I am getting a first rib resection, scalenectomy, and pec minor tenotomy in about 2 weeks. I am a recovering heroin addict, and have been using opioids for about 3 years. I have been prescribed oxycodone 80mg every 4 hours, dilaudid 8mg every 2 hours, fentanyl 100mcg patch, morphine 100mg every 4 hours, and so on. Eventually, my doc stopped prescribing me opiates because of a crackdown on opioid prescription in california. I looked for other doctors, but it became so expensive that I eventually started using heroin. While heroin contains many impurities, it is diacetylmorphine - essentially a stronger version of morphine or oxycodone. I know there is a lot of taboo regarding heroin, so I don't want any judgment here. I have been through rehab, and have been almost completely clean for about 6 months.
I am worried that my doctor will not prescribe me a high enough dosage for me to even feel the medication. I plan to tell him about my extremely high tolerance, but I'm concerned that there is some kind of policy that prevents him from giving me a certain dose. This is Dr. Jeffrey Ballard, at St. Joseph's Hospital in Orange County, CA. I am really not exaggerating when I say "extremely high tolerance." At one point, the best prescription I could get was thirty 5mg vicodin pills. I took all of them, 150mg, and did not feel a thing. Hydrocodone and codeine simply do not affect me. Tramadol is even weaker. I was prescribed other drugs on top of the opioids, but they did nothing. Basically, the minimum dose that will be even noticeable for reducing my pain is 80mg of oxycodone orally, or 12mg of dilaudid IV. The amount of diacetylmorphine and morphine I was consuming would probably be enough to kill a few normal people, but it barely made a dent in my pain. I am on suboxone 8mg/day now, which does virtually nothing to my pain.
Basically, I'm concerned that whatever they prescribe me won't be enough, and I will have to go back to heroin or suffer excruciating pain for months. I have a very, very low pain tolerance, as my opioid receptors are so tolerant to my own natural endorphins. The slightest pain makes me cringe, so having muscles and a rib removed sounds horrifying to me. If I can't get a dose prescribed to me that has any effect, I don't know if I will do this surgery at all, honestly... What has me really terrified is the pre-operation medication. If I understand correctly, they give me anesthetic and dilaudid right before the surgery, so that I don't wake up or experience the pain during the surgery. The normal person would probably be fine with 2-3mg of dilaudid, but I used to use up to 36mg of dilaudid IV, and the last time I used any pain medication, my tolerance did not go down at all (since I am still on suboxone). If I tell them beforehand that I have a high tolerance, and they give me only 5mg, thinking that it's just slightly higher than normal, will I wake up during the procedure, or experience the pain of having my RIB removed? I hope this doesn't come off as overly dramatic, but it is very terrifying for me. Will they test out my tolerance beforehand, so they can see just how extreme my tolerance to pain meds actually is? And after the surgery, what regulations are in place that might prevent me from getting medication that will actually affect my pain levels? Will they do some type of analysis, to ensure that I don't spend the next couple months without any kind of pain management? I feel like they might really need to see it to believe it, but I was a hardcore heroin user, and I worry that if I bring that up, they might refuse to give me any pain meds altogether, out of concern that I might get addicted.

Thanks for your time, I appreciate any input,
Shane H.