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Can I take pain pills while on Suboxone?
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- What pain medication can you take on Suboxone?
- Non-medication pain relief
- Continuing Suboxone maintenance therapy and adjusting the dosage of a short-acting opioid medication (e.g. morphine or oxycodone)
- Dividing Suboxone dose and take it more frequently
- Discontinuing Suboxone slowly to avoid withdrawal and start an opioid medication
- Switching from Suboxone to methadone at a dose of 30-40 mg per day to avoid acute withdrawal
Taking Suboxone to treat an opioid addiction doesn’t mean that you’re doomed to suffer after surgery or injury
Life is unpredictable. Sometimes we experience an injury, illness, or surgery that causes us acute pain. Acute pain goes away when whatever is causing it goes away—when the injury heals or when you recover from the illness. (This contrasts with chronic pain, which is long-term.) People in recovery from opioid use disorder often fear facing acute pain because they don’t know if they will be able to get any relief from it. Will they just have to suffer now? This fear can be even stronger if their opioid use began with prescription medication in the first place.
You do not have to simply white-knuckle your way through pain just because you are using a medication-assisted treatment like Suboxone. Talk to your healthcare provider about your concerns, and they will suggest pain relief options. This article will discuss some of the solutions they may bring up.
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Non-opioid options for pain relief while taking Suboxone
Humans have been using opioids as painkillers for thousands of years, so you may assume that when you’re in pain, opioids are the only option. But there are other alternatives. If your doctor recommends avoiding opioid painkillers while you are engaged in Suboxone treatment, that isn’t a sign that they’re being controlling or that they don’t trust you. Your Suboxone treatment may not be compatible with opioid pain medications, so your provider will make suggestions taking that into account.
What pain medication can you take on Suboxone?
Nonsteroidal anti-inflammatory drug (NSAID)
- ibuprofen (popular brands include Advil, Motrin, Nuprin)
- aspirin (popular brands include Bayer, Bufferin)
- naproxen (popular brands include Aleve)
Acetaminophen
- Acetaminophen (popular brands include Tylenol) does not relieve inflammation, so it is not an NSAID, but it can be effective against many kinds of pain and is safe to take while on Suboxone.
Multiple active ingredients
- There are several pain medications that combine multiple active ingredients, including brands like Excedrin and Midol. These are also compatible with buprenorphine treatment like Suboxone.
Despite being common and readily available, these medications still need to be taken as instructed. Your provider will tell you the best dosage and timing in order for you to get the best (and safest) relief.
Your doctor may also prescribe a medication that addresses pain differently, like gabapentin for nerve pain. Make sure your provider knows that you’re taking Suboxone so they can consider any possible drug interactions.
Non-medication pain relief
Most people in our society default to taking a medication for pain, but there are a whole range of techniques for managing pain that don’t involve drugs. Many are surprised at how effective these strategies can be. If your healthcare provider suggests one or more of these strategies, try to keep an open mind. You may find unexpected relief.
These may include:
Managing pain without medication
- physical therapy
- massage
- chiropracty
- mild electrical current from a TENS unit
- counseling
- meditation
Our program is based in harm reduction—you won’t be kicked out of our program based on a positive drug test
Four ways of managing acute pain with opioids when on Suboxone:
Sometimes—and only sometimes—you and your doctor may decide that an opioid pain medication is the best choice, even though you’re in recovery from opioid use disorder. This is more common for treating severe, acute pain following surgical or dental procedures. If your provider suggests using an opioid pain medication, be sure all of your healthcare team—including doctors, paramedics, ER staff, anesthesiologists, and dentists—know that you are taking Suboxone. Here are four strategies that we have seen used to manage acute pain with opioids for a person on Suboxone.
Remember that these should be done only under the guidance of your doctor!
