it seems to be that there are folks who get down to small doses and get good results.

I will put the idea of "other than bup" to taper out of my mind. I will try the liquid method.

A positive note: I had good results from neck injections. Pain is way down, and if I was asked today if I wanted surgery to fix it, I would say no. I have another injection scheduled for next week, and I am thinking about pushing it back whilst I taper. My wife made a good comment: Don't take on too much when you are tapering. Focus. I plan to be on here bugging you guys while going through this, so thanks in advance for your time.....


Top
 Profile  
 
PostPosted: Fri Jan 27, 2017 1:11 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 658
Hey Em,

Glad you're sticking w bup only taper. I was conflicted answering your question bc 1) I am against the use of full agonists to taper, 2) bc I really don't know what would work and 3) bc somewhere in Dr J's Talkzone on surgery, I recall him saying not to use tramadol and bup - don't work together bc of tramadol's unique properties which pharmacologically blocks its effect w bup or something, just can't remember...

Like Mike on his post w his experience, when tolerance really drops, takes only tiny amounts of bup to feel ok. Which is why to me, seems its best to stick w bup to taper and not introduce a different substance and all the work, uncertainty and risk that comes w it.

I understand it doesn't provide pain relief for you, especially given your high level of I assume nerve pain, degenerative disc disease. Any cervical stenosis?

We do have some folks here on bup for mild to moderate pain. I get that bup Dr's say bup doesn't work for pain, maybe its their unique patient population w high opiate tolerances that skews their results, IDK. Buprenorphine is well used for pain in other countries. I also recall when the US clinical trials came out for Butrans and Belbuca, micro doses of bup, they showed pain relief for for both opiate naÏve and opiate experienced (30-160mg morphine equiv). And Buprenex, the IV form is utilized by some DDS oral surgeons for implants, etc. if I need more oral surgery, that's what I'll ask for. And its used by veterinary DVM's too! For dental and other...

Also, folks can and do stay on long term bup to avoid any more life pain and loss they feel might occur if they stop bup. They're choosing to stay healthy and happy! Good for them! And for their families too.

Good news on the injection! I like your wife.

Best, P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
   
PostPosted: Sat Jan 28, 2017 10:58 am 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
My cervical Dx is : severe foraminal narrowing, eccentric to left, C3-C4 chronic. atraumatic.
dealing with it.

I'm really happy with the liquid taper, and I switched to a night dose so there is no way I can convince myself in the AM that I have WD. And you are correct, very small amounts are working for me. This time last year I was on 24mg, now I'm guessing .24mg is a more accurate description, though I have no way of measuring it. Working for me so far.... I'm a little worried about hyper pain once I stop, but I'll cross that bridge later.


-M


Top
 Profile  
 
PostPosted: Sat Jan 28, 2017 7:38 pm 
Offline
Moderator
Moderator
User avatar

Joined: Sun Jan 02, 2011 12:35 am
Posts: 2840
Location: Southwest
Yes EmBanks, lower doses of Buprenorphine has been used for decades to control pain. Mostly in the U.K. I think but now we have the Burton's Patch in micro doses for pain. There is another one but I forget the name. Just Google Buprenorphine and pain relief and you'll find it.

I'm in agreement with your doctor about being on low doses for possibly forever. In the future if you decide you are ready and want off, then do it. You can always get back on it later if need be. What you need to ask yourself is whether or not you can handle anymore full agonist pain meds again. With me, the answer is no. I tried and failed and am back on a low too. Not for pain but for addiction.

Good luck finding what you need,

r

_________________
Don't take yourself so damn seriously


Top
 Profile  
 
PostPosted: Mon Jan 30, 2017 11:55 pm 
Offline
One Month or More
One Month or More

Joined: Fri Dec 23, 2016 10:49 am
Posts: 34
The only way I see myself on a full-ag pain med again is for post-op. And I would tell the doc give the script to the Mrs. and please (learned this bit on this forum) make sure your recovery room staff know what's up. Good news is as of right now surgery is a no-go. Pain level is under control. I see the Doc on Feb 2. He was aware of my bup history because i told him but it made him uncomfortable.


Top
 Profile  
 
PostPosted: Tue Jan 31, 2017 8:46 pm 
Offline
Long Time Member
Long Time Member

Joined: Sun Feb 14, 2016 9:40 pm
Posts: 658
EmBanks aka $$banks (heh) aka M,

I am surprised your Dr. said you might need 7-10 days of post op pain pills. Imo and Ime, this surgery is not that painful and is unlikely to require pain pills that long. Wondering why your Dr's patients need them that long?

In case cervical spine (C-spine) surgery is needed one day... a couple of thoughts/opinions... consider only Neurosurgeons (NS), not orthopedic spine (OS) surgeons. NS's area of expertise and focus are the head and neck. OS's are more the lumbar and thoracic spine and do far less C-spine work. As in any surgery, look for a Dr w lots of experience in that surgery. Means better results and lower complications, including LESS pain.

Be sure to get a 2nd opinion consult. Its that important. I know of 3 examples where after 2nd opinions, either no surgery or a far less aggressive surgery was needed. Spine surgeries are highly lucrative for both surgeon and hospital. Have heard where this can unduly influence a recommendation for surgery. Disc replacement surgeries can provide higher revenue than a fusion for that same level. Cervical disc replacements are new, 2 - 7 yrs depending on the disc manufacturer.

C-spine fusion/disc replace can be outpatient or 1 night. I had C-spine surgery C4-C6 a few yrs ago after I'd been off bup for a couple yrs. It went well and luckily, no reigniting of active addiction. I was in 2-3 nights bc mine was a bit more complicated. Needed a pain pump for 24 hrs, then switched to oral. By 36 -48 hrs post, I had almost no pain. By then I had throat swelling and was unable to swallow an oral med anyway so it all worked out. I didn't need or take any pain meds after that. Seems like none of the NS's patients that I met in the waiting rooms and in the hospital, needed pain meds for 7-10 days.

My NS recommended this site to me.
http://www.spine-health.com/treatment/b ... ne-surgery
Lots of great info including disc replacements. Best, P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 17 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

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

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

Powered by phpBB® Forum Software © phpBB Group