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PostPosted: Wed Apr 14, 2010 8:25 pm 
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Hi everyone, so today I had to get two wisdom teeth removed, one had to get sawed in half and get stitched. The Dentist said it's gonna hurt pretty bad.

Now, I've been on Suboxone after my Vicodin addiction for 1 month, quite successfully, and I am dedicated to staying sober and just enjoying life without drugs and alcohol.

Anyway (sorry, I tend to blab lol), at first the Dentist wanted to perscribe me Darvocet after I told him I am on Suboxone and could not take opiates, was quite skeptical because Darvocet sounds a lot like Percocet which is something I can't have lol. At the pharmacy they confirmed my suspision and said I should not take Darvocet while on Suboxone. The pharmacist called my dentist and agreed on perscribing Ultram.

I am still worried about taking Ultram, because from what I have read, anything having to do with opiod receptors will be blocked by subox. But apparently Ultram is an artifical opiod and works only on the mu receptors, and have read some reports that the effects of tramadol are not blocked by subox or naloxone, the nurse said so as well.

I just want to hear from anyone who has used tramadol/ultram while on suboxone w/naloxone for short term pain, and how it worked out. Please let me know, thanks!

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PostPosted: Wed Apr 14, 2010 8:47 pm 
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Hi blumac and welcome!

Unfortunately I have no experience taking ultram/tramadol while on suboxone. But I did want to point out that suboxone occupies the mu receptor, so you may very well get zero effect from taking it. If a person on suboxone needs acute pain relief, the doses need to be very short acting and higher than normal. If one knows ahead of time that they'll need pain meds one usually goes off the suboxone 48+ hours before needing the pain meds and maybe also taper down on the dosage beforehand.

I just don't know how much pain relief you'll get. So how are you feeling? Did you call your Suboxone doctor about it? Maybe tomorrow if you don't have adequate pain relief you can have your suboxone doctor speak with your dentist and get you on the right medication/dosage.

Good luck and please let us know how you're doing.

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PostPosted: Wed Apr 14, 2010 10:12 pm 
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Well technically I have two suboxone doctors, I started with a civilian subox doctor since the VA subox doctor wouldnt be able to see me for a month (when I wanted to quit). Anyway, I left a message with my VA subox doctor, and tried calling the civilian subox doc but he wasn't there, but still, his nurse was there. She said that 'no, suboxone does not block tramadol, but the tramadol still may not help, so if that is the case, take 8mg suboxone instead of 4mg).

I just went straight to the 8mg subox because I'm afraid of taking the tramadol, I heard if you take opoids (even synthetic) while on suboxone, you feel sick and it feels like you are going through withdrawls. I just don't want that to happen! Then again I think there is some confusion in that area, I have also heard that if you take opoids while on suboxone, you just one feel the effect from it at all, it won't make you sick though. Which is correct?

How I'm feeling? Well, the numbness stopped and as expected there is a sharp stinging pain where my 2 wisdom teeth were. I keep putting new gauze in but it doesnt seem to be clotting, saliva is saturated with blood, so, keeping the gauze in.

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PostPosted: Wed Apr 14, 2010 10:53 pm 
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Wow - it sounds like you're in pretty bad shape. I'm so sorry. Taking opiates while on suboxone will not put you into precipitated withdrawals. Worse case it just won't do anything. As far as I know, the only time that will happen is if one shoots up suboxone (per the manufacturer) or if one starts suboxone too soon after taking opiates - like induction.

That said, I am NOT a doctor, pharmacist, or any type of medical professional. This is just what I've learned on this forum and from a couple other sources.

You really need to talk to one of your sub docs, because if I understand correctly the nurse is saying ultram works at the mu receptor and suboxone doesn't, when suboxone actually DOES.

Can anyone else explain this better than I? I'm sure you'll get some more responses. Hang in there.

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PostPosted: Wed Apr 14, 2010 10:56 pm 
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Hey man sorry to hear your going thrrew this pain. i know when it comes to wisdom teeth it def hurts cause i remember haveing mine out. def dont want to take darvys so good call on that and as of ultram ive heard your not suppost to take it with sub but i myself have had no ex with it so i could be wrong.