Continuing Suboxone maintenance therapy and adjusting the dosage of a short-acting opioid medication (e.g. morphine or oxycodone)
If your medical provider suggests continuing your regular Suboxone doses and also taking an opioid pain medication, you will need to be very careful to follow their dosing instructions precisely. You may need a higher dose of opioid than a person not taking MAT. This is because the buprenorphine in Suboxone binds to opioid receptors in the brain, so a higher dose may be needed to compensate for this. Your provider may consider putting you on a medication like hydromorphone, which binds opioid receptors strongly.
Your doctor will determine the safest dosage that will also be effective. If you and your provider decide to go this route, it is vital that you continue taking your Suboxone dose.
Dividing Suboxone dose and take it more frequently
In this case, the “opioid pain reliever” being used is the Suboxone itself. Suboxone is not usually used as a pain reliever for acute pain, but buprenorphine does have analgesic properties and is prescribed to manage chronic pain in many contexts. Like pain pills, buprenorphine binds to and stimulates opioid receptors, but it only stimulates the receptors partially (whereas pain pills and methadone stimulate them fully).
Depending on your pain and situation, your provider may recommend using your Suboxone dose itself to manage your pain. When it is used in this way, your clinician may direct you to split your regular dose into smaller pieces and take them more frequently throughout the day. For example, if your usual dose is one 8mg strip, they may tell you to divide it into four pieces and take 2mg at a time, four times a day.
Discontinuing Suboxone slowly to avoid withdrawal and start an opioid medication
Sometimes a provider may tell you to prepare for a medical procedure by stopping your Suboxone temporarily so that you can be given an opioid pain medication during and immediately after your operation. If this is the case, talk to your healthcare team about how and when you will restart your Suboxone once your acute pain is resolved. Having a plan in place will make this much less stressful! In most cases, you will be prescribed the opioid pain reliever for as short a time as possible.
The plan will guide you in how to best discontinue your Suboxone with the least discomfort. Dana Forman, N.P., says, “Many patients that are being treated for opioid dependence feel they need to put off having surgery because they are on Suboxone, but that is simply not the case! The surgery can be performed and acute pain can be adequately managed. At Workit, we generally ween the patient off of their Suboxone over a course of a few weeks, and then 3-4 days prior to the procedure, we take them off completely and start them on Norco or Percocet. We want the patient to restart Suboxone soon after their procedure, usually about 2-3 days post-op.”
Switching from Suboxone to methadone at a dose of 30-40 mg per day to avoid acute withdrawal
Methadone is another medication that is FDA-approved to treat opioid use disorder. It is sometimes prescribed for pain, so your provider my suggest switching you from Suboxone to methadone. This change in medication has to be carefully managed to avoid acute withdrawal, so follow your doctor’s instructions exactly and talk to them if you encounter any problems. If you go this route, be sure your doctor clarifies how you will receive the methadone doses, as this medication is highly regulated in many areas.
Regardless of which method you and your provider choose—non-opioid medications, alternative treatments that don’t include drugs, or a carefully managed plan that includes opioids—know that it is possible to manage acute pain while still taking Suboxone for opioid addiction.
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Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. Workit Health, Inc. and its affiliated professional entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.
You should look up the bio-availability of Nalaxone.. It is not that it’s a low dose, it’s that it cannot be absorbed subliminally or orally. It is only there to prevent it from being IV’ed.
Hi Andrew, thanks for the comment! I passed it along to the writer of this blog so he can clarify. We appreciate it.
Kali would I be able to take buprenorphin and oxycodone together I’m on 2mg of buprenorphine and am still in pain from a back injury. Could someone email me with any info as I can’t find nothing. I’m wondering if i should stay off buprenorphine while on oxycodone.
Hi Mr. D Green – Thanks so much for reaching out, and I would say "no!" Just because of the way Suboxone works, this could put you into precipitated withdrawal. But I’m not a medical provider, and so I can’t offer any medical advice. I would relay that you are still in pain to your Suboxone provider, and see what sort of solution they can offer you: either a non-narcotic pain medication, some sort of alternative therapy like physical therapy, or another medication solution. Sorry you are struggling but don’t be afraid to speak up about the discomfort you are still experiencing despite your current medications.
