Can You Take Morphine While on Suboxone?

Sometimes patients who are on Suboxone may need additional pain control, after an acute surgery or accident. In these circumstances, morphine (or other opioids) can be taken while on Suboxone for additional pain control, but there are special considerations to follow.

The Hesitation to Prescribe Morphine & Other Painkillers With Suboxone

Suboxone is an effective medication used in Medication for Addiction Treatment (MAT) for the treatment of opioid use disorder (OUD). It contains the partial opioid agonist buprenorphine as well as the opioid antagonist naloxone. Buprenorphine helps to prevent cravings for opioids, but can also serve as a pain medication, particularly in patients who have both chronic pain as well as an opioid use disorder. 

Initially, doctors were hesitant to prescribe full opioid agonists such as morphine to patients on Suboxone due to the potential for breathing issues and respiratory depression.[1] However, now that Suboxone has been readily available for many years, we understand more about its safety. In fact, Suboxone binds preferentially to opioid receptors in the brain over full opioid agonists, so it can actually be protective against respiratory depression and overdose if a patient takes opioids in addition to Suboxone.

How to Safely Take Morphine & Suboxone Together

If you take full opioid agonists like morphine and then subsequently take Suboxone, this can cause precipitated withdrawal. However, if you continue to take your Suboxone dose regularly and then subsequently take a full agonist like morphine, this should NOT cause withdrawal and should actually be a safe and effective way to give you pain relief. 

This pharmacology can be a little confusing both for patients and even for doctors who do not frequently prescribe Suboxone. 

Make sure you talk openly with your doctor, so you are on the same page about your Suboxone and how to dose it along with other pain medications postoperatively. This will allow you to control your pain and still help you maintain your abstinence from opioid misuse.

Is It Safe to Use Morphine in Surgeries While on Suboxone?

Yes, it is safe but only under medical supervision. There are differing reports on using morphine to control postoperative pain in people taking Suboxone. 

In some cases, people taking Suboxone (who are therefore opioid tolerant) may have more postsurgical pain than those who are opioid naïve. This means that patients on Suboxone may need additional pain control after surgery with full opioids. [2] 

Buprenorphine binds tightly to opioid receptors in the brain, which can keep other full opioid agonists like morphine from having analgesic (pain-relieving) effects. 

Providers will often want patients to discontinue use of Suboxone and allow it to process fully out of the body before surgery and the use of morphine. This can be an issue, leading to withdrawal symptoms and the potential for a relapse. 

Instead, more research shows that it is actually safe to continue a patient’s regular Suboxone dose and simply add additional opioids for acute pain control.[3] 

Here are several options for how to manage post surgical pain in patients on Suboxone: [4]

• You may be able to continue your Suboxone and add additional pain medications, including opioids, for pain control as needed. 
• If you do not want to take opioids, you may be able to simply temporarily increase your dose of buprenorphine after your surgery. This alone may provide enough temporary pain relief. 
• For surgery with severe pain, buprenorphine can be temporarily discontinued and replaced with carefully adjusted high-dose, short-acting opioids. Opioids can then be stopped and Suboxone can be re-started when pain is improved.

Are There Alternative Options to Morphine or Opioids for Acute Pain?

Yes, there are many alternative options for acute pain, particularly for patients who are in recovery from opioid use and may not want to use opioids even temporarily for pain control.

Some individuals with a history of opioid misuse on Suboxone may adamantly want to avoid being exposed to opioids, as it may trigger relapse to opioid misuse.

If this is the case for you, there are MANY non-opioid pain medications that you can take in addition to your Suboxone, including:

• Nonsteroidal and anti-inflammatory medications
• NMDA receptor antagonists
• Gabapentinoids
• Alpha-2 agonists
• Muscle relaxers 

It is also beneficial to take a multidisciplinary approach that helps to control stress related to pain. There are other therapies such as meditation, acupuncture, topical creams and patches, etc. All of these can be added to your plan to help control your pain. 

What Should You Tell Your Surgeon if You Are on Suboxone

Some surgeons may or may not feel comfortable managing Suboxone and acute pain at the same time. If you are on Suboxone and expecting a surgery or any other reason for acute pain, it is very important to discuss your options for pain control openly with your surgeon and/or your Suboxone prescriber. 

If your surgeon is unsure of how to dose your Suboxone postoperatively, have them reach out to your Suboxone prescriber directly. Suboxone prescribers often have more experience with pain management and may be able to advise your surgeon on how best to control your pain while still maintaining your Suboxone for OUD. 

If you are expecting a procedure or any other reason for acute pain, the more planning you do with your doctors ahead of time, the better you and your team can be prepared to continue therapy for OUD while also adequately managing your pain.