Suboxone and post op surgery

[Sunshine98]

Had a phone call over the weekend in which a patient we fill Suboxone for said no one would fill his/her prescription for post op pain cause we filled the Suboxone. Ive never encounted a patient with post op pain meds while on Suboxone, but has anyone here? I don't know what was prescribed as I told the patient I would have to contact both dr's (to make sure each is aware of what is going on etc). Thoughts?

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[Old Timer]

Had a phone call over the weekend in which a patient we fill Suboxone for said no one would fill his/her prescription for post op pain cause we filled the Suboxone. Ive never encounted a patient with post op pain meds while on Suboxone, but has anyone here? I don't know what was prescribed as I told the patient I would have to contact both dr's (to make sure each is aware of what is going on etc). Thoughts?

Both doctors need to be made aware.

 

[BidingMyTime]

This isn't that uncommon, the surgeon should have wrote something on the script to indicate he knew about the suboxone and that pt was post-op.

Of course, it is suspicious that the patient apparently went to several other pharmacies, before calling the pharmacy that filled his suboxone, why didn't he take his post-op script to the pharmacy that he gets his suboxone filled at?

 

[MyRealNameIs]

This isn't that uncommon, the surgeon should have wrote something on the script to indicate he knew about the suboxone and that pt was post-op.

Of course, it is suspicious that the patient apparently went to several other pharmacies, before calling the pharmacy that filled his suboxone, why didn't he take his post-op script to the pharmacy that he gets his suboxone filled at?

Sometimes pts get their surgery far away from home for the best doctor and stay at the family/relative's house. The usual pharmacy they go to may be too far away. But then again, who knows.

 

[BidingMyTime]

Sometimes pts get their surgery far away from home for the best doctor and stay at the family/relative's house. The usual pharmacy they go to may be too far away. But then again, who knows.

Good point, that is a possibility.

 

[NateRobinson]

This isn't something unusual. Both doctors need to be aware, and the person taking suboxone needs to be off it for a week in order to reset tolerance and get all the Bupe out of his system.

The problem is, can the patient be off bupe for a week? Is that too much time without an opiate? Also, if you can go one week without Bupe, then you don't need Suboxone anymore. Opiate withdrawal lasts 5-7 days. It's a tricky situation to say the least.

 

[Sunshine98]

Agree on the tricky.

Patient still hasn't brought in prescription. Dr that did the surgery knows patient was on suboxone. So I called the Dr who prescribed Suboxone to let them know what is going on...and what they would want the patient to do reguarding the suboxone so she could take the Percocet.

Rep for the Dr (who prescribed the suboxone) said he would not prescribe the patient suboxone any more (if she takes the Percocet). Said the other Dr (surgery dr) would be held liable. Would NOT offer me any time frame/table for the patient to be off suboxone etc.

I have no idea if patient has even stopped the Suboxone.

And since it has now been over a week....I would think maybe she could get something else prescribed (cause I told her to come in Monday).

 

[SClENCE]

I guess it depends on the situation but if she walked in a week after surgery with a script for a 3 day supply of Percocet while seeing a sub doc I would not fill it.

 

[BidingMyTime]

Rep for the Dr (who prescribed the suboxone) said he would not prescribe the patient suboxone any more (if she takes the Percocet). Said the other Dr (surgery dr) would be held liable. Would NOT offer me any time frame/table for the patient to be off suboxone etc.

That is pretty harsh, what does he think the surgery dr would be held liable for....treating a patient's post-op pain? People with addiction histories do run into situations where they have a genuine need for pain management, a doctor authorized to prescribe suboxone should know that and be willing to work with the pt to minimize the risk of a relapse, not just say they're on their own.