Buprenorphine does not help my pain. Neither does morphine unfortunately oxycodone is the only pain med that helps my pain, I have severe neck pain, n burning tingling painful feet n hands, I can’t hardly walk , I don’t know what to do and my pain is intolerable…
Hi Lorraine – We are so sorry to hear about your struggles with pain. This is one of the reasons categorizing all opioids as bad is a dangerous thing – we understand there are folks in severe chronic pain, such as yourself, who may need medication to help with chronic and intense pain. At Workit, we offer an online program to support those with chronic pain – it includes lessons on self-care and mindfulness, as well as advice on how to cope and pace yourself from day to day. You can learn more about it here: https://app.workithealth.com/signup
How long do people usually wait to start taking Suboxone if they’re taking pain pills?
My friend said she had to wait until she was in full withdrawal before she started the Suboxone. Like 24 hours without anything.
Is that true?
Hi Karin – This is true. Suboxone is best taken under the guidance of a medical expert, and you can often use something called a COWS score to determine when in withdrawal Suboxone should be taken. If you take it too soon after taking other opioids, it can result in precipitated withdrawal. Here is the COWS score, which helps you determine if you are in withdrawal or not: https://www.mdcalc.com/cows-score-opiate-withdrawal
After being clean for 1 year and 1/2 I started using again. I want to start taken suboxone but how long do I need to be opiate free? I used Naltrexone (100mg) after not using opiates but had a HORRIBLE! overdose because I took them not 7-14days after my last use. Will this happen with Suboxone ?
Hi James: It’s very important to take Suboxone under the care of a medical provider, who can guide you through when and how to start taking it. If you take Suboxone too early you may go into precipitated withdrawal. You can find a Suboxone provider near you by looking on the directory at Suboxone.com, or if you are in Michigan or California you can call us at Workit Health: 855-659-7734.
I have taken suboxone for 5 days now but my pain isnt going away. I took the last sub 24hrs ago…when can i take my oxycodone?
Hi Carrie, thanks so much for reading our blog. I’m sorry to hear that you are still in pain, despite taking Suboxone. I can’t really give you an answer to this question safely. The best thing to do would be call the doctor who prescribed you either the Suboxone or the Oxycodone and let them know you are still in pain and see what specific instructions they give you. Everyone’s unique situation is different and your medical provider will know the best plan for you. Hang in there and I hope that you feel better soon.
Hi,
Im from Canada and I am taking Suboxone. The way you explain on this page, is the best description I came accross. Especially the part about co-therapy. I wanted to say thank you. You have answered all my questions and more…
M.
Hi Melanie, Glad we could answer your questions, and thanks for reading!
I have surgery the day after tomorrow…its the second surgery in 2 weeks. On Oct 4 they operated on my left knee and the doc prescribed 40 norco 10/325 I believe….this did not cut it…So I take Suboxone… 8/2 three times daily…so my tolerance is pretty high and I knew the hydrocodone wasn’t gonna help the pain much but I didn’t say anything and I suffered for a week or so after the surgery… This time I took action and called the docs nurse and she understood my tolerance issue but didn’t know if the Dr. would….she said he only ever prescribes the Norco….what can I ask him to prescribe me that will help manage the pain effectively??
Hi Jason: If your surgeon isn’t familiar with managing pain while on buprenorphine treatment like Suboxone, we’d recommend contacting your Suboxone provider and asking them to coordinate a care plan with your surgeon.
Leaving msg because I can’t get a hold of my Dr. I just had the 2nd phase of a root canal this morning-painful. DMD prescribed me 5 Tylenol & codeine for today & tomorrow. I lowered my Suboxone from 8 to 4 mgs about a month ago. I took my latest dose at 1am, surgery at 10:30, so Suboxone has been in/out of my system for 13 hours. Is it safe to take 1 of the "fake" percosets, and how do I manage balancing the 2 meds over the next 2 days? Thank you!
