Suboxone Patient Needs Surgery, Refused Pain Control

First Posted 10/21/2013

I have received MANY messages over the years from patients on buprenorphine/naloxone (Suboxone) who required surgery, but whose doctors refused to provide post-op analgesia.  Those of you not on Suboxone– can you imagine having surgery, and being told that ‘it is too much hassle to give you any medicine for pain relief’?

Below is a comment to my last post, followed by my suggestion.  I am usually not a fan of getting medical boards stirred up over other doctors’ business, but this type of situation is RIDICULOUS, and must be stopped.

The comment:

I’m scared to death!!  I have been on Suboxone for over a year.  Previous to  that, I was on it for a couple of years before stopping its use.  At that time I  developed some gall stones and presented to the ER in pain I can not even begin  to explain.  Ultimately the stone passed but I need to have the gall bladder  removed.  I figured this was a good time to maybe get off of Suboxone.  I knew I  would be getting some standard opiates after surgery to manage pain so I thought  it could manage the Suboxone withdrawal as well.

It was an awful experience and I eventually resumed Suboxone.  It has been a  little over a year now back on.  About 8-12 mg/day.  So about a couple of months  ago, I needed shoulder surgery.  Here we go again.  I tapered back on the sub  and went through with the labrum repair.   I did discuss it with my  psychiatrist but he basically said he wanted NOTHING to do with the acute  pain management portion of this surgery.  And I actually experienced very little  pain post-surgery and went almost immediately back on  sub.

Now I have had complications mainly from scar tissue.  Tremendous pain.  My  ortho recommended a surgical manipulation to clean out the scar tissue.  So I  went along and although the post surgical pain was much worse this time, I got  through it OK and back on sub.  Now I need to to go back to my psychiatrist for  a refill on the sub.  But, because I did not discuss THIS event with him (I  already knew he didn’t want anything to do with it) he said he would not refill  or treat me anymore.  So now I am one year in on Suboxone and being told to take  a flying you know what because of surgery I needed.  I just feel that if I’m on  Suboxone, I am at the mercy of whomever is treating me.  It is like blackmail.  

My response:

Shoulder surgery can be one of the most painful operations to endure.  If patients have inadequate pain relief after surgery, they risk developing scar tissue formation because of inadequate movement and physical therapy.  In other words, you second shoulder surgery might have been required BECAUSE you didn’t get pain meds after the first surgery.

Even if that is not exactly the case, people on Suboxone deserve pain relief after surgery.  Can any of you non-Suboxone patients imagine having a surgeon say ‘you will need pain meds after surgery, but it is too much hassle so I’m not going to give you any’?

I suggest sending a letter to your medical licensing board and saying something like this:

I am prescribed buprenorphine/naloxone, an FDA-indicated treatment for opioid dependence, by Dr. Whatever.   That doctor is certified to prescribe buprenorphine and Suboxone, and so should be aware of the proper way to treat post-operative pain in patients on that medication (as described inthis article).  I realize that there is a certain stigma for addiction even for those of us trying to do the right thing with appropriate medication— but refusing to treat post-operative pain is not consistent with the Hippocratic Oath.  Because my doctor simply refused to ‘get involved’ with treating my surgical pain, I was forced to endure the pain of surgery without any significant postoperative pain control– a level of care that would not be tolerate even for a family pet.   I wish to speak to someone at the board about the postoperative care that I did not receive.

Will it help?  I have no idea.  But the ONLY way things will change is if enough people start to complain.  Good luck.