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Unread 11-13-2014, 05:12 PM   #1
jekmimi
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Default Surgery in January

Hi, my dear friends - So I've been worried about the switch (temporary) from Zubsolv to hydrocodone in January, for abdominal surgery, which I have been putting off way too long, and now must "face the music". My buprenorphine doctor laid it out this way~~~I am to stop taking my Zubsolv two days before surgery, in other words, take my last dose on Wednesday evening, then nothing Thursday and Friday, then surgery on Saturday. She said she realizes it will be uncomfortable for me by Sat. morning, but said that she will talk to my surgeon regarding my case, and they should be OK with giving me "a little something" when I come into the hospital, early in the a.m., to get me over the cruddy feeling that I'll undoubtedly have. Then, post-surgery, I'll take hydrocodone until my pain is manageable with just extra-strength Tylenol. Then, two days w/o narcotics, and back on Zubsolv. Hopefully, with the help of my husband who will be my pill dispenser after surgery, I won't have any problems the two days I must wait before returning to buprenorphine. It's just the 48+ hrs. before surgery that I'm worried about! The thing is---this whole thing has gotten me thinking.....what would someone who is in my position of being (thankfully) on bupe, do if, God forbid, he or she was in a vehicular accident or any other type of accident, serious enough to be hospitalized immediately? I mean, would he or she have to go without pain medication b/c they are on buprenorphine??? That would be horrible! I mean, really! So, what can someone tell me about this terrible possibility? Also, is there someone who has had to quit taking their bupe before surgery and how did you manage? Thank you so much to all, and God bless you. Your friend, Joan
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Unread 11-13-2014, 08:05 PM   #2
NancyB
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Hi Joan, I'm sorry to hear about your upcoming surgery. I hope you'll heal quickly from it! If you don't mind my asking, what dose of Zubsolv are you taking? Will your doctor being talking with the anesthesiologist also about a plan also?

As far as emergency surgery or accidents, there's information on this link about it.
https://www.naabt.org/emergency/

Sorry for all the questions.

Nancy
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Unread 01-24-2015, 07:09 PM   #3
jekmimi
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Hi Nancy - I'm so sorry to have been so lax getting back to you. This month we traveled out West to visit family, got back Mon. My surgery is next Friday, the 30th. I am on Zubsolv 5.7mg./1.4mg. I have to stop taking my Zub after my last dose Monday evening. Then, three days with nothing, then the surgery. While I know I can keep away from narcotics with no trouble those three days, I'm frightened of symptoms of withdrawal! I have been on buprenorphine for well over 5 years. Frankly, I am very, very worried, though my surgeon told me yesterday he "didn't see why I should have any problems". This is the same person who had to look this drug up in his massive medications book---it was like he'd never heard of it!! So, as the time rushes up on me to temporarily quit Zubsolv, (I'm trying to remain calm) what am I looking at? What have others experienced? I'll be on pain meds for 5 days (my husband will be my nurse), then a few days off narcotics, and back onto Zub. I don't see any difficulties leaving the narcotics behind as I want to take them sparingly as possible, then using Extra-Strength Tylenol, but I am very worried about "those three days" before surgery!!
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Unread 01-25-2015, 08:24 AM   #4
NancyB
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Hi Joan, I hope you had a good trip! I see willito posted to you, and over the the years, I've seen others at your dose stop a few days before surgery and they did fine because of the halflife. Just try to keep busy so you're not sitting there kind of 'waiting' for something to happen. Also ask which would be better for you afterwards - Tylenol or Advil.

Keeping my fingers crossed that you heal very quickly after surgery. Keep posting too, sometimes writing will help just getting things in writing and not bottling them up.

