Preparing for and recovering from surgery can be stressful for anyone. Patients with opioid use disorder (OUD) have the added concern of managing their pain after surgery without risking their OUD recovery process.
It is possible to balance the need for post-operative pain relief with continued OUD treatment. In such situations, the patient’s care team must carefully address both factors to achieve an optimal outcome. A crucial question is whether patients on buprenorphine who are undergoing surgery should temporarily discontinue the use of their medication or not. And, if so, how long before surgery should you stop Suboxone® (which contains buprenorphine as an active ingredient)? In light of new research, the default recommendation may be changing to provide patients with the best possible care.
Using buprenorphine when undergoing surgery
Historically, many doctors have advised patients taking buprenorphine for OUD treatment to stop before and immediately following any surgeries. This outdated recommendation came from a concern that continued buprenorphine use would get in the way of effective post-surgery pain management. Buprenorphine binds to opioid receptors in the central nervous system, preventing other opioids—like methadone and morphine—from binding to those receptors and taking effect. Patients on Suboxone would seemingly have to stop taking the medication to ensure their pain medications took effect.
It remains true that patients should generally not take regular doses of Suboxone and opioids like morphine simultaneously. The interaction between Suboxone and these other drugs can increase the risk of overdose, among other dangerous side effects. However, the default recommendation for patients on Suboxone who are undergoing surgery is changing.
According to new research, the previous recommendation around buprenorphine and surgery that instructed patients to temporarily stop using the drug around the time of their surgery may have been misguided. Instead, OUD patients should continue using buprenorphine before and after their surgery to decrease the risk of OUD recurrence.
This is a welcome development, as the consequences for OUD patients taking buprenorphine can be severe when they have to suddenly stop taking the medication. If a person taking Suboxone quits the medication “cold turkey,” even temporarily, it may trigger buprenorphine withdrawal symptoms. Dealing with withdrawal symptoms is difficult at any time, particularly when a patient is recovering from surgery. Being able to continue using buprenorphine as prescribed before and after surgery should reduce the risk of withdrawal or relapse.
Efforts to reduce reliance on opioids for post-surgical care
Out of the over 100 million surgeries in the U.S. each year, over 90% of patients are prescribed opioids. Opioids offer strong pain relief, which many patients require after surgery, but also come with significant risks of dependence and abuse. In light of the overwhelming number of opioid-involved drug overdose deaths, medical practitioners and researchers have been working to reduce the reliance on opioids as a part of post-surgical care.
One option that may be effective for some patients is treating post-surgical pain through means other than opioids—whether that’s prescribing non-opioid medications or using other interventions like physical therapy or acupuncture. The effectiveness of these pain relief methods is the key consideration when medical providers are deciding whether to prescribe opioids for pain relief. Drugs like nonsteroidal anti-inflammatory agents (NSAIDS), for example, are often effective in treating mild to moderate pain levels. Doctors may choose to prescribe these medications instead of opioids to avoid the potential side effects of opioids. Whether patients on Suboxone can also use other pain medications will depend on the drug and its interactions with buprenorphine.
When it may be less common to be able to avoid any opioids for post-surgical care, medical providers can still reduce the risk of opioid misuse through intervention strategies. Offering opioid counseling to OUD patients undergoing surgery is one such strategy. Providers can extend counseling to other high-risk patients receiving opioids for post-surgical care as well.
Buprenorphine and pain management
Buprenorphine itself has significant pain management properties that can be useful in post-surgical care. Research has shown that, just like other opioids, buprenorphine effectively treats chronic pain, something patients commonly experience post-surgery. While this is not the intended use of buprenorphine for OUD patients, continued use of the drug may help manage any pain they experience after surgery, especially when the dose is split and used every six to eight hours throughout the day. Compared to other opioids, buprenorphine has a much lower risk of fatal adverse events, such as overdose.
For patients with OUD, post-surgical care requires a delicate balance between pain management and avoiding setbacks in their OUD treatment. The new findings regarding Suboxone and surgery are a step in the right direction to ensuring OUD patients get the best possible surgical care.
Comprehensive care that puts your health first
Surgery doesn’t have to disrupt OUD treatment. Before undergoing any procedure, discuss your questions and concerns about pain management with your Ophelia care team. With the right recovery plan, you can manage your post-surgery pain and continue moving forward with your OUD treatment, including using Suboxone.