How long after taking my last dose of sublimate will pain meds work

Questions I've received about buprenorphine, Suboxone, Zubsolv, and addiction treatments... and my answers.
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How long after taking my last dose of sublimate will pain meds work

Post by Cioli »

I am a cancer patient and I need to take some pain meds as my cancer pain is really pad
I need to quit because I can't take pain meds with sublicade
How long after my last dose can I take pain meds I get a monthly injection now
Are the meds that will work with the sublicade
My dr who I like thinks I should stay on it but my dr is not dying of cancer

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Re: How long after taking my last dose of sublimate will pain meds work

Post by rule62 »

Please look through the Talk Zone link up top to view our doctor's recommendation on how to properly take pain meds with buprenorphine. I had cancer and the pain was intolerable. What I thought was the right thing to do ended up being wrong. Like you, I stopped my Suboxone the day before surgery and then took the pain pills prescribed. They did nothing. When I finally read what Dr. Junig wrote it was opposite of what was needed. It's better to stay on the Sublocade and take stronger meds from your doctor. The problem will be your doctor not understanding how buprenorphine works to raise your tolerance level and if he's like mine he will be afraid to prescribe stronger meds.

My doctor would not read the printed article from Dr. Junig and refused to discuss my pain meds so I suffered for several weeks until I went back on the Suboxone. Read the article, print it out, then try to get your doctor to read it. If you have difficulty finding it, I'll supply the link or copy it over. It is not hard to find.

Sorry to hear about your C. Terrible stuff to deal with.
Don't take yourself so damn seriously
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Re: How long after taking my last dose of sublimate will pain meds work

Post by docm2 »

Hello, are you in hospice? If death is truly eminent then the Sublocade is not really needed and adequate pain relief should be the goal.
Hospice uses many alternatives for pain.
If there is a chance of survival and staying on the Sublocade is necessary then it is ok to take pain medicine while on it.
Make sure you are not late for each 28 day injection.
There won't be any precipitated withdrawal as long as you keep the buprenorphine above the ceiling effect, and getting an injection will keep it way above the ceiling effect.
Different situation, but I have had people need surgery, they received full agonist (dilaudid for one, oxycodone for another) without any problems. They did need more than usual due to their high tolerance and their constipation was worse for a couple of weeks.
I reread your post and realized I didn't specifically answer your question. I am assuming that you have had a couple of doses of Sublocade and prior to that taking Sublingual buprenorphine. You can take oral pain medications the same day as your dose of Sublocade, you don't have to wait.
The meds will work with the Sublocade in your system, but generally would need a higher than usual dose.
Tough management decisions to make, I hope you get to be involved and are listened to.
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Re: How long after taking my last dose of sublimate will pain meds work

Post by suboxdoc »

Yes, so many advantages to staying on buprenorphine and using a larger dose of an agonist. Fentanyl is probably the best (the in-hospital, IV kind -- not the fake xanax tabs!). As the doc said above, Dilaudid is a good idea. I'm always slow to use Dilaudid because I don't have that much experience with it compared to oxycodone, but Dilaudid has a higher potency so I'll have to try it the next time a patient has surgery.

People who go off buprenorphine describe things that I didn't expect... like significant withdrawal symptoms every 3-4 hours as the agonist wore off. On buprenorphine, the pain relief may be reduced at those intervals but you would not go into withdrawal. And of course, going off buprenorphine, before getting pain meds, is not a great experience.

I now inject Sublocade for a few patients. It sticks around a LONG time. One injection creates meaningful levels of buprenorphine for at least several months, and as long as 8 months. I've read, somewhere, that the ball of hardened gel can be removed with a small incision? Now sure where I heard that... may have been a presentation from 10 yrs ago, so I don't know if it is true. The 'ball' seems to be fairly discrete and superficial, but it can be hard to find things once the site is bloody. Plus, people receiving regular monthly injections likly have 2-4 small balls, each reducing some amount of buprenorphine. Best to just boost up the dose of agonist.
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