Fast Metabolism? (the metabolism of opiates in pain patients)

[Sara]

Has anyone ever had problems with having a too fast metabolism or bad absorbtion? When I first got insured, I was prescripbed percocets and after 2 months, I had really bad break through pain and went to the Urgent care. They ran a drug screen on me and they told me that I was negative for Opiates! I told them that there was no way because I had taken 2 pills about 2 hours prior. Regardless they refused to run a new test and the doctor I had at the time stopped prescribing me and refused to talk to me about it.
I know that I've always had trouble with medication not working very well; and I'm not sure if my body is not absorbing it or it gets rid of it too quick.
I research online and I found a multitude of people that had the same problem. Now, I'm kinda of scared and I'm not sure if this is something I should tell my current doctor or keep quiet. I mean, there has to be an explaination for it... I wish they could run some tests and see how long it takes before they don't show up on a UA. Here's my dilemna, it I tell him, they may not prescribe anything to me. If I don't tell them, and they start prescribing me opiates again they'll eventually do a UA and if its clean, I'm in the same boat as before...
Advise?

[KBear]

There are a few of us on here who have issues with anesthesia. I don't have problems with medication by mouth, or it may just be that I don't notice it as much. I have had problems with dental work, where they keep giving me shots, yet I will start feeling them doing the work. Eventually they will just tell me to 'tough it out'. I also have issues with being sedated. I am extremely hard to sedate and process medication quickly. When I had my first daughter my epidural lasted all of 30-45 minutes and was gone. I've had issues with not being sedated enough during procedures or them having to keep giving me more and more medication to knock me out. That said, I am randomly drug tested at my doctor's office and as far as I know, everything shows what it should. I don't know how long it takes Percocet to get into your urine after taking it or how long until it is out of your system, so no clue on that. As far as it becoming not as effective after 2 months, this is very normal as your body becomes tolerant to the medication and requires more for the same effect. This is why a good pain management doctor is a must, because they can switch up medications to help you from becoming tolerant too quickly.

[davemmevad]

Hi Sara,

Yes, I've got much the same problem. Opiates in particular do nothing to me, regardless of the means by which they are given (oral or injection), except of course, cause constipation .

Otherwise, for many years oral pain meds were completely ineffective for me, until we finally found out I had Celiac disease, and simply didn't have the ability to absorb enough of them. Now that that is under control stuff works better.

So yes, from my personal experience, malabsorbtion can cause them not to work.

Hope you find something that does work - pain sucks.

Cheers,
Dave

[Justin]

Sara,

Your post is a particular research interest of mine (the metabolism of opiates in pain patients). I will attach an interesting paper that I wrote on this very subject. I will be posting more on this very important topic (and personal interest) in near the future.

The document is entitled "Non-Responsive Pain Patients with CYP-2D6 Defect." I tried to write in layman's terms, so if anything doesn't make sense, feel free to ask.

I hope this helps.

[Dave]

Great paper Justin. So if one has this deficiency, what type of pain medication will work, or is there a medication that will aid in the absorption?

[Justin]

Great paper Justin. So if one has this deficiency, what type of pain medication will work, or is there a medication that will aid in the absorption?

I've spoken with many doctors about this. They always answer "just increase the dose."

Some medications that bypass the CYP2D6 metabolic pathway are morphine, meperidine, methadone and fentanyl. (Patients with abnormal CYP2D6 genes don't respond to normal dosages of the common opioids, codeine, hydrocodone, and oxycodone.)

I believe that even though the testing to determine if a patient has an altered expression of the CYP2D6 enzyme is not commonly covered by insurance* (*I am still looking into insurance coverage), that it might be worthwhile for a chronic pain / spine patient to undergo this testing. Please note that this is not medical advice.

My thought process is that if you have altered genetic expression of the CYP2D6 gene, that you should have this documented so that it is part of your permanent medical record. Thus, you won't be labeled as a drug seeker.

Here's an excerpt from the attached document:

The altered expression of the CYP2D6 enzyme should alert physicians to the possibility of a genetic defect in those patients that present as non-responders to the analgesic effects of commonly prescribed opioids. Instead of labeling these patients as “crazy” or drug seekers, it behooves physicians to investigate the possibility of a CYP2D6 deficiency to help select the appropriate medication(s) that are able to bypass the CYP2D6 metabolic pathway and provide pain relief to these patients.

I hope this helps.

[KBear]

Wow, very interesting Justin.

[nolonger_superman]

This is a quite interesting topic to me as I've mentioned more than a few times to my PCP (and now my neuro) that pain meds I've been given really have no effect on me and if they DO make a difference, it only lasts a short while.

Gonna give your paper a read now Justin. Thanks for sharing!!

[Cindylou]

Great paper Justin. Very interesting. So, how do they test for such a deficiency? Just curious. CL

[sandy]

Im new and found this very interesting, i am the same, the oral drugs did not work right, i had a stool test and i have malabsortion , i asked GI why he has no idea ran 3 celiac tests on me nothing said so why am i loosing weight , so he is gonna do a pill camera for small intestine to see what is going on, right now i have found alot allergys to medications they try to give me i break out right away, and others dont work, or others just cause problems with the heart raceing, nausea ,shaky ,nervous , break out in a sticky sweat which is all horrible for me,, i have not been on pain meds since november 2010, i just cry when the pain comes strong and scream alot, i thnk alot my pain the bulge and inflammation and i found i can not tolerate steroids pills shots or injections my blood sugar rise over 200s in an instant and causes so many bad side effects , i told doctor if you want me to keep doing this your gonna ruin my kidneys you had better give me insulin if you want me to continue on this for pain management they wont do that, so i get a new pain doctor said no steroids just block with Novocaine something , he gives me a facet c right side shot july1 2011 and july 3 2011, i call him my whole right side numd face and head also and pins needles could barley speak right and saying words backwards he said not the shot i said what did you give me, he said some antinflammatory not steroids, so now i have to see neurologist the doctor hospital said i may have had a tia attack, so in 48 hrs of shot i have a tia attack could the shot have done this pain doctor says no, i do not care just tell me the truth, i do not want another shot for pain in my spine and have another attack, why are these doctors so clueless and they can only think or maybe, all i know is my metabolism is not handling oral drugs injected drugs of any kind , all i want is pain reduction but if medications arent working right or cause worse problems what do you do, you talk with your doctors about what effects you have and they are not working and they look at you like your nuts.