Do patients with substance use disorder need additional analgesic management when prescribed buprenorphine or methadone for opioid use disorder during surgical procedures?

Patients with substance use disorder who are prescribed buprenorphine or methadone for opioid use disorder may not require additional analgesic management solely due to their medication. Buprenorphine, being a partial agonist, has a ceiling effect, which limits its opioid effects in terms of euphoria and respiratory depression, making it less likely for those patients to require higher doses of analgesics.

Additionally, patients on methadone can achieve stable plasma levels that may provide effective pain control, especially since methadone has a long half-life. When managing postoperative pain in patients on these medications, it is important to assess their individual needs and consider factors such as tolerance and the type of surgery performed.

In many cases, standard analgesics can be effective without needing to significantly alter pain management strategies, as buprenorphine and methadone themselves may provide some degree of analgesia. Thus, it is not automatically necessary to provide additional analgesics solely based on their use of buprenorphine or methadone. This understanding informs how surgical teams approach pain management in patients undergoing procedures while receiving MAT.