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Because naloxone can block heroin and other opioids from stimulating the receptors while not itself stimulating them, it can precipitate opioid withdrawal and is classified as an opioid receptor “antagonist.” The buprenorphine/naloxone mixture in Suboxone is touted to reduce the possibility of illicit use by injection if an attempt is made to abuse the Suboxone by a parenteral route, presumably because “naloxone antagonizes the opioid effect”. Repeat after me…at normal therapeutic doses, naloxone will never see that mu receptor because buprenorphine has a higher binding affinity, a longer half-life, and therefore naloxone is not capable of reversing it.
In fact, to the contrary, it’s more believable that buprenorphine could reverse naloxone.
Also, tell us if you’ve seen disasters because of the issues outlined above.
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For patients, we sure would be interested to learn of your surgical experiences.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.I encourage clinicians to engage ii studies to validate a stepwise approach to treating surgical patients that have active prescriptions for buprenorphine.
For now however, the bottom line is…USE COMMON SENSE!
Essentially, this is what’s happening when you perform surgery on a buprenorphine (Suboxone®) patient, but with some inherent analgesia activity from the buprenorphine.