Hey Jason, The only thing that makes sense is that when using twilight sedation, they found your tolerance to be higher than normal, they likely increased your dose of opiates, Opiates alone will not cause someone presently dependnent on opiates to experience withdrawal or someone that is not presently physically dependent to go into withdrawal.
What likely happened, is that because it was minor surgery, and they likely used extra opiates on an already opiate dependent CP patient, they reversed your anesthesia with an opiate antagonist which would cause any opiate dependent to experience imediete withdrawal upon wakening. Ask your doc friend about that scenario and get a copy of the op report.
Opiate antagonists "Naltrexone" are not used in anesthesia other than for reversal of anesthesia, usually to speed you out of recovery and off to a room or home. If you know your physically dependent, you have to tell them your dependnet and tell them not to reverse anesthesia. You must awake naturally. The only drug that would send an opiate dependent patient into instant withdrawal is an opiate antagonist like naltrexone, brand name Narcan used for opiate overdoses.
Many of of us have had twilight sedation while being dependent on meth, morphine, fentanyl or oxy, It's the nature of the beast. Is your pain worth the trade? If not, your options are pretty limited as far as pain relief for severe pain.
Opiates are considered opiate receptor agonists, they bind to opiate receptors and give pain relief. Opiate antagonists block and purge opiate receptors causing wthdrawal in opiate dependent patients in high enough doses. If you were slow to come around, a little narcan would wake you right up with NO pain meds on board. Not a good way to wake.
Some meds like Talwyn have a very small amount of antagonsit placed in them, now called Talwyn NX to prevent IV users from injecting this drug. Talwyn and speed were a popular combo in the 70"s. Adding the opiate antagonist Naltrexone prevents the buzz if you crush and inject it.
Talwyn NX does have pain relieving properties that aren't blocked by the naltrexone when taken properly, "orally" the amount is too small when consumed orally, But it does have enough Naltrexone to activate if crushed and injected.
Opiate dependent patients can be sent into withdrawal when given combination opiate agonist/antagonist pain meds like Stadol, Buprenex, Nubain or Talwyn NX.
Physical dependnence is less likely with The combination drugs but are not as strong and dependence or adiction is still possible. Psychological addiction or physical dependence is possible with any of these meds used to treat pain, Including Ultram.
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