Nancy
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Unread 01-25-2015, 10:57 AM   #5
jekmimi
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Thank you, NancyB! I can't take Advil, it causes terrible stomach pain for me, so I have to stay away from nsaids, but my husband always has hydrocodone on hand, and I'm wondering if by Thursday evening (the night before surgery), if I'm having a lot of trouble, whether I could take 1/2 of a tablet? Will the Zubsolv be out of my system by then, do you think? You're right, though, I need to do something. If I had something that tasted like menthol, maybe I could fool my brain into thinking I'm taking my Zub!
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Unread 01-25-2015, 03:30 PM   #6
Sam Bailey
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Hey Jekmimi,

You ask,
Quote:
I'm wondering if by Thursday evening (the night before surgery), if I'm having a lot of trouble, whether I could take 1/2 of a tablet? Will the Zubsolv be out of my system by then...
I'm not sure if I'm interpreting your question correctly. It suggests (as I read it) that you're afraid of taking any Hydro on top of Bup/Zubsolv, fearful that doing so could put you into withdrawals.

If I'm not understanding properly, all apologies.

If I DO get your concern, let me assure you, taking any kind of opiate when Bup is in your system will NOT have any negative effect on you. No withdrawals, specifically. The Zubsolv, however, may prevent the Hydro from "working" as well as it ordinarily would.

See, it's the opposite that can cause a problem. Other words, if one has a "fair amount" of opiate in one's system THEN takes some Bup/Sub/Zub, one COULD be thrown into withdrawals.

The way you are describing your situation, taking some Hydro on top of the Zub? Yes, you can do so without worry or concern, except, as I noted, for the potential ineffectiveness of the narcotic.

Hope that helps.

Good luck with your surgery.

PS: Though I hesitate to even mention this, I reckon I will. Yes, yes, yes: it is a good idea to tell your docs everything about any/all meds you're taking prior to any operation.

However, several years back, I had double knee surgery, which ended up with the meniscus in each knee being removed.

At the time I was taking, best I recall, 2mgs of Sub a day. And? Like a dope, I did not tell the docs about the Sub. Didn't mention a-thang! Dumb-butt thing to do, to NOT do, I mean---though it's what I did.

And the result? Not a singe problem. Operations were successful and I left the recovering room that same day. With a script for 50 Lortabs (10/500) too, one refill.

Then, iIn a freakin' astonishing turn of events, I actually asked my wife, Mrs. Sam, to take charge of all my meds. First time for everything, right? ha!

For the record, it was THAT time, that post-op event that really put me on the pathway to actual addiction recovery. From that point on, I turned honest. Told the world, or those interested in my place in it, all my dark dope secrets.

Nobody was shocked, by the way. By that time, my lies and other personal bullcrapola, was better known by family, friends, work, etc, than I understood.

But for me? Something happened that I didn't comprehend, that I didn't get---not for a while. Soon though, I did. Soon though, I got it. And what happened was this wonderful event: I was free, and, truly, I FELT free. It was the first time I felt ANY genuine freedom in, oh, 20-something years.

Sorry, now I am rambling. Point being. Tell the truth, best you can. In any case, apropos your question? You'll be fine.

Really, you're gonna be okay. Really, you are.

best,

sam b
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Unread 01-26-2015, 12:10 PM   #7
jekmimi
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Hi Sam! Thanks for your letter---I appreciated it very much. I know I'm working myself up in to a frenzy about not being able to take my buprenorphine for 3 days before my surgery (in fact at this time, I have one more dose to take this evening, then no more till after surgery). I'm just pre-worrying, so to speak, as to how I'll be feeling by Thursday night, the night before surgery. So, I was wondering if that was enough time that my Suboxone would be out of my system, that IF I felt awful, would I be able to take half a Hydrocodone to ease my symptoms? I'll be taking hydros for pain relief after surgery, for about 5-6 days, as per my doctor, with my husband keeping charge of the meds...then, I'll have to be off the pain meds for a few days (I'm guessing) before I can resume taking my Zubsolv (Suboxone/bupe). How will I feel by Thursday? I don't know. At nearly three days off Suboxone, IF I am miserable, CAN I take 1/2 of hydrocodone? Or will I pay dearly?
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Unread 01-26-2015, 03:32 PM   #8
Sam Bailey
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Hello Jekmimi,

You ask,
Quote:
At nearly three days off Suboxone, IF I am miserable, CAN I take 1/2 of hydrocodone? Or will I pay dearly?
Dear, what do you mean, "will I pay dearly?"

