I am on maintenance with buprenorphine and I can say that Drs don't know a shit about treating acute pain in ORT patients.
I was few months ago in a legit need of pain management because of my back which is mainly a mess after getting hit by a roadside IED while in Afghanistan as a peacekeeper.
I woke up one morning unable to get my socks on and getting out of the bed hurt like a hell. Then I call my clinic what to do and they told me to get asap into to health center where I went and the Dr sent me to university hospital to a adult psychiatry ward (wtf I thought at that point). Nevertheless when I went to that university hospitals acute care with the paper that my doc gave me the nurses were just like "Oh another junkie comes to seek pills" and let me wait for some hours before I finally got pissed and went to the nurse's office and asked what the hell takes so long.
They answered that they have waited three hours someone from adult psychiatric ward to do somethhing and they finally just transfered me into acute care waiting list and doc come to see me in 20minutes. He reacted a lot differently and did all the necessary tests like raising my leg when I was on my back and even put a finger in my anus to check if that muscle contracts so there isn't marks from some very serious nerve compression.
So I got into acute ward where I could hear the doctors arguing what the hell give to me for pain management and I heard that they were going to give me Oxanest (IV oxycodone) and I knew that buprenorphine would block it and wouldn't do a shit. I took off from the bed I was laying and struggled to walk towards the doctors and told me about that and I got just eye rolling and although I know a lot about pharmacology than average joe And could tell them why it wouldn't work with the language they use and I basically were shut down by disagreeing with doc as he said he knows better than some addict.
Well they started to inject 15mg at a time at first and then 30mg while checking my BP and pulse which were high and racing due the pain and there was no change at all and neither was in my pain levels. Then they finally asked me that what do I think would work. O just answered fentanyl or ketamine and got another "There that druggie tries to get the good stuff" look but they decided to consult some specialist who treats addicts at psych ward. I overheard the conversation and it was like "What the hell, you injected IM 160mg of oxycodone to a ORT patient using Suboxone, of course it doesn't work. Start giving ketamine slowly and and administer fentanyl until ketamine starts to relief pain.".
The doctor put a canyl into me and started ketamine infusion and gave some fentanyl which helped a little and the he gave another shot after few mins and I got quite good pain relief but not enough. Took BP and pulse and it showed some improvements and they gave me a bigger shot of fentanyl and finally my pain was gone nearly totally. The doctor gave me an apology and told me that this kind of things happens so rarely so he doesn't have enough knowledge or experience about it.
Then the ketamine started to help and I was totally painless.
I was sorted out to chirurgic ward to wait for MRI pictures to which I went soon and I spent the night receiving ketamine all the time and small amounts of fentanyl for breakthrough pain. When I came back from MRI I asked the guy strollying me around in a hospital bed that I needed something from the snack automat near that nurse's office and bought some snacks and that nurse came out of her office and I just started to give him a lesson how she should treat patients and she was totally red in shame or anger and told me to think about changing her attitude.
On a chirurgical ward every nurse attending me was very dedicated to their jobs and treated me in a same way as the three other patients in the room and even made me some evening snack although it was officially already served and kept asking me for a while how I feel.
Now luckily these all things are in hospital documents so I can refer to those if something like that happens again.
When I got back home finally after spending weekend plus two days in a hospital and my pain was somewhat stabilized my clinics nurse was already organized my pain management which involved some nsaids and acetaminophen, tizanidin for muscle cramps and stiffening and they had decided to up my buprenorphine dose by 40% for two weeks max as well as (free or should I say tax payed) physiotherapy times for me.
Wasn't a nice trip but worth it after all those some minor problems on their side. And I understood that pain management for drug addicts are done at psychic ward as they know about how to deal with pain in addicts. What I miss though was having to use catetry for peeing as those nerves allowing me to pee were just compressed enough that I couldn't get my bladder empty and it took twenty minutes to get peeing started and it left me unable to cum for several weeks (not a big deal at all for my gf and now my current fiancee).
Thank god I am talking to a group of people in rehab center either starting ORT or doing detox about what ORT actually is from a view from patient and can tell what to do if acute pain becomes their problem too. I am somewhat nervous about giving that speech as it is my first time talking about my drug abuse and how I got my life quality improved after starting ORT but I am going to keep in topic there. Also some students come there too and some of them are my fiancees friends and they might get shocked that I am recovering drug addict but wo cares about that
I am fine talking about my situation and don't feel remorse as I happen tu relate on.
