Does Suboxone Interact With Anesthesia?

Suboxone could interact with anesthesia, but it depends on the medication used for your anesthesia—anesthesia may include many different substances, such as sedatives, opioids, propofol, muscle relaxants, and local anesthetics like lidocaine.

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. 

Can you have surgery if you take Suboxone?

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 ‘general’ anesthesia, the kind that makes a person unconscious, every day.[1] It’s a safe and effective technique doctors use to keep you both still and comfortable during procedures. 

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 and naloxone. 

Buprenorphine and Anesthesia

Buprenorphine is a partial opioid agonist, meaning it weakly stimulates opioid receptors in the brain. It also displaces other opioids at the receptor site, which means opioids used for anesthesia may not work.

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]. 

Naloxone and Anesthesia

Naloxone is an opioid antagonist, meaning it blocks 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, relieving withdrawal symptoms and cravings. 

However, if opioids are used, the naloxone is activated and sends the person into precipitated withdrawal, meaning they’ll experience opioid withdrawal symptoms. This is why it’s important the anesthesiologist knows that you are on Suboxone—that way, they can choose the anesthesia components that will be most effective for you.

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] 

Suboxone Could Reduce the Effectiveness of Opioid Medications

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. 

Alternatives to Opioids

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. 

Discuss Your Pain Management Plan with Your Surgeon

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.

Suboxone & Surgery: What You Should Know

Suboxone is a medication to help treat opioid use disorder (OUD) as well as manage pain. It has analgesic properties and helps relieve pain to a certain degree. However, during and after surgery you may have increased pain control needs, and therefore it is very smart to talk to your surgeon and post-operative team ahead of any planned surgery so that you can discuss a plan for your pain management. 

Depending on your specific case, your doctor may decide to stop Suboxone temporarily or to continue it but give you additional pain medications after your procedure. 

During anesthesia, doctors typically provide high doses of opioids to produce unconsciousness. Suboxone could keep those therapies from working as they might in an opioid-naive patient. Therefore it is important to tell your doctor ahead of time that you are on Suboxone so that together, you can come up with a plan for your care both intra-operatively and post-operatively. 

Your doctor may recommend the following:

• Replacing: Swapping out Suboxone for another opioid could remove your cravings without blocking more drugs from latching.[1]
• Staying: Your risk of relapse is high if you stop Suboxone. To lower that risk, some doctors recommend that their patients keep taking doses as planned with no changes. They make a surgery plan with this situation in mind.[2]
• Tapering: Your team may decide that now is a good time to lower your Suboxone dose. A smaller amount could allow the anesthesia to move smoothly without increasing relapse risks. This requires careful management by your treatment team.

As you determine what to do with your Suboxone dose, your medical team can consider how to keep you comfortable on the operating table. They might do the following:[3]

• Increase: Your team might give you a very large amount of opioids that can overpower your Suboxone dose. 
• Alter: Your team could use local anesthetics to lower your pain and allow for smaller general anesthesia doses. 
• Monitor: Your team should also watch your breathing carefully, as large opioid doses can slow down your inhales and exhales. 

Every surgery is different, and medical teams often have complex flow charts and rules that help them decide what is best for their patients. Be as open and honest as you can during your surgery planning process so the team can work with you.

Emergency Surgeries: What You Should Know

If you require urgent surgery and you don’t have time to alter your Suboxone, it can be a tricky situation. 

Your team has three basic approaches, depending on the level of your anticipated postoperative pain:[4]

• Mild: They might continue your buprenorphine dose as usual. 
• Moderate: They might continue your Suboxone and add additional pain medications, even opioids, to your regular Suboxone.
• High: They might temporarily stop your Suboxone and start opioid medications with a plan to restart Suboxone promptly either at the end of your hospitalization or immediately upon leaving the hospital.

Make sure you advocate for yourself! Because Suboxone is a relatively new medication, a lot of surgeons may not be familiar with how best to manage pain in patients on Suboxone. They may incorrectly believe that because you are already on Suboxone, your pain should be controlled without additional medications. This is often not true. 

In addition, they may not feel comfortable prescribing you additional pain medications for fear that they will interact with your Suboxone. This is also a mistake – many pain medications can be given along with Suboxone without stopping the Suboxone, safely. 

Ask your Suboxone prescriber – either a primary care doctor, a pain management specialist, a psychiatrist, etc. – to contact your surgeon directly so they can advise the surgeon about how best to manage your pain needs for any upcoming surgery.

Frequently Asked Questions About Suboxone and Anesthesia