Hi Dave: This is something you would absolutely need to check with your Suboxone provider and dentist about. Suboxone will stay in your system longer than other opioids, so it is crucial that you work with your care team to coordinate both of these medications or find a safe alternative that may be able to manage your pain while on Suboxone. if you aren’t able to get ahold of your Suboxone provider, give your dentist a call. They should be understanding of your situation and want you to have the best care possible.
Re. Below message – i forgot to mention that I also forgot to tell the dentist I was /am on Suboxone. Oops.
I was on 32mg of jurnista 3 a day for chronic pain but my dream refused to refill my script so now I’m on suboxen at 32mg once a day as taking it over 24hrs dosent help the pain I have issues with my back still I’m walking a mile a day I have more energy since I’ve come off jurnista but my back pain literally eats me I haven’t slept in a bed for a few years as it makes my back pain worse so I sleep on the couch I’m having difficulty getting across to my suboxen provider that.. yes I feel better in myself but my back pain just throbs I feel I’ve been put in the too hard too bad basket like you feel better now so put up shut up situation is there anything I can take other than panadol..ibufuron etc??
Hi Allison – Sorry to hear that you are still struggling with chronic pain. I would absolutely check with your doctor about other options for you in managing your pain. They may be able to recommend non-narcotic solutions for you, or adjust your medication to give you better pain relief.
Hi I took a 2 milligram soboxone yesterday at 9 30 pm only once is it safe to take and pain pills at 1 30 pm next day
Hi Stane: Thanks for reaching out. This would depend on what medication you were trying to take. I would talk to your Suboxone prescriber, they should be able to give you an answer and a medication plan that will work for you.
I took 12 mg of suboxone 2 days ago & 4mg of suboxone yesterday. Will my normal prescription of oxycodone work for my pain relief today?
Hi Shane: Suboxone has a longer half-life than a lot of other opioids, so we would recommend talking to your Suboxone prescriber about your situation and checking to see if you are safe to take your medication. The doctor who prescribed either med should be able to let you know what to do.
Hi! I want to thank you about the wonderful explanation of subutex as a cure of opiate Addiction!
May the best at all around of web and would like add EVEN a lot docs don’t know so well tricky right paths to follow.
Best Regards. M. Memishev
Thanks for reading!
Thank you for sharing this information. I resesrched some of your data that you shared and compared to my personal experience. It all makes sense and it is greatly appreciated. Thanks again and may you receive countless blessings for your knowledge my friend.
i have some question concerning suboxone and pain. i have cancer of the kneck i was on methadone for 14 years i went thru detox to get off of it, due to no doctors would write scripts for it but they would give me morphine oxycodone which did not work so i am stuck with pain falkedavidscott@gmail.com. please i live in ohio williams county i would like ro be back on it but do not know where to go i so not want to turn to streets.
I’m having back surgery Friday and today is Tuesday. I stopped taking suboxone one week ago. I have been on it for 13years. Approximately how long does it take to be able to feel relief from pain meds? The back doctor has me on 3-hydrocodone 5-325 a day. I’m extremely sick feeling and I cannot walk or get out of bed. I’m just wanting to know the average time table of when I can feel relief from the hydrocodone and to make sure that I don’t wake up from spinal surgery in severe pain.
Holy Moly Carol! Find a new Dr…? You’ve been on Sub for 13 years & your Dr gives you #3 Hydrocodone a Day…?!? Is he trying to kill you? I see it’s been a week since your post, I’m assuming you’ve had back surgery by now. I can only hope he’s gained a clue & is not putting you thru extra torture for no reason. Don’t be afraid to tell your Dr how your feeling & how frustrating this must be for you. Find the literature about recommended higher doses needed for people who have been on Buprenorphine. Well I hope your doing ok, I pray your not being tortured. Good Luck honey.
