People get hooked on OxyContin, Vicodin, and other narcotic pain relievers because of painful conditions or traumatic accidents, and many of them end up on heroin when their supply of pain pills dries up. So you’re thinking of going into Suboxone treatment for opiate addiction, but then you wonder: What if you have an injury or a chronic condition and you need pain pills? How will the Suboxone affect your pain levels, and can you take Suboxone for pain?
The answer is both yes and no. The FDA has approved generic buprenorphine formulated as Buprenex, an injectable medication to control pain, and Butrans, a transdermal patch. However, they are not widely used in this country. You’ll find them more common in Europe and down under in places like Australia and New Zealand.
Why do American doctors consider other options rather than Suboxone for pain? There are a few problems with using buprenorphine for that purpose: First, the liver metabolizes buprenorphine very slowly, 30 percent less efficiently than other pain medications. Second, emergency room doctors have discovered that if someone overdoses on buprenorphine, they cannot count on Narcan to reverse the effects on the respiratory system. It can be fatal. Third, people will be more likely try to abuse it.
So it doesn’t sound too smart to use Suboxone for pain. What’s a person to do, then, if they’re on Suboxone or generic buprenorphine to treat opiate addiction and they anticipate a surgical procedure and the accompanying pain?
Medication-assisted treatment programs routinely put pregnant women on Subutex rather than methadone. They choose the Subutex because the Suboxone includes naloxone, while Subutex contains simply the buprenorphine. Those women anticipate the eventual pain of childbirth, and even C-sections. What are they to do?
Many chronic drug users that find help in Suboxone treatment centers have also abused methamphetamines, and they’ve badly damaged their teeth. Other drug users simply neglect their personal hygiene, and they have also done considerable damage to their teeth. They face tooth extractions, and sometimes they lose multiple teeth all at once. What are they to do? Can they take Suboxone for pain?
Suboxone For Pain: Not a Wise Choice
The National Alliance of Advocates for Buprenorphine Treatment (NAABT) does not give support to the use of Suboxone for pain. Its website instead posts a letter from the Drug Enforcement Administration to a Dr. Heit, who wrote and asked about the possibility of prescribing Subutex or Suboxone for pain. The letter states that while the use of sublingual buprenorphine “is not prohibited under DEA requirements” there is a problem posed by the scheduling and dispensing of the various buprenorphine formulations. Buprenex and Butrans are not scheduled as drugs that can be used in opioid addiction treatment, and Subutex and Suboxone and not scheduled to be utilized for pain.
It’s also tricky to give Suboxone for pain because people commonly mix their pain medications with alcohol or benzodiazepines such as Xanax. Even those who would scoff if anyone told them they were abusing their medication are guilty of mixing those substances. But it’s well established that Suboxone, like methadone, can be fatal if it’s mixed with other opiates, with benzos, or with alcohol.
Off-Label Use of Suboxone for Pain
If you anticipate a procedure such as a C-section or dental extractions, or even a small surgical procedure, it’s a good thing to ask your doctor at the Suboxone program what they think of prescribing Suboxone for pain off label. Off-label use refers to the practice by doctors of prescribing medication for a condition that it’s not normally recommended for.
For example, Cymbalta is an SNRI antidepressant medication that often helps with pain. In fact the FDA now approves it for painful conditions such as diabetic neuropathy and chronic low back pain. Minoxidil was originally a blood pressure medication that was discovered to have amazing hair-growth properties.
It doesn’t hurt to ask your buprenorphine doctor about using buprenorphine or Suboxone for pain. There have been cases when a woman saw her doctor for the last time before a scheduled C-section, and her dose was increased a little bit temporarily for the days immediately after the procedure, maybe from 8 to 12 mg. However, this is not a recommendation of this type of therapy. It is strictly a matter between the doctor and the patient whether the Suboxone dose is slightly titrated when a surgical procedure is anticipated.
In the meantime, it’s a good idea to seek out other options for treating pain. You can take acetaminophen and ibuprofen together when you experience a higher degree of pain, whether it’s from arthritis, dental pain, or other causes. Acetaminophen and ibuprofen are two different categories of over-the-counter analgesics. You cannot, however, take aspirin and ibuprofen or ibuprofen and naproxen. Aspirin, ibuprofen, and naproxen are all categorized as non-steroidal anti-inflammatory medications, and so they cannot be taken together; but one of them can be taken along with acetaminophen to help you deal with pain. That is why it so important to obtain medical direction and guidance rather than mixing medications at your own discretion.
Hypnosis is also used as an adjunct for pain relief. Rather than seeing a hypnotherapist just once or twice, as occurs for those who want to stop eating or smoking, hypnotherapy for childbirth involves multiple sessions. The expectant mother learns certain cues that will help her relax during labor and also that will stimulate the production of helpful endorphins during labor. Production of stress hormones also drops. While obstetricians practicing from their offices would rather advocate spinal analgesia or natural childbirth, many birthing centers will provide access to hypnotherapy sessions before childbirth.
What about hypnotherapy for dental extractions or other small procedures such as a biopsy? Many people believe hypnosis can help all types of pain, but hypnotherapy for pain is very poorly regulated in this country. The Mayo Clinic lists conditions helped by hypnotherapy to include cancer pain, irritable bowel syndrome, fibromyalgia, and mandibular jaw pain—often associated with stress.
NAABT Recommendations
Along with its publication of the DEA letter to Dr. Heit, the NAABT also recommends other choices for handling pain during surgery:
- Your doctor can continue your regular Suboxone treatment and gradually introduce an increasing dose of a pain medication, with a higher-than-normal dose required in order to break through the effects of the naloxone.
- Your doctor can order your Suboxone dose to be taken as a divided dose. Instead of one 8mg film daily, you would take half the amount twice per day. This may well help with your pain—but it’s not a guarantee.
- Your doctor can halt your Suboxone therapy 72 hours ahead of your procedure. Once the procedure has passed and the analgesics you took are out of your system, you can resume Suboxone therapy—but you will undergo the induction period once again.
- Your doctor can switch you from buprenorphine to methadone at a small dose—30 or 40 mg—so that your pain is managed and you also do not experience withdrawal symptoms.
The most important thing to consider in your decision regarding Suboxone for pain is your doctor’s opinion. Ultimately, with or without your input, he or she will make the medical decision that’s right for you.