Hey man just so you know i take sub for pain mang and addiction as well but b4 that i was perscribe 160mg of oxy a day for a bad knee. some days i could even walk with out my oxy but my point is i switched to suboxone for my pain and it blocks it all for the most part so your nurse is right just take more suboxone for the pain. BUT THIS IS IMPORTANT MAKE SURE YOU GET IN TOUCH WITH YOUR SUB DR ABOUT THIS CAUSE IF YOU ARE TAKEING MORE YOU WILL RUN OUT. AND THE LAST THING YOU WANT IS TO BE IN PAIN AND WITHDRAWL. so make sure you get in touch with your dr if you are going to take more then perscribe.


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PostPosted: Thu Apr 15, 2010 2:23 am 
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Thanks for the comments all. I did end up taking 4 tablets of 50mg tramadol. I noticed muscle relaxation, and drowsiness. that's it. Tooth extraction sites still hurt a lot. I know I can't take Asprin for it since that thins the blood, I guess I could try APAP but my liver is already messed up as it is.

Oh and I know about the whole keeping the doctor informed if taking extra thing since I also take Xanax regularly, and if you run out of that, nasty withdrawls hit. And for that matter, SSRI's do too.

Right now I'm really anxious because my mouth just won't stop bleeding. The surgery was 9 hours ago and every time I spit up some saliva its almost all blood. I used all the gauze they provided with which to clamp on, I wonder if I should try paper towels...? Or hopefully if I go to sleep it will just heal/clot overnight. I just don't want to bleed till I faint! lol

Also I'm hoping that I'm not over-sedating myself tonight for sleep. I have chronic insomnia and before bed I take 3mg Lunesta, 2 pills of cyclobenzaprine (muscle relaxer), 1 pill of robaxin (muscle relaxer), and 1mg xanax. I was careful at first when combining xanax with suboxone, but it had no ill effect on me. But tonight, I have tramadol too... hmm.

I'm just a worry wart hypochondriac type don't mind me lol

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PostPosted: Thu Apr 15, 2010 3:05 pm 
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hatmaker510 wrote:
Taking opiates while on suboxone will not put you into precipitated withdrawals. Worse case it just won't do anything. As far as I know, the only time that will happen is if one shoots up suboxone (per the manufacturer) or if one starts suboxone too soon after taking opiates - like induction.


I found a website that contradicts that quote, so I'm still thoroughly confused regarding the matter in terms of if you take an opiate while on suboxone it simply will not work, as opposed to will put you into very painful withdrawls. Of course the shooting up is a give in, I remember my doc saying that that is what nalaxone is there for, to prevent shooting suboxone up. Another note, that has me wondering... my subox doc told me that if I get in a situation where I desperately need pain relief but am still on Suboxone, they could just perscribe something stronger than suboxone (like morphine) to trump those opiod receptors. This is sure a weird drug, fascinating though.... lol. Here is that link for my counter-arguement for Mr. Moderator ;).

Quote:
If you take any kind of opiate with suboxone the naltrexone Naloxone will send you in to VERY painful withdrawal. Do not do this, you might end up in the emergency room as well.

Reference HERE: From Wiki Answers

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PostPosted: Thu Apr 15, 2010 3:16 pm 
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I'm sorry you're getting such confusing information. I know what you mean, though, it was like that for most of us in the beginning.

The quote that's confusing you: If you take any kind of opiate with suboxone the naltrexone Naloxone will send you in to VERY painful withdrawal. Do not do this, you might end up in the emergency room as well.

This is simply not true. Many people on this forum have relapsed or have have needed to be treated for acute pain. In either case there's no precipitated withdrawals. The naloxone will send the person into PW if they shoot it up. But when taken correctly - sublingually - the naloxone is barely absorbed. Hopefully you'll get more people here who can help explain it to you better than I. The trick in treating suboxone patients for acute pain is to do so with a short-acting full-agonist opiates at higher doses to get past the suboxone, so to speak. I posted a paper from NIH in the "Links" section on treating acute pain - maybe that will help a little bit.

