Dea post dating prescriptions
And finally, it is a bad idea to continually dose the ambulatory surgery patient with pure opioids per standard surgical orders immediately post-op if they were on buprenorphine, because pure opioids will not make it to the mu-1 receptors.
Upon hospital discharge, AOT may finally get to the receptors when the patient is home and unsuspecting.
Or, I have seen scenarios where the patient is sent home with oxycodone, hydrocodone, morphine, or others, and told to resume their buprenorphine…and the patient wonders why their pain isn’t controlled.
That is a simple answer; the buprenorphine is blocking the pure opioid agonists from getting to the mu-1 receptors as I clarified earlier.
Essentially, this is what’s happening when you perform surgery on a buprenorphine (Suboxone®) patient, but with some inherent analgesia activity from the buprenorphine.
If a patient has a scheduled or elective surgery with an active prescription for any buprenorphine product, the approach is not too difficult, but it requires an understanding of pharmacology, rational polypharmacy, but most importantly, common sense.
Here’s the figure from Jones’ writing with italicized dialogue from his article.