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Certain literature (available upon request) misinterprets previously published recommendations and makes the leap that methadone 30-40mg/day could be used in the acute surgery setting to replace buprenorphine. The methadone could stay around for quite some time (half-life of 10-60 hours)…just enough time to cause significant toxicity as the buprenorphine wears off.

Others say use hydromorphone by continuous IV infusion.

[AOT examples include morphine, oxycodone, hydrocodone, hydromorphone, fentanyl, and others.] One of the most misunderstood opioids among clinicians is buprenorphine, and even more especially when combined with naloxone in the branded form of Suboxone®.

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.

If the patient arrives on site in an emergency situation with an active prescription for any buprenorphine, the approach is a bit more challenging compared to elective surgery.