1. Narcotics typically given in an emergency department setting do not work if you are on Suboxone, even if they are administered intravenously.
  2. Advise your physician you are on Suboxone. Fentanyl, a powerful narcotic, can be given while you are on Suboxone and will be effective

Procedure for Same-Day Surgery

Emergency surgery leaves no time to completely taper off of buprenorphine; even if stopped abruptly, about 2 to 3 days would still be needed to entirely clear the drug from the patient’s body.

In this case, providers have 3 main options, depending on the anticipated level of pain:

  • If they deem that the surgery will only cause mild to moderate acute pain, they may continue buprenorphine, while adding and optimizing non-opioid pain modalities.
  • If the providers anticipate that surgery will cause moderate pain, they can treat the patient with intravenous buprenorphine.
  • If they anticipate severe pain, providers can discontinue buprenorphine in lieu of high-dose and carefully titrated short-acting opioids until the buprenorphine is cleared from the patient’s body. Hydromorphone (Dilaudid) or fentanyl is the best option for managing severe postsurgical pain under these circumstances; however, there are no standard conversion or dosage recommendations that have been studied or that can be considered a standard of care. Optimizing nonopioid analgesics, including nerve blocks, also plays an important role in all of these scenarios.