Remember, taking Hydro (or any Opiate) at the same time, or soon thereafter, after one has taken Sub, is NOT a problem. One will NOT suffer any negative consequences, other than the opiate possible not being as effective at curtailing one's pain.

I think you may be confused about this situation.

If one is actively taken Opiates then takes, at the same time, or soon thereafter, any type of Bup (Sub/Zub) one COULD be thrown into some hellish withdrawals.

However, you will NOT pay an negative price if/when you take Hydro on top of, or soon following, taking Bup, in any form.

I hope I am finally being clear. If not, please ask again---and again I'll try to explain. Perhaps another member can better explain this odd dynamic.

In any case, good luck with your surgery, your operation and your post-op.

sam
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Unread 01-26-2015, 08:19 PM   #9
jekmimi
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Really?? B/c I always thought that IF you mixed the two (the opiate and buprenorphine) at ANY time, you would suffer like you've never suffered before! Sorry to sound so uninformed, but this is what I thought I understood from the Suboxone pamphlet I received from my doctor who handles my prescription. NancyB said I shouldn't have any problems b/c of the half-life of buprenorphine, but I have been through some withdrawals that I wouldn't have wished on my worst enemy. This is why I'm so timid about doing anything that might make this occur again. Well, this at least makes me feel that if I am having a very difficult time by Friday, I should be able to take that 1/2 a Hydrocodone to help me. Sorry to sound like such a goof, but this is what I understood to be true, that mixing the two in any way would cause, well, awful things!
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Unread 01-28-2015, 11:11 AM   #10
jekmimi
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One and a half days till surgery----off Zubsolv since Mon. late afternoon. Having some cold chills now and then, but nothing severe. My husband has been very helpful, bless him. I hope to be on pain meds as few days as possible, then go back on my Zubs, just using Extra-Strength Tylenol. Keeping fingers crossed!
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Unread 01-28-2015, 11:19 AM   #11
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Hi Joan, maybe illustration will help in understanding - it's sometimes easier to have a visual.
http://www.naabt.org/collateral/How_Bupe_Works.pdf

If the receptors have full agonist opioids on them, the buprenorphine will knock them out and replace them. BUT that knocking the opioids off of the receptors is withdrawal.

Once the bupe is in the receptor, and someone takes a full agonist, the bupe blocks it so there is no effect at all - no pain relief, no euphoria and no withdrawals. Does that help?

That's good to hear that you just have cold chills now and then. If you can, try not to think about how you're feeling.

You're doing great!!!

Nancy
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Unread 01-28-2015, 01:40 PM   #12
Eliza12
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Hi Joan,

Just wanted to wish you good luck with your surgery. You have a great attitude and I'm sure you will be back on Zubsolv in no time. Take good care!

Best,
Elizabeth
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Unread 01-28-2015, 05:30 PM   #13
jekmimi
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Thanks for the good wishes---much appreciated! NancyB, I think I understand what you mean, but I'm hoping that once I have the surgery on Friday, all the Zubsolv will be out of my system, and pain medicine will do what it's supposed to do~~~relieve my pain! I am pretty sure that three days is enough time, at least, my MD says so. Just hoping for sleep tonight. Love you all!
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Unread 01-28-2015, 05:46 PM   #14
jekmimi
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Nancy, I looked at the site you advised me to see, and am still a bit confused. It says "Over time (24-72 hours) buprenorphine dissipates, but still creates a limited opioid effect (enough to prevent withdrawal) and continues to block other opioids from attaching to the opioid receptors." Does this mean, even after dissipation (post-72 hrs.)?? How would I get any pain relief from surgery, in this case? Just don't understand very well.
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Unread 01-28-2015, 06:13 PM   #15
reti4455
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Hi jekmimi, My gf was on subs quite awhile ago and had some dental surgery done. She stopped taking the subs several days before the surgery. She was given lortabs afterwards. I remember her saying that she did not get any buzz off the tabs but they did help ease the pain.
I think that if your not feeling well the morning of your surgery when they give you some meds your gonna feel better. Maybe not the high you would have felt before you got on subs but any wds feelings should be gone.
I think whatever they give you for pain will work the same way.
I havn,t gone through it personally but that's what gf said and I,ve read elsewhere that this is what happens.
When you get to hospital, during and after, don,t be afraid to speak up if your in pain. Don,t be shy.
Your gonna get through this!
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Unread 01-28-2015, 07:22 PM   #16
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Hi again, as long as your surgeon and anesthesiologist know that you're a Suboxone patient, you should be just fine. There may be some bupe left on your receptors, but they can carefully give you more pains to compensate. Plus, because everyone's so different - with their doses and absorption, I think that link is more of a generalization of the properties.

