Does Suboxone Interact With Anesthesia?

Suboxone could interact with anesthesia, but it depends on the medication used for your anesthesia.

Suboxone contains buprenorphine and naloxone, which could block traditional anesthesia medication from working effectively. This may mean that you need additional and/or different pain medications during or after a procedure. 

A specialist could help you understand your options. Some people stay on Suboxone both before, during, and after the surgery. Others taper off Suboxone temporarily when they are undergoing a planned procedure or surgery. 

What Is Anesthesia?

Anesthesia is a general term for medications used to prevent pain during surgery or other medical procedures. Anesthetics are administered by licensed professionals, such as anesthesiologists, nurse anesthetists, dentists, or other health care providers.

Anesthetics are available in various dosage forms, such as these:

• Intravenous injections
• Topical lotions
• Patches
• Sprays 
• Inhalation

Depending on the clinical need, they can be used in both minor and major medical procedures.

About 60,000 people have surgery under anesthesia every day.[1] It’s a safe and effective technique doctors use to keep you both still and comfortable while they work on your body. But if you’re taking Suboxone, you may require different medications to help control your pain both intra-operatively or post-operatively. 

How Does Anesthesia Interact With Suboxone? 

Suboxone contains two ingredients that could potentially interact with anesthesia medications. 

Buprenorphine is a partial opioid agonist, meaning it weakly stimulates opioid receptors in the brain. Naloxone is a full opioid agonist, meaning it blocks other opioids from binding to opioid receptors in the brain. When taken sublingually as prescribed, Naloxone is not absorbed, and the body is only absorbing Buprenorphine. 

Because Buprenorphine is an opioid, it does act as a pain medication and provides some degree of pain relief. However, because it is only a “partial” opioid agonist, it may not provide enough anesthesia to control pain post operatively. Therefore, patients on Suboxone may need additional medications, even additional opioids, after surgery, in order to control their pain [2]. 

What Are the Risks of Taking Suboxone With Anesthesia?

Historically, we didn’t know if it was safe to take Suboxone along with other anesthetics, specifically other opioids. As a result, doctors would often stop a patient’s Suboxone prior to surgery. While this was well-intentioned, it often resulted in people who had been stable in their recovery on Suboxone developing cravings and even potentially returning to opioid use. 

These, days, we believe that most people can take Suboxone both before and after their surgery without stopping or interrupting their dose, which prevents the risk of cravings, withdrawal, and relapse. [2] 

It is also important to bear in mind that the use of Suboxone can decrease how effective opioid medications are, possibly causing inadequate pain control. This means that patients on Suboxone may require even higher doses of opioids while still on their suboxone than a comparable patient. 

Conversely, if you are on Suboxone and have an addiction history, you may decide that you want to minimize or avoid additional opioid medications altogether, in order to prevent temptation or risk of relapse. These patients may prefer to use only non-opioid medications – of which there are many! – for additional pain control after surgery. This is also a reasonable approach. 

If you are taking Suboxone and need elective surgery, you should discuss your pain management plan with your surgeon and Medication for Addiction Treatment (MAT) provider before the surgery. Make sure you express to them your desires around what medications you feel comfortable taking for pain control, and discuss a plan about whether to continue your Suboxone during the procedure or to hold it temporarily and restart it once the procedure is over. There is no right or wrong decision – only the decision that works best for you and your specific preferences. 

If your surgeon thinks it’s best to stop Suboxone, you should work with a specialist on a tapering plan.[3] Never stop taking your medication without talking to a doctor first. 

If you have a planned surgery or event for which you know you will need anesthesia or pain management, make sure you plan ahead by discussing with both your surgeon and your Suboxone prescriber. Be open and honest with your surgical team about your medications, your addiction history, and your personal desires about how to best manage your pain during the postoperative period.

Sources

1. Waking Up to Anesthesia. National Institutes of Health. https://newsinhealth.nih.gov/2011/04/waking-up-anesthesia. April 2011. Accessed November 2022.
2. Perioperative Management of a Patient Taking Suboxone at the Time of Surgery. Case Reports in Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085354/. March 2020. Accessed November 2022. 
3. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. https://pubs.asahq.org/anesthesiology/article/126/6/1180/18722/To-Stop-or-Not-That-Is-the-QuestionAcute-Pain. June 2017. Accessed November 2022.