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Opioids Genetic testing for pain management drugs

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
Hey guys, I'm new to BL and wanted to ask some questions about some metabolic mutations I found out I had most notably at CYP2D6. So, I've been in pain management for 4 months now and I started out on Oxycontin 20mg q12. Which I started to realize after a couple of days that the drug lost it's effect within 4 or 5 hours leaving me feeling rough. So, my physician threw in some ir oxys to fill the gaps. This helped for a week and the ir's started to wear off rapidly too. Finally, I requested my doctor run GeneSight testing on me. It came back to show I was a poor metabolizer at CYP2D6 and an intermediate at CYP3A4 which seems to explain the quick duration of the oxy. Anyway, I'm still on 40mg Oxycontin q12 with 20mg of ir oxy q8 and it doesn't last. I take the 40mg OC around 8am with a 20mg ir and around noon I experience a rapid drop off of analgesia and have moderate but uncomfortable withdrawal symptoms. Then I take another ir which is gone in an hour and a half and so on. I try to stretch it out as long as possible so I can take the 2nd OC around 6 or 7pm. Sucks. Especially when you're trying to do shit throughout your day. I could switch to a morphine product but it'll take a fairly high dose of morphine to equal my current dose of oxy. I recently came up with the idea of staying on the OC 40mg but implementing 10mg oxymorphone ir in place of the 20mg oxycodone ir. The oxymorphone doesn't have any CYP activity and the ir form claims to have a 6-7 hour half life. The problem is it's absorbed orally like 10% right? I'm wondering if you guys have any suggestions or have any significant experience with oxymorphone ir orally. I'm worried because of the poor oral BA that the oxymorphone won't be very effective at 10mg probably 3x daily. Would I need a higher dose of oxymorphone to make up for the poor BA? Plus, my insurance doesn't cover Opana ER and I'm not sure the ER form is even available anymore? Any suggestions would be great. Thanks
 

LucidSDreamr

Bluelighter
Joined
May 23, 2013
Messages
5,248
Location
Silicodone Valley
Oxymorphone intranasal is 43% vs 10% oral. Theres your amswer. You will basically be quadrupling your script. Iv is not worth the risks even though it is 100%.

Dissolving in water and applying via afrin nasal sprayer will maximize absorption. Adding a very small amount of ethanol will also help the solution maximize absorption but don't add so much that it burns. Store in fridge so that oxy doesn't decompose in solution.

Sad that it's come to abusing our meds amd using street meds to manage chronic pain. More regulation ≈ more abuse and more addiction.

Not sure if governemtn is that stupid or if they actually want more addiction
 
Last edited:

MsDiz

Bluelighter
Joined
Mar 31, 2020
Messages
6,298
Location
Ireland
Hey guys, I'm new to BL and wanted to ask some questions about some metabolic mutations I found out I had most notably at CYP2D6. So, I've been in pain management for 4 months now and I started out on Oxycontin 20mg q12. Which I started to realize after a couple of days that the drug lost it's effect within 4 or 5 hours leaving me feeling rough. So, my physician threw in some ir oxys to fill the gaps. This helped for a week and the ir's started to wear off rapidly too. Finally, I requested my doctor run GeneSight testing on me. It came back to show I was a poor metabolizer at CYP2D6 and an intermediate at CYP3A4 which seems to explain the quick duration of the oxy. Anyway, I'm still on 40mg Oxycontin q12 with 20mg of ir oxy q8 and it doesn't last. I take the 40mg OC around 8am with a 20mg ir and around noon I experience a rapid drop off of analgesia and have moderate but uncomfortable withdrawal symptoms. Then I take another ir which is gone in an hour and a half and so on. I try to stretch it out as long as possible so I can take the 2nd OC around 6 or 7pm. Sucks. Especially when you're trying to do shit throughout your day. I could switch to a morphine product but it'll take a fairly high dose of morphine to equal my current dose of oxy. I recently came up with the idea of staying on the OC 40mg but implementing 10mg oxymorphone ir in place of the 20mg oxycodone ir. The oxymorphone doesn't have any CYP activity and the ir form claims to have a 6-7 hour half life. The problem is it's absorbed orally like 10% right? I'm wondering if you guys have any suggestions or have any significant experience with oxymorphone ir orally. I'm worried because of the poor oral BA that the oxymorphone won't be very effective at 10mg probably 3x daily. Would I need a higher dose of oxymorphone to make up for the poor BA? Plus, my insurance doesn't cover Opana ER and I'm not sure the ER form is even available anymore? Any suggestions would be great. Thanks
Ooooh, hard to know what’s best to do in this situation.

Was that all the gene mutation info you got? Any more that were off?
 

MsDiz

Bluelighter
Joined
Mar 31, 2020
Messages
6,298
Location
Ireland
Also, started on OxyContin 20mg… then increased so easily when it was clearly odd that it was wearing off. Not changing it… This is all really poor prescribing. I’m shocked.
 

MsDiz

Bluelighter
Joined
Mar 31, 2020
Messages
6,298
Location
Ireland
Hey guys, I'm new to BL and wanted to ask some questions about some metabolic mutations I found out I had most notably at CYP2D6. So, I've been in pain management for 4 months now and I started out on Oxycontin 20mg q12. Which I started to realize after a couple of days that the drug lost it's effect within 4 or 5 hours leaving me feeling rough. So, my physician threw in some ir oxys to fill the gaps. This helped for a week and the ir's started to wear off rapidly too. Finally, I requested my doctor run GeneSight testing on me. It came back to show I was a poor metabolizer at CYP2D6 and an intermediate at CYP3A4 which seems to explain the quick duration of the oxy. Anyway, I'm still on 40mg Oxycontin q12 with 20mg of ir oxy q8 and it doesn't last. I take the 40mg OC around 8am with a 20mg ir and around noon I experience a rapid drop off of analgesia and have moderate but uncomfortable withdrawal symptoms. Then I take another ir which is gone in an hour and a half and so on. I try to stretch it out as long as possible so I can take the 2nd OC around 6 or 7pm. Sucks. Especially when you're trying to do shit throughout your day. I could switch to a morphine product but it'll take a fairly high dose of morphine to equal my current dose of oxy. I recently came up with the idea of staying on the OC 40mg but implementing 10mg oxymorphone ir in place of the 20mg oxycodone ir. The oxymorphone doesn't have any CYP activity and the ir form claims to have a 6-7 hour half life. The problem is it's absorbed orally like 10% right? I'm wondering if you guys have any suggestions or have any significant experience with oxymorphone ir orally. I'm worried because of the poor oral BA that the oxymorphone won't be very effective at 10mg probably 3x daily. Would I need a higher dose of oxymorphone to make up for the poor BA? Plus, my insurance doesn't cover Opana ER and I'm not sure the ER form is even available anymore? Any suggestions would be great. Thanks
Morphine isn’t metabolised by CYP2D6 by the way.

I’d probably taper you down from whatever dose it is you are on now to something more suitable and start from there with the conversion to morphine and see how that goes.
 

MsDiz

Bluelighter
Joined
Mar 31, 2020
Messages
6,298
Location
Ireland
Also I’d have started you on tapentadol. It’s a great analgesic and the CYP enzymes don’t play a major role in its metabolism.
 

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
Yeah. I didn't think it was metabolized by CYP at all. I'm just sure the conversion is off the charts high and you know the doc is gonna use like 30% cross tolerance and I'm gonna end up on a dose that is subtherapeutic. Although if I get to the point of no other options I might have to do it.
 

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
Yeah, I've never tried Tapentadol but, I'm on a high dose of two antidepressants and I'm a little worried about serotonin syndrome with a drug like that. Plus, I know its kind of similar to tramadol and I had a seizure last time that I took tramadol.
 

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
Ooooh, hard to know what’s best to do in this situation.

Was that all the gene mutation info you got? Any more that were off?
Yeah, as a matter of fact I was an intermediate at CYP 3A4. Which I realize is more significant in the metabolism of most opioids and benzos ect. I didn't mention this because my physician and more importantly the literature that reflected my test said that 3A4 metabolized drugs would have normal effects on me. I took that to mean it possibly had something to do with the alleles involved in the mutation. In other words, even though the test said I was intermediate at 3A4 that maybe the particular alleles involved dictated how significant the mutation is. I have no idea if that's true. It's just a guess. If you have an explanation that could shed some light on that situation please let me know because it is inconsistent with a basic interpretation of the results .
 
Last edited:

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
Oxymorphone intranasal is 43% vs 10% oral. Theres your amswer. You will basically be quadrupling your script. Iv is not worth the risks even though it is 100%.

Dissolving in water and applying via afrin nasal sprayer will maximize absorption. Adding a very small amount of ethanol will also help the solution maximize absorption but don't add so much that it burns. Store in fridge so that oxy doesn't decompose in solution.

Sad that it's come to abusing our meds amd using street meds to manage chronic pain. More regulation ≈ more abuse and more addiction.