Others, help me out here...

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PostPosted: Thu Apr 15, 2010 8:57 pm 
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Not a very good position to be in Blumac. Ideally it would have been best to get all of this figured out prior to having your wisdom teeth pulled. Unfortunately, we can't turn back time. Perhaps I can provide at least a little bit of help.

First and foremost, YOU WILL NOT have pretty much ANYTHING happen to you if you take an opiate while on Suboxone. As HatMaker stated, you WILL NOT get thrown into withdrawals. The fact that you are finding things on the Internet that are telling you otherwise is why I'm always so adamant about making sure we post correct information on this site. But relax, taking an opiate while on Sub will not put you into withdrawals. Unfortunately, while it won't do that, it very likely won't give you much if any pain relief either. While Sub is not a great pain medication, it is "king of the hill" when it comes to binding with your brain's opiate receptors and not letting any other medications attach. That's why if you take Oxycodone or anything else, it won't work - unless you are on a very low dose of Sub. As an aside, Davocet is about the weakest pain medication out there. In fact there are national healthcare groups that claim it should be removed from the market because it simply is very weak but worse yet can cause problems - especially in the elderly. That really doesn't matter much in your case but the fact that your dentist wanted to give you this makes it pretty clear that he was just guessing. He really should know better.

Now, for pain relief. The Sub nurse gave you some good advice. I would add, however, that while Sub lasts about a day and a half in the body, it only reduces pain for about 6 hours - 8 at the most. So if it does work for you, you'll have to take it more than once a day and to do that you really should clear it with your doc or you'll run out early. You may want to try 800 mg of ibuprophen. Many people report that this medication works rather well for dental pain. Some claim it works as well or better than hydrocodone does. It's worth a try. You can give the Tramadol a try as well. It, again, is not all that strong of a pain medication so even if it does get through the Sub, it may not work that well for you. But you can certainly try it.

Beyond those ideas, I'm not sure I can think of any other medication options for you - other than going back to see a medical provider. You'll need to be off the Sub 48 hours at the very least in order for pain meds to work. I have been told by my Sub doc that IV Fentanyl can push past the Sub. Again, you will only, very likely, get that at an ER. Tordol IV or IM may work as well - but again, you need a medical provider. Ice packs to the OUTSIDE of your mouth may help as well. Ora Gel or one of the other Lidocaine-based meds on the market might be an idea but I would not do that until you talked with your dentist first.

If nothing else, you have just helped others reading this as they will likely make sure they get all of these things worked out prior to having anything like this done. If you simply can't stand it, you can always try the ED. Otherwise if you can make it until tomorrow, try your Sub doc as he/she will have the best ideas for you - especially since your dentist doesn't seem to have much experience in dealing with Suboxone at all.


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PostPosted: Thu Apr 15, 2010 9:00 pm 
Sorry I didn't see your post earlier. I would have told you that Sub completly blocks the mu agonist effect of tramadol. Can you take ibuprofen? Prescription strength is 800 mg which = 4 Advil. That stuff usually works pretty well. Good luck.


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PostPosted: Tue May 13, 2014 12:08 pm 
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Sorry for resurrecting an old thread, but I feel that I must add to this conversation for harm reduction purposes; it could benefit people who come across it in the future.

First of all, as others have said, taking an opiate after you have already adjusted to a regular suboxone regiment will not put you into precipitated withdrawals... it simply will not work the way you WANT it to... you will still feel the histamine reaction (which is why some say they still get the rush from heroin), but the mu (euphoric) effects are gone, which essentially means, "No Soup For You!".

