You will still be able to be treated for pain with elective dental or surgical procedures. Your doctors should speak with each other about the plan. They will likely stop your Buprenorphine medication, at least 36 hours before the procedure, and then when you are ready to go back on Buprenorphine you will need to be re-induced, which means stopping your pain medicine, experiencing mild withdrawal (for a very short time) and restarting your Buprenorphine.
Your doctor can contact The SAMHSA-funded Physician Clinical Support System (PCSS) and consult one of the buprenorphine mentors prior to your surgery.
Recommendations for Patients Receiving Maintenance Buprenorphine Therapy (Ann Intern Med. 2006;144:127-134)
Treatment options are as follows:
1. Continue buprenorphine maintenance therapy and titrate a short-acting opioid analgesic to effect. Higher doses of full opioid agonist analgesics may be required to compete with buprenorphine.
2. Divide the daily dose of buprenorphine and administer it every 6 to 8 hours to take advantage of its analgesic properties. However, these low doses may not provide effective analgesia in patients with opioid tolerance who are receiving OAT. Therefore, in addition to divided dosing of buprenorphine, effective analgesia may require the use of additional opioid agonist analgesics (for example, morphine).
3. Discontinue buprenorphine therapy and treat the patient with full scheduled opioid agonist analgesics by titrating to effect to avoid withdrawal. With resolution of the acute pain, discontinue the full opioid agonist analgesic and resume maintenance therapy with buprenorphine, using an induction protocol.
4. Convert patient from buprenorphine to methadone at 30 to 40 mg/d. At this dose, methadone will prevent acute withdrawal in most patients.
Pain and addiction co-occur frequently, and each can make the other more difficult to treat. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. http://www.naabt.org/education/documents/challenges.pdf
We never know what could happen. What if there is an emergency and you need to be treated for pain? Worse yet what if you are unconscious? A potential problem is you could be unnecessarily under-treated for pain. Since many doctors out there are still unfamiliar with Buprenorphine, there are a few documents that will be helpful. We suggest you print out a few of these and tell a loved one or your “in case of emergency” person, where they are.
Keep this in a folder, jump drive, or CD, just in case of emergency. Hopefully it will never be needed.
Most of these files are PDF files and require the standard reader to view them. This comes with newer computers but if these files don’t open for you, you can download the free and virus free reader here. This is something you only have to do once and will allow you access to all kinds of information as the pdf file format is becoming more and more popular. http://www.adobe.com/products/acrobat/readstep2.html
To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -