Opioids and drug metabolism...

Interesting bit about how our bodies metabolize some opioids,
and why some of us get such annoying s/e.

http://www.dr-bob.org/babble/20040407/msgs/334194.html
Something about
It sounds possible to me that you could be a poor CYPIID6 metabolizer
Codeine, hydrocodone, oxycodone, and tramadol are "activated" via this enzyme system by transformation into their respective prodrugs: morphine, hydromorphone (Dilaudid), oxymorphone (Nubain), and o-desmethyltramadol.

And maybe this is why some people respond better to a certain kind of painkillers considered weaker
than other stronger but of particular opioid group?

Risa

I've wondered that issue and have asked many times at Rondas. Cause I don't get me

Vicoprofen does better for me than the stronger Norco. It does better for me than Dilaudid and oxycontin. Not just in making me feel better, but if I take it on an empty stomach vicoporfen is the only one that gives me any semblance of a "woo hoo" feeling. I take dilaudid and oxy and wonder why in the world any one would become addicted to it. The Vicoprofen? I understand!

I have a slightly hard time following/understanding the science part of it. I take twice-daily oxycontin, and I get absolutely zero buzz off of it. Nada. Does it help the pain? Slightly. In the past I have taken fioricet. That was a whole different story. That did give me a buzz, and I liked it. Bad stuff. Safer for me to take the oxycontin and toss back a few tylenol or excedrin for breakthrough pain.

Ive no idea why anyone would get addicted to it either. The oxy takes the edge off the pain, no way is there any kind of high.

I had to have an upper GI. Actually I had two of them, the first I was in no pain, but wide awake watching it on the tv monitor. They had to give me, dilaudid I think, several times. Whenever I felt uncomfortable really. Many years later I had to have it again. This time they doped my on demerol, a whole lot of it! It did nothing, and I felt the whole procedure, and it was painful!

The DR asked if I wanted to stop about half way through. ???? I said not to. Why go through all that prep again? They wanted to re-do it while I was out in twilight. I figured we might as well continue! As soon as it was over I passed out from the pain. I woke up only about ten minutes later, and the DR came in. She said that my liver enzymes don't do whatever with demerol that they are supposed to and therefore it doesn't work for me. DUH YOU THINK????

When I had my c-section, they gave me morphine for the pain. I repeatedly asked for Nubain, which I know helps me, but the nurses talked me out of it. I pushed the morphine pump 83 times in one hour! I finally told them to just take the IV out. I kick myself now for not demanding the Nubain!

It is very strange what helps some folks and doesn't do anything for others! I also have a theory that sometimes it is the mode not always the method. Meaning that some drugs given IV or injection might work instead of the pill, and so on. Just in my experiences.

They gave me Demerol for childbirth also. All it did was put me to sleep in between contractions, then I'd be wide awke during the contacting. What is the point of that?.

Lynelle and MG, I'm the same way with the oxycontin. Can't tell if I've taken it or not. So I don't get the addiction part on it. Maybe if it's shot up?

But I also have vicoprofen. My neuro (also a certified pain manager) said that most Drs err by only giving the oxy., that a extended relief (the oxy) should always be used in conjunction with short acting (vicoprofen, dilaudid, etc).

With my back and head, I take more narcotics than I like. But the Oxy keeps me from going through mini withdrawal through out the day from the short acting ones. I dont watch the clock anymore to see if it's time for my short acting. In fact I sometimes work right through the dose if my back is doing pretty good. So, even though I dont feel it, I guess the oxy is working.

I used to take the Oxycontin twice daily. I asked my DR about the buzz, or lack there of, because I couldn't understand why people became addicted to it either. She said that since I was taking it for the right reasons (being in pain all the time) I probably wouldn't notice the 'buzz'. She said that when you take it and don't really need it is when you 'feel great' and enjoy that feeling so much you become addicted to the feeling itself. Just thought I would add that.

The research I did before I went the pain management route backs that up, Steph. It said that the addiction rate for PROPER pain management is very low. The goal of my Dr. is to keep my pain level at a 2/3, rather than a 7/8. In other words to make life tolerable. If you try for the 0 pain level, then you're walking a very thin line to the euphoria and addiction.

I feel I already walk the line, because there are some days where I silently scream "If I could just have ONE DAY with no pain, just ONE!" And I have a purse full of pills. But, its not worth being short at the end of the month because I will go through physical withdrawal (so many folks don't understand that difference either, between addiction and physical dependence...my neuro said its sad how many in the medical profession don't get it either).

But, I have fewer and fewer of those days since I started on cymbalta, a anti-depressant and am sleeping better at night. It's easier not to get as frustrated.

I never ever get a buzz from my pain pills, either.

And the lack of understanding on the addiction issues, is sometimes a suffocatingly infuriating.
I have a friend who doesn't understand a difference between the short acting oxycodone and slow release oxycontin,
yet after seeing the news about a young man getting addicted to the latter, taken crushed, and dying of it,
she lectured me on me taking the first. argh.

Risa

Yes the oxycodone and oxycontin are different. A lot of the drug abuse is from the later.
I usually feel better after about 15-20 minutes of taking the oxycodone. And I've stayed with a
Low dose. All I want to do is be functional.