Now that being said... Tramadol is very different. Not only is it a completely novel and synthetic opiate, but it get's metabolized in-vivo (inside your body) into some other related but different drugs, and some of these appear to NOT be blocked by suboxone. If you google this yourself, you will see that many people on suboxone therapy have taken tramadol and experienced full opiate effects. A theory which has been proposed suggests that M1 (the most Mu-active metabolite of Tramadol) actually has a higher affinity then buprenorphine, which means that it will literally rip bupe right off your receptors and take its place... the same thing that bupe does for all other opiates/ioids.

Even if (on the ODD chance) your body chemistry is totally different, and the Mu effects are completely blocked for you, Tramadol also doubles as an SNRI, and these medications are frequently prescribed off-label (and are indicated) for some people which chronic pain. Basically, Tramadol has multiple different actions that all block pain synergistically, and some of these are not opiate based at all.

To summarize: Doctors prescribe Tramadol to patients on suboxone for a reason: suboxone - for whatever reason - does not effectively block Tramadol - and/or its metabolites - from binding to Mu-Opioid receptors within the central nervous system. If you do not believe me, google it for yourself, and you will see that many have discovered this for themselves. ADDITIONALLY, the SNRI effects from Tramadol also relieve pain, and these have nothing to do with the opioid receptors.

DISCLAIMER: I am not posting this so that people will go out and abuse tramadol; I made this post because nobody in this thread mentioned this fact, and for people on suboxone who need pain relief after a surgery or similar, this is valuable information. I realize that this information could be misused, but I firmly believe that harm-reduction - along with ACCURATE data - should always come first when pertaining to drugs. So please, if someone is prescribed tramadol and needs it for pain relief, PLEASE let them know about this. Thank you.

And if you are about to flame me for this post, please just Google it for yourself and see.


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PostPosted: Tue May 13, 2014 12:22 pm 
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My sub doctor prescribes me another synthetic opiate for pain that is effective as well. I take Nucynta ER on days when my pain is out of control. There is no high, particularly because it is extended release. And it is very effective for my pain. Now, I only take 2mg of sub per day, so I'm not sure if the Nucynta works well because I'm on a smaller dose of sub, or if it acts differently enough in the brain that it works despite the sub. If you're in chronic pain or have flair ups, it's worth checking into. One drawback is that it is fairly new so it's still very expensive. I think that it runs about $10/pill.

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PostPosted: Sat Nov 22, 2014 10:52 pm 
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hey buddy i hate to brake this to you but you were better off on vicodin. it's easy to quit and walk away from. do you have ANY IDEA how much stronger and more potent suboxone is than hydrocodone??? You just traded a weaker drug for a stronger drug so i hope you dont plan on ever getting off of it because then you will long for the days of hydrocodone withdrawal.

And lets say you run out of money or your insurance changes and you all of a sudden cant get your subs anymore, then you will understand. They got you off a cheap drug and got you hooked on a very expensive one.

I was forced on suboxone 3 years ago when the idiot rednecks ran all the pain drs out of my state, and i HATE it. I can not WAIT to get back on regular opiate pain meds. Oh, and by the way, adding the naloxone to the bupe was doubly unecessary as the bupe has very high receptor affinity itsself, so it wouldve kicked other opiates out on its own. The just added naloxone to change the name and extend the patent. Suboxone is garbage.

but yes ultram is ok to take i cant imagine why you would refuse weak aXX darvocet. Were you really a raving animal on vicodin? Was it that bad? Dude, you had your teeth sawed, take a pain pill and quit asking ppls permission online.