As reti said, don't be shy if you're having any pain, they will know how to adjust your medication if need be. There's no need to be in pain!

Nancy
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Unread 01-29-2015, 12:42 AM   #17
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Knew you'd be ok. Glad to hear your not feeling bad. Good luck with the surgery!
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Unread 01-29-2015, 10:21 AM   #18
jekmimi
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Day 3 off Zubsolv, day before surgery, thank you to all who responded; I know I must sound like a whiney baby, but I've never had surgery while on Suboxone. Not worried about feeling high (and wouldn't dream of jeopardizing my recovery, I am just terrified of pain. Hot/cold flashes have increased a bit, some minor queasiness. How does Tramadol interact with Suboxone? Tramadol supposedly is not a narcotic, but acts like one; can be highly addictive, I know, but I'd only be taking them a few days. So, would I be having to go three days post-pain meds in order to go back on Zubsolv? I don't anticipate any w/d after just a handful of days on pain meds, but I do have that question in my mind. I'll have to look up Lortab, never seen nor taken them. Bless all of you! (Joan)
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Unread 01-29-2015, 07:08 PM   #19
reti4455
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Hi, You will not have to wait 3 days after you finish taking your pain meds to go back on Subs.
My sub doctor recommends waiting around 16-18hrs. after taking your last pain pill or whatever opiate your taking.
You want your body to be starting wds. Like yawning, runny nose, feeling edgy, can,t sleep etc..
If you don,t wait you could go into precipitated wd and from what I hear you don,t want that to happen.
Some folks that are gonna be starting subs will take there last meds around 7PM then go to bed there normal time and sleep as long as they can.
Say you got up at 8AM you could wait a couple hrs or so then take your sub.
Good luck tomorrow.
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Unread 01-29-2015, 08:39 PM   #20
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Hi Joan, I've heard people have good pain relief with tramadol and others not that great. It really depends on how your body reacts to it and what kind of pain I think. Just remember to speak up if you are in pain, ok?

Good luck tomorrow!! Let us know how things went when you feel up to it.

Nancy
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Unread 01-30-2015, 10:15 PM   #21
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hello! just dropping by to wish you good luck on your surgery
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Unread 02-12-2015, 06:43 PM   #22
jekmimi
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Hello, dear friends. Hope you are all well and God bless you! I had my surgery as scheduled on 1/30; tomorrow, it'll be 2 weeks since undergoing it. Didn't feel very well morning of surgery, after being off Zubsolv for three days, but not bad. Afterwards, it's like you all said---even with the Percocet being "upped" (my husband had to rush me in to the surgeon's office 4 days afterwards b/c the pain was really bad), I seemed to get minimal relief, having to take 3 at a time for awhile. I got no "buzz" whatsoever, not that I was looking or expecting this, but it's weird to take a high-powered pain med with no effect! It would take the edge off the pain, but it wasn't until 8 days afterwards, when I stopped the pain meds for 12 hrs. and went back to Zubsolv, that I got relief! I truly believe that the narcotics participated in making me feel so terrible....once I was back on Zubsolv, I felt almost immediate improvement, didn't need so much as a Tylenol, and I have been making leaps and bounds recovery-wise ever since. The day my husband took me to the surgeon's office, I was crying and incredulous that my pain medication had hardly done anything to relieve the post-surgical pain; my doctor explained that buprenorphine, over the years, has changed my liver's chemistry, that it now chews up narcotics like Pac-Man, making sure that the buzz from the narcotic is non-existent, and pain relief is harder to achieve. He apologized for giving me a lower dosage of Percocet, knowing that I am a long-time buprenorphine patient; he upped the dosage and gave me a separate script for Tylenol #3 (none of which I took). As I said, afterwards, I still had a very tough time till I shoved the meds aside, suffered through 12 hrs. of chills, sneezing, nausea and aching-everything, and resumed my Zubsolv. Ever since, Life has been good, my healing has speeded up, my outlook positve. So, I just hope and pray I never have an accident or illness for which I'd be hospitalized or forced to take serious pain meds for any reason; I guess I should also hope there is an antidote made that can stop the effects of buprenorphine so pain medication can be used and be effective for PAIN! Wonder if that's in the future? Thank you all so much for your care and concern; you're all wonderful!
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Unread 02-12-2015, 07:12 PM   #23
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Hi jekmimi,

