Can You Take Morphine While on Suboxone?

Under some circumstances, patients who are on Suboxone may need additional pain control, after an acute surgery or accident. In these circumstances, morphine (or other opioids) can be taken while on Suboxone for additional pain control, but there are special considerations to follow.

Suboxone is an effective medication used in Medication for Addiction Treatment (MAT) for the treatment of opioid use disorder (OUD). It contains the partial opioid agonist buprenorphine as well as the antagonist naloxone. 

Initially, doctors were hesitant to prescribe full opioid agonists such as morphine while on Suboxone due to the potential for breathing issues and respiratory depression. [1] However, now that Suboxone has been readily available for many years, we understand more about its safety. In fact, Suboxone binds preferentially to opioid receptors in the brain over full opioid agonists, and so it can actually be protective against respiratory depression and overdose. 

If you take full opioid agonists like Morphine and then subsequently take Suboxone, this can cause precipitated withdrawal. However, if you continue to take your Suboxone dose regularly and then subsequently take a full agonist like morphine, this should NOT cause withdrawal and should actually be a safe and effective way of giving you pain relief. 

This pharmacology can be a little confusing both for patients and even for doctors who do not frequently prescribe Suboxone. 

Make sure you talk openly with your doctor so that you are on the same page about your Suboxone and how to dose it along with other pain medications post-operatively in order to control your pain and still help you maintain your abstinence from opioid use. 

Is It Safe to Use Morphine in Surgeries While on Suboxone?

Yes, although under medical supervision. There are differing reports on using morphine to control postoperative pain in people taking Suboxone. There are indications that people taking Suboxone, who are therefore opioid tolerant, may have more postsurgical pain than those who are opioid naïve. This means that patients on Suboxone may need additional pain control after surgery with full opioids. [2] 

Buprenorphine binds tightly to opioid receptors in the brain, which can keep other full opioid agonists like morphine from having analgesic (pain-relieving) effects. 

Providers will often want patients to discontinue use of Suboxone and allow it to process fully out of the body before surgery and the use of morphine. This can be an issue, leading to withdrawal symptoms and the potential for a relapse. 

Instead, more research shows that it is actually safe to continue a patient’s regular Suboxone dose and simply add additional opioids for acute pain control. [3] 

You should know that: [4] 

• For surgery with mild pain, you may be able to continue your MAT as is and add additional opioids for pain control as needed 
• For surgery with moderate to severe pain, you may need to titrate your dosage of buprenorphine before your surgery.
• For surgery with severe pain, buprenorphine can also be temporarily discontinued and replaced with carefully titrated high-dose, short-acting opioids until the buprenorphine is processed out of the body.

Are There Alternative Options to Morphine or Opioids for acute pain?

Yes! Some individuals with a history of opioid misuse on Suboxone may adamantly want to avoid being exposed to opioids as it may be a trigger for them to return to use. 

If this is the case for you, there are MANY non-opioid pain medications that you can take in addition to your Suboxone, including:

• Nonsteroidal and anti-inflammatory medications
• NMDA receptor antagonists
• Gabapentinoids
• Alpha-2 agonists
• Muscle relaxers 

It is also beneficial to take a multidisciplinary approach that helps to control stress related to pain. 

What Should You Tell Your Surgeon if You Are on Suboxone

Some surgeons may or may not feel comfortable managing Suboxone and acute pain at the same time. If you are on Suboxone and are expecting a surgery or any other reason for acute pain, it is very important to discuss openly with your surgeon and/or your Suboxone prescriber what your options are for pain control. If your surgeon is unsure of how to dose your Suboxone post-operatively, have him or her reach out directly to your Suboxone prescriber. Suboxone prescribers often have more experience with pain management and may be able to counsel/advise your surgeon how best to control your pain while still maintaining your Suboxone for OUD. 

Obviously there are emergency circumstances that we can’t plan for, but if you are expecting a procedure or any other reason for acute pain, the more planning you do with your doctors ahead of time, the better you and your team can be prepared to continue therapy for OUD while also adequately managing your pain.

Sources

1. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed August 2022.
2. Case Series of Successful Postoperative Pain Management in Buprenorphine Maintenance Therapy Patients. Anesthesia & Analgesia. https://journals.lww.com/anesthesia-analgesia/fulltext/2017/11000/case_series_of_successful_postoperative_pain.45.aspx. November 2017. Accessed August 2022.
3. Perioperative Management of Buprenorphine: Solving the Conundrum. Pain Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963209/. July 2019. Accessed August 2022.
4. Buprenorphine and Surgery: What’s the Protocol? Practical Pain Management. https://www.practicalpainmanagement.com/resource-centers/opioid-monitoring-2nd-ed/buprenorphine-surgery-what-protocol. April 2019. Accessed August 2022.