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PostPosted: Sat Nov 22, 2014 11:51 pm 
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I am sorry that you're in pain and your experience with suboxone wasn't a positive one, however, the rest of your post in particular the parts, which are only your own opinions, not facts: "suboxone is garbage", you've traded one addiction for another", etc etc ad nauseum. .. ARE AGAINST THE RULES OF THE FORUM AND ARE GROUNDS FOR BEING BANNED! For many of us, this medication has saved our lives and strengthened our recoveries. Addiction is a disease that deserves any and all effective treatment modalities, including medication if necessary. If full agonist opiates are so easy to get off of, who would need suboxone? Some people are actually able to get through the withdrawal and even put together some"clean" time, however, staying off the opioids is harder than getting off of them. This is where buprenorphine is so effective and unique for treating opiate dependence. It takes away the constant obsession and cravings for opioids, which are the hallmark symptoms of addiction, and major cause of relapse, inducing remission of the disease. The ceiling on its effects prevent one from being high on the medication. We have not traded one addiction for another, but rather have replaced the horror of active addiction with dependence on a life saving medication, much like a person with high blood pressure or diabetes becomes dependent on antihypertensive meds or insulin.
Please refrain from making such inflammatory statements here as the rules clearly state that debating or arguing that one type or path to recovery is better than another, or stating your own opinions as fact is NOT allowed. Your false statements may deter someone in need of treatment and contemplating using buprenorphine as part of their recovery from doing so, and that would be a shame.


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PostPosted: Sun Nov 23, 2014 2:10 am 
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What Lizzie said plus..... Vicodin is def not easy to quit and walk away from. It may be easier to quit than heroin, but you won't walk away unscathed (is that a word?).. I hope nobody reads that and says "oh cool, I can play with Vicodin".. I watched a dear friend spend years quitting and relapsing on Vicodin, it had him hooked bad. I hope things work out for you man. I hope you find good in suboxone, it can help if you let it. Good luck to you.


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PostPosted: Sun Nov 23, 2014 11:18 am 
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Oh wow realist, u posted ur first post to pretty much insult someone who was asking for help and obviously doesn't think suboxone is garbage. Then u say stop asking for ppls opinion on the internet and take a pain pill. Sounds like ur pissed over something, but why not go to "hate suboxone talk zone" instead of trying to make this person feel bad? I kinda doubt someone forced u onto suboxone and there's more suboxe doctors than regular drs in ur area or anywhere else for that matter. So ur facts are harsh and we only want ppl with good intentions and the way u talked to the person needing help in that earlier post was not cool. Hope u change ur opinions a bit and become a positive person on this forum cause ur not doing anyone any good with ur mean ass comments so far. Have a wonderful super day :)

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PostPosted: Sun Nov 23, 2014 11:33 am 
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I also wanted to add, realist, that the original poster asked that question several years ago if you'll check out the date of the post, so that person likely won't see your answer anyway. What exactly was your intention in posting something so negative? It's easy to keep your membership here if you want to. Just follow the rules and show respect to others. Perhaps you were just angry and you'd like to try again? Why don't you make a post in the introductions section and tell us a little more about yourself. You'll find that this is a very supportive place of all different types of recovery.


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PostPosted: Sun Nov 23, 2014 12:33 pm 
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Thank u Lizzie, I saw this post last night and even though it upset me, I thought I should wait for a moderator to post a response before I put my two cents in. Some ppl like myself, are standoffish to post questions in fear of judgements and when someone comes along and makes it like ur questions or problems are just ridiculous like realist just did really sucks, even though it was an older post originally. I smiled so big when I saw ur response :) great to know ppl are looking out for each other from ppl who just wanna be so negative to someone who really needs help.

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PostPosted: Sun Nov 23, 2014 12:50 pm 
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Jennjenn, no one should ever fear judgment here when they have a question. Realists response didn't even really answer the op's question, just gave a snarky, angry opinion about suboxone. Mods always try to be on top of posters who insult others, it's against the rules. Sorry realists post upset you though, hopefully he'll/she'll come back wuth a better attitude and be more polite in the future. If not, one of the mods will step in and take care of it, but feel free to let someone know if their post is insulting or rude. This is everyone's forum, and we've all git the right to come here to get support and encouragement and ask questions without being judged or insulted. Thanks for your reply also. :)


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PostPosted: Sun Nov 23, 2014 2:16 pm 
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People out there in opiate addiction have so many ways of looking st it and dealing with it.We know this.
To understand this type of treatment addicts need to see that it is a life loug problem.
The simple answer is to just stop using, walk away. Good luck.
People either hate sub or like it. We all know the many different attitudes there are toward this treatment. Its education and understanding. Thats how I see it.
Good grab Liz.


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