Holy Moly Carol! Find a new Dr…? You’ve been on Sub for 13 years & your Dr gives you #3 Hydrocodone a Day…?!? Is he trying to kill you? I see it’s been a week since your post, I’m assuming you’ve had back surgery by now. I can only hope he’s gained a clue & is not putting you thru extra torture for no reason. Don’t be afraid to tell your Dr how your feeling & how frustrating this must be for you. Find the literature about recommended higher doses needed for people who have been on Buprenorphine. Well I hope your doing ok, I pray your not being tortured. Good Luck honey.
I’ve got chronic pain from nerve damage, left over from cancer, in addition to that orthopedic pain from two different accidents. I’ve been taking Oxycontin and hydrocodone for the pain for years. Now with this so called "Opioid crisis" he’s taken me off those and put me on the buprenorphine. So what am I supposed to do for pain? The buprenorphine isn’t a pain reliever and I have a lot of pain, I would love not to take the meds, but I wake up screaming at night some times because of the pain. That’s with my current doses of medications.
Hi Chris! Suboxone does have some pain relief properties in it so instead of taking one 8 mg strip a day. I would cut the strip into 4 little pieces and take it 4 times a day. With the opioid epidemic we really need to work on using other techniques along with the pain meds. For example meditation and distraction. These do work if you let them. I do find that these don’t work if your in withdrawals. Just try different combinations a meds/distraction. That is the best (at least for me) to fight this war. You also need to be real with yourself too. Do you really have that much pain? Or do you like the “high” of the pain meds while you get the pain relief. I hope this helps a little bit.
Hey Chris, man I really feel for you. My husband deals with similar life long chronic pain & these ‘other/recreational’ folks have really destroyed the benefits of pain management. Not to mention the professionals that treat you like herion fiending, crack heads because they’re ignorant. That includes Doctors & Pharmacy Staff. What happened to knowledge & compassion? My husband is not an addict, he wishes he didn’t have to take opioids, but he has no other options at this point. So I feel your pain & frustration! On top of dealing with physical debilitating pain, that most people have no idea of, you also get to carry around guilt & shame. That suggestion to cut your Suboxone dose into tiny quarters gave me a chuckle, enough to want to post a comment… I feel for ya, the medical field has turned into a bunch of idiots ‘practicing’ medicine. Cause quality medical care has become an extreme rarity. Best wishes & Good Luck!!!
Chris, buorenorphine DEFINITELY DOES help with pain! I’ve been on & off very strong, potent pain killers most of my adult life, due to having Crohns disease since my teens; then physical pain which are residual & side-effects from living with Crohns all my adult life. I was finally put on subutex to get me off the strong opiods (fentanyl patches, etc), and once they adjusted my dose upward, i got plenty of pain relief!
Buorenorphine is a different TYPE of pain killer opiod; called an agonist/anti agonist. It still works on your brain’s pain receptors, just in a different manner.
Opioids like Fentanyl & dilaudid are opiod agonists.
In any event, as long as the dose is high enough, buorenorphine (subutex) or buorenorphine with the naloxone (suboxonne) work fine for pain. And believe ME, i KNOW, because i am in constant, severe pain. I’ve been lucky to have been graced with a very high pain tolerance. However, you will not get the “euphoria/“high” feeling, from buprenirphine, that you would get from a standard opiod. In fact, you get very LITTLE euphoric feeling. That’s the whole point of using it for addicts & opiod dependent people…
I wish you luck! It’s NOT easy! I wear a Butrans patch (which is buprenorphine in a patch), for 7 days at a time, and it works well enough to keep the severe edge of pain away & tolerable. I will ALWAYS be in severe pain, but as long as i can function..
Again, best of luck to you Chris!!
I have been on pan meds for 15 years went to pain clinic.Now she has cut me off my pain meds I started taking suboxone off the street I need a doctor to prescribe them I’m in constant pain from 3 back surgery I’m in Ohio where do I go?? Dont want to use heroin ever.