Good to hear from you. SO glad that everything worked out OK (except for the pain meds not working!). After two weeks here you are already back on Zubsolv and doing well. Congratulations on making it through and hope you have a speedy recovery.

Best,
Elizabeth
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Unread 02-12-2015, 08:19 PM   #24
NancyB
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Hi Joan, good to hear that everything went well and you're on the mend, especially now since you're back on Zubsolv.

One thing that doesn't make sense is when you said "my doctor explained that buprenorphine, over the years, has changed my liver's chemistry, that it now chews up narcotics like Pac-Man, making sure that the buzz from the narcotic is non-existent, and pain relief is harder to achieve." That's incorrect - bupe doesn't do that to the liver. There most likely was still bupe on your receptors that was blocking the effect of the pain meds. Buprenorphine has a halflife of around 37 hours, so the 3 days without it may not have been enough time for you system, especially at the 5.7mg dose. Then they probably didn't adjust your pain med dosage to compensate for the bupe still doing some blocking.

If you look at it this way, buprenorphine is an opioid painkiller (with antagonist properties - the blocking), if your liver changed so much, then you wouldn't have gotten the pain relief when you went back to Zubsolv. it seems like an effective pain med for you. So please don't worry about an antidote. Hopefully you won't ever have to do that again, but if you do, it could mean tapering down on the Zubsolv for a couple of weeks so when you do stop 3 days prior, it will be from a lower dose, therefore less bupe blocking the full agonists. Hope that makes sense.

In any event, the most important thing is that you are healthy!

Thanks for letting us know.

Nancy
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Unread 02-15-2015, 08:55 AM   #25
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Hi, Glad to hear you made it through the surgery ok and are doing well.
Nancy is correct. Subs stay in the system a long time. With the 37hr half life they seem to take forever to get out of the system. Before I decided to give it one last shot at staying straight I was on and off subs.
I can tell you through experience that it takes a good 2 weeks for subs to get out of your system. If your older like me it may take longer.
Glad your allright!
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Unread 02-18-2015, 04:19 PM   #26
jekmimi
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Thanks, everybody! I'm just repeating what my surgeon explained about Suboxone, and it made sense to me. He did say the changes had occurred in my liver; as buprenorphine is a powerful drug, I wouldn't be surprised that my liver has been affected by 5 1/2 years of its use. I got pain relief from taking 3 Percocets at a time, and that was the only way I did get any relief. Which is what scares me! Also, a lady wrote in on this site saying that her daughter suffered a great deal withdrawing from Suboxone---it took her over two weeks to finally have it over with. This is not something I look forward to, b/c I'm sure at some point, I'll have to get off of Zubsolv, I'm guessing. Maybe I should have just stayed off them, and I'd have it over with by now. Sorry for rambling, but after this, I'm wondering what I got myself into, deciding to go on Suboxone in the first place. Am I so weak-willed that I felt I had to have a "crutch" to stay off narcotics? I'm over-thinking things---I'd better have a chat with my doctor. Am I the only one who feels this way?
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Unread 02-18-2015, 05:23 PM   #27
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jekmimi,
I think you are taking a glass half empty view and its making you angry. Buprenorphine is a lifesaving medication, you need to look at it in that context. When people take buprenorphine they are doing so because the alternative is ongoing addiction. We know the long-term survival rate for opioid addiction is low, while few if any people have died as a result of buprenorphine alone. The question is, would you be in better shape now if you didn't get treatment for your addiction? Probably not.

