Should You Stop Suboxone Before Surgery?

Suboxone is a prescription medication doctors use to treat opioid use disorder (OUD). If you're using Suboxone, you might have a history of using drugs like heroin or Vicodin. That drug use history could make your surgery difficult.

People using Suboxone often need higher-than-average doses of medications to control pain after surgery.[1] 

As we have learned more about pain management in patients postoperatively on Suboxone, we have found that it is generally safe for patients to continue their Suboxone without interruption in most cases, and add additional pain medications as needed. [2] However, some patients and doctors may be more comfortable temporarily discontinuing the medication during and after surgery and then re-starting once the patient recovers.  

The decision to continue or stop Suboxone before surgery largely depends on patient preference, type of surgery, expected recovery time, pain requirements, severity of addiction history, etc. 

Factors That Determine if You Should Stop Suboxone Before Surgery 

Determining whether you should stay on your medication or stop it should be a conversation between you and your doctor.[3] You might talk about the following:

• Your procedure: Procedures that are short or minimally invasive may not require a long recovery time or significant pain medications, in which case it may be easier to simply continue Suboxone without interruption. 
• Your dose: People on very high doses of Suboxone may struggle to lower their dose or stop it acutely. In contrast, if you have a very small dose, it might be easier to stop temporarily. 
• Expected recovery: Some people bounce right back after a surgery, and others need a longer time to get better. The longer you'll need, the more pain medication you might require. 
• Preference: Some people feel panicked and upset at the idea of stopping a medication that's helped them with an addiction. You might therefore be more comfortable continuing your medication during the post operative period.
• Your doctor: Since most surgeons do not routinely prescribe Suboxone, they are hesitant when deciding whether or not to continue prescribing it before and immediately after surgery. They may ask for consultation or advice from pain management or addiction specialists for patients on Suboxone.

What Do Experts Think?

Even among Suboxone-prescribing doctors and pain management doctors, there is a debate about how Suboxone should be managed during surgery because every patient responds to pain differently. 

Most doctors who prescribe Suboxone recommend patients continue at their normal dose during and after surgery. In particular, this applies to patients who are worried about relapsing without the medication. In that case, additional opioids can be given on top of the patient’s normal Suboxone dose to control post-operative pain.

Talk to Your Doctor First 

Many hospitals and surgery centers have special pain management teams to help patients with complex pain needs (like those on Suboxone) manage their pain after surgery. If you are anticipating surgery, talk to your surgeon, anesthesiologist, and opioid prescriber before surgery. Together, you can craft a clear plan for pain management while still maintaining your treatment for OUD.

Sources

1. 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 November 2022.
2. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. https://pubs.asahq.org/anesthesiology/article/126/6/1180/18722/To-Stop-or-Not-That-Is-the-QuestionAcute-Pain. June 2017. Accessed November 2022. 
3. Perioperative Management of a Patient Taking Suboxone at the Time of Ambulatory Surgery. Case Reports in Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085354/. March 2020. Accessed November 2022.