Not sure if governemtn is that stupid or if they actually want more addiction
Ok. So I got the 10mg oxymorphone filled this morning and it's written for 3 a day. So, since the oral BA is so low insufflation is the best ROA for me. However this medication's long half life paired with the fact it's an active metabolite of the Oxycontin I'm still taking is what made it attractive to me. I don't want to blow powder 3 times a day if I'm going to use this medication long term. Although, what you said about an aqueous nasal solution may be something I could get on board with. If you know how to do this correctly I think I'd be down to try it out. Thanks
 

LucidSDreamr

Bluelighter
Joined
May 23, 2013
Messages
5,248
Location
Silicodone Valley
Just don't do it with yourbl whole script....do it in small batches. Becsuse drugs will decompose faster in solution than in solid form...so you don't want it in solution for a long time before you use it. Plus it will take some experimenting on your part to figure out how concentrated to make it. More concentrated means less liquid sprayed up your nose but also residual liquid Lost or left in the dispenser will have more drug inside it that will be wasted.
 

negrogesic

Moderator: BDD, OD
Staff member
Joined
Jul 21, 2002
Messages
8,962
Location
Negronesia
Its probably not a good idea be snorting your pain medication 3x a day. It's harmful to the lungs and mucosa and will also decrease the extended duration of action that you are seeking. I suppose rectal administration is just as effective and safer but really you should just find a suitable oral dose (i realize this is easier said than done).

What is the source of chronic pain out of curiosity?
 

LucidSDreamr

Bluelighter
Joined
May 23, 2013
Messages
5,248
Location
Silicodone Valley
Its probably not a good idea be snorting your pain medication 3x a day. It's harmful to the lungs and mucosa and will also decrease the extended duration of action that you are seeking. I suppose rectal administration is just as effective and safer but really you should just find a suitable oral dose (i realize this is easier said than done).

What is the source of chronic pain out of curiosity?
Good point on nasal dosing Regular rectal administration is probably not ideal either now that I think if of it if your med isn't soecificslly formulated to be put up there. After I stopped IV I went through a phase of using rectally a lot and ther was irritation eventually
Also a great deal of your dose gets wasted if you don't clear your lower colon/rectum first which when youre on opioiods everything is backed up usually. Then you get into using enemas regularly which is what I did amd this irritates too and can actually cause muscle dysfunction like levator Ani if your muscles basically start weakening amd forgetting how to shit on their own.
 

MsDiz

Bluelighter
Joined
Mar 31, 2020
Messages
6,298
Location
Ireland
Yeah, I've never tried Tapentadol but, I'm on a high dose of two antidepressants and I'm a little worried about serotonin syndrome with a drug like that. Plus, I know its kind of similar to tramadol and I had a seizure last time that I took tramadol.
Tapentadol shouldn’t give you serotonin syndrome if you’re using it correctly. I’m not sure of your doses or what SSRIs you are on.

It’s nowhere near the same level of an SNRI as tramadol.


Ok. So I got the 10mg oxymorphone filled this morning and it's written for 3 a day. So, since the oral BA is so low insufflation is the best ROA for me
I also advise against insufflating this medication. The oral BA is crap but you will get some benefit from it. Give it a try at least.
 

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
Its probably not a good idea be snorting your pain medication 3x a day. It's harmful to the lungs and mucosa and will also decrease the extended duration of action that you are seeking. I suppose rectal administration is just as effective and safer but really you should just find a suitable oral dose (i realize this is easier said than done).

What is the source of chronic pain out of curiosity?
Hey, sorry for the late response. My source of pain stems from an accident I sustained while riding my bicycle. I was run over on purpose. Hit n run. Anyway after that I had surgery the next morning because I had a complete Tib/Fib fracture on left leg. So, when you suffer a high speed traumatic injury like that especially with a fracture to an extremity you got to watch out for compression of the fascia in the compartments of in my case the gastrocnemius muscle. It can also happen as a result of the surgery. Well, after my surgery I started not being able to feel my big toe and extreme pain. So, I had gotten compartment syndrome. Which is a medically emergency. Long story short it was misdiagnosed by the orthopedic surgeon and nine surgeries later my left leg was amputated below the knee.
 

Au-Confidential

Greenlighter
Joined
Jun 9, 2021
Messages
9
Location
Alabama
I'm on Opana ir 4x daily now. I'm tired of blowing it. Oral route isn't great. I'm looking in to buccal/sublingual ROAs. Any advice?
 
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