Palliative care--asking doc about switching to suboxone or buprenorphine post surgery for a bit ?

[frozenborderline]

Hey all. If I'm on high dose full agonists like oxy for pain post surgery and theres evidence for it and I want to switch to suboxone e or buprenorphine at high /equivalent dose (not belbuca ) , do you think there are docs who will prescribe that for pain or a diagnosis different than opioid use disorder ? For ex I obviously have dependence or tolerance from being on oxy , its plausible that theres an icd code for dependence that's not for addiction/opioid use disorder

My concern is wanting to try suboxone, not wanting to get inaccurate dx in my chart, and also not wanting that to limit choices of what to try for pain on future.

The reason I'm interested in suboxone is this: it can be very effective and potent for pain while having a ceiling effect where you dont tend to need to double and triple and quadruple your dose to get same effects on pain t ht at happens with oxycodone or dilaudid or whatever full agonists. Those are all good in many circumstances but I've read studies showing suboxone working great bc it's long lasting and had this dose ceiling effect. But I want it prescribed for PAIN, not addiction which I dont have.

And I know a pain doctor who uses suboxone , should I contact him, or is it too forward to ask about this ? And maybe he cant prescribe it for pain specifically

 

[frozenborderline]

@lenora @Hip

 

[Hip]

It sounds reasonable to ask this doctor for suboxone.

 

[bensmith]

Never thought about sub for pain, but maybe it would
Work.

 

[frozenborderline]

Never thought about sub for pain, but maybe it would
Work.

It's a partial opioid agonist. Theres no reason it shouldn't work. It's still an opioid agonist... partial agonists can still be very powerful, it binds tightly and is potent at very low doses.

It is used in pain, there are studies and precedents , but the strange regulations set up to manage its use as a modern day methadone and opioid replacement for addicts make it trickier to use for pain as you have to have a specidal license to prescribe it and not all doctors have this license , and the ones that do are often suboxone /addiction doctors not pain doctors.

 

[lenora]

I agree with Hip, it won't hurt to try. If that doesn't work, then perhaps you could ask for something for anxiety and it may help reduce the pain levels. And yes, it can be addictive, but if it helps get you through a difficult period, then at least it's an acceptable addiction. Yours, Lenora.

 

[frozenborderline]

If for some reason the doctor finds it weird or offputting that you ask like this. Does HIPAA mean they cant tell other doctors about it without your permission? Unclear on the boundaries. There are lots of weird small things that doctors consider bad signs for drug seeking.

 

[frozenborderline]

Hi all. I wanted to post the study itself that made me confident buprenorphine at high doses could work for even the most intense post surgical pain.

It's a study where they replace full agonists at very high doses in cancer patients on hospice with buprenorphine.

It seems that tolerance to full agonists doesnt have a ceiling but with buprenorphine there is a ceiling and while you develop some tolerance to it it doesnt ever become wholly ineffective or needing a dose escalation especially at the middle or higher doses , unlike full agonists. That may not be correct but is an extrapolation from what I've read and experienced.


https://www.karger.com/Article/Fulltext/349917

 

[frozenborderline]

So here are some graphs with my guesstimate of the difference btwn tolerance development with oxycodone and suboxone. The different lines on oxycodone was more bc I thought it has more variance than oxycodone , they're meant to represent a few common courses rather than anything complex. Here you go

Buprenorphine is the drug I refer to when I say suboxone btw although suboxone pairs buprenorphine with some naloxone as abuse deterrent but the active thing is buprenorphine and that's what we want for pain, not the naloxone, so I made the graph with that name and trying to switch to saying that. Do these make sense to people