Hi Debra: I’m so sorry to hear of your struggle, and you aren’t alone, right now pain patients are really suffering due to the laws cracking down on opioids. If you have insurance, I would check in with your insurance provider about where they would recommend you receive treatment.
Hello and Wow!
How scary is all of this.
I am now 28 years of pain managememt and the last 2 years have been a tragedy of nothing prescribed except a bicept tear surgery. Then I was prescribed hydromorphone which was very helpful I successfully negotiated the surgery and the discontinuation of the Dilaudid. Now I am having to prove I have been made into an addict by doctors… Via visit to addiction doctor.. To rule out addiction and confirm pain management need. I’m going to try that route supposedly there is a saving grace where people lime me, who have been on more meds than anyone here posted, 6×30 mg oxycodone 6×60 mg morphine sulphate 2x100mcg Fentynal patches, 4x600mcg Fentynal lollipop and 4×10 mg valium day. Oh and Marinol 3x10mg at night
I took that forever!! Now nothing Ive bought peoples scripts who have ‘good doctor’s but that’s a waste of time amd leads to heroin. Oh yes it does…. Say it cant happen to you well if your really in pain you’ll drink elephant urine to relieve it… Now I am lost I ha r. Congestive Heart Failure and they want me to give a damn about taking care of myself so I can live longer.. Please as if life was that special. And Im a positive guy most of the time for most everyo e else.. We need togather our voices and make the posers that be playi g the powers that be and let them know we are dying slowly. This happened at the beginning of the 19th century too… Those poor bastards were left to their own devices.. If methadone is needed than let it be so….. the Subutex Suboxone route scares the hell out of me I’ve been on methadone before so I suppose it’s possible I’ll go on it again. I do think there is some promise and Gabapentin so I’m trying. Also I wish every person the best of luck and I hope your life gets improved.
Sarge
Firefightertartaglia@gmail.com
Hi, Ive been on suboxone for 6 or 7 yrs now(i quit heroin the day i started & haven’t done it since). I had orthopedic surgery just Thursday & was told to only stop my suboxone 24 hrs pre-op. I continuously expressed my concern for needing stronger meds due 2 the 12mg/day of suboxone i take & after they couldnt get an iv with 2 dr’s going at me for over an hr(even digging in my foot,ankle & shin-OUCH!) they finally gassed me out (had 6 more bruises when i woke up) when i woke up, i wasnt in the least bit woozy but in IMMENSE pain,crying & hyperventilating. They gave me two 5mg oxycodone(oral) & toradol. Said id had fentanyl in the back a while ago,finally gave me a whole 1/2mg dilaudid IV-nurse said 2 other nurse it was allowed evry 15 mins,when i said i was still in pain ‘oh we don’t want u too loopy’-I FELT COMPLETELY SOBER-NOT EVEN SLEEPY,i didn’t feel a thing-except pain. They were whispering 2 eachother & I was treated like a total drug seeking addict. Only given #20 of 5mg oxycodone (1-3/4hrs for 10 days) when i called for refill like they said, I was told to take ibuprofen(which could kill me cuz im on xarelto). Why are dr’s/nurses doing things like this?
Does anyone now if u can take an oxycodone after taking a subutex… if so how long should I wait … subs not really helping me with my pain. And yes I was getting oxycodone prescribe to me last month but dr told me i need to take this well it’s not helping me with my pain….I took my last oxy about 7 hours before taking the subs and I was fine but is it the same way around subs the oxy.. please help me someone I can’t find anything on the
Hi Jessica: No, you can’t take oxycodone while on Subutex, this isn’t safe as you risk putting yourself into precipitated withdrawal. I would recommend relaying to your clinicians (the subutex provider and the oxycodone provider) that your pain isn’t managed on subutex alone, and seek further pain management with medications that may be safe for you to use. Best of luck!