As far as side effects go, they appear to mirror those of other opioids just to a lesser degree. So if you stayed on whatever opioid you were on before, you'd probably experience the same side effects but much worse. Any way you look at it, addicted people improve their situation with buprenorphine. Now if you are comparing never being addicted to being on buprenorphine then of course never being addicted is better, but that's not the choice people in buprenorphine treatment have, at least not if they are dosed correctly.

If your liver is unusually susceptible to opioids, it is in much better shape now with buprenorphine than it would be if you stayed on other opioids. The Tylenol in the Percocet is much more harmful to the liver than bupe. Acetaminophen is proven to cause liver damage and even renal failure.

If you are saying that you would have been better off just quitting everything and not starting buprenorphine, then yes of course that's better, but that is not who buprenorphine is for. If someone can quit and be fine, they don't need bupe and they should never start it. Bupe is only for those who would relapse without it, not for people who can just quit.

Remember what we always say here, the correct dose is the lowest dose which still stops cravings and withdrawal. If you follow that rule. you will never take more than is needed to prevent relapse, nor will you maintain any more physical dependence other than what is absolutely necessary to maintain addiction remission.

The withdrawal people get after tapering is not directly caused by the buprenorphine. It is a symptom of physical dependence, the same physical dependence first created while in active addiction, the bupe only maintains some of it. This is why taper experiences vary so widely, it has to do with how much tolerance you had before ever starting bupe. You can minimize it with a slow taper to very low doses (see this taper schedule http://www.helpmegetoffdrugs.com/taper ) but it comes from the original addiction, not the bupe, the bupe only maintains some of what you already had.

Please don't feel weak-willed, you have successfully stopped your addiction, you should be proud. Using evidence-based treatment is smart and shouldn't be viewed as a crutch no more than antibiotics should be seen a crutch.

Tim
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Unread 02-18-2015, 11:17 PM   #28
gotoffmdone
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The problem comes in the reverse. It is when you take Bupe on top of hydros that may precip wds. Taking hydros on top of bupe will do nothing to you or for you. The Bupe has such a long half-life I am surprised to hear your Dr say to stop two days before surgery. I would think there would not be much room on your mu receptor for the hydro to attach itself. I too had abdominal surgery and my sub Dr had me to switch to hydros five days before hand.

wayne
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Unread 02-24-2015, 03:08 PM   #29
Eliza12
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Originally Posted by jekmimi View Post
Thanks, everybody! I'm just repeating what my surgeon explained about Suboxone, and it made sense to me. He did say the changes had occurred in my liver; as buprenorphine is a powerful drug, I wouldn't be surprised that my liver has been affected by 5 1/2 years of its use. I got pain relief from taking 3 Percocets at a time, and that was the only way I did get any relief. Which is what scares me! Also, a lady wrote in on this site saying that her daughter suffered a great deal withdrawing from Suboxone---it took her over two weeks to finally have it over with. This is not something I look forward to, b/c I'm sure at some point, I'll have to get off of Zubsolv, I'm guessing. Maybe I should have just stayed off them, and I'd have it over with by now. Sorry for rambling, but after this, I'm wondering what I got myself into, deciding to go on Suboxone in the first place. Am I so weak-willed that I felt I had to have a "crutch" to stay off narcotics? I'm over-thinking things---I'd better have a chat with my doctor. Am I the only one who feels this way?
Hi jekmimi,

How are you doing? I think Suboxone served a good purpose to help you get off narcotics. If you would like to start tapering off, you don't have to be afraid of it. Tapering slowly off should not cause you to suffer bad withdrawals. If you read the taper threads, you will find a lot of us who have done it successfully. Tapering too fast, or jumping from too high a dose can cause problems. As far as being weak-willed, I just don't believe that. You took a medicine, just like a diabetic takes insulin, or a heart patient takes medicine to manage their symptoms. Studies are showing more and more that medication-assisted recovery is much more successful than stopping cold turkey. It gives people time to work on their recovery without cravings or withdrawal. It's like crutches, but for a broken leg :-).

Anyway, thinking of you and hoping you are recovering well from your surgery.

Best,
Elizabeth
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