Opioids Why does Codeine not work for me?

[Lorne???]

^ Funny thing is, APAP was actually originally available in the form of a toxic prodrug- acetinalide- and then discovered it was highly toxic, and so they invented apap, yet instead used phenacetin- another apparently carcinogenic prodrug for Tylenol; this was sold by Bauer and quite popular; however it was toxic and, finnaly, apap was released as, triogenic or something, a combination product-yet bad luck(or a warning) struck again, as it was temporarily removed from the market, until proven, well, "safe"- Finally we get Tylenol- and it becomes very popular apparently quickly, and was otc "analgesic" and antipyretic of choice, pretty much(in US, at least) so multiple companies had a chance to market this, and decades longer one hits the jackpot; an odd story, though interesting, IMO

 

[Lorne???]

And Ibuprofen is the most effective NSAID arguably, and otc analgesic

However, comparing aspirin to Tylenol is a different story- for another time

Just putting it out there

Weird history of non-nsaids(double negative?) and other nsaids(or neutralized?)

 

[Dispersible]

Redosing low amounts of codeine

I understand that when taking large amounts of codeine, the enzyme used to convert to morphine becomes depleted and a recovery time is necessary before redosing.
I am currently taking therapeutic doses of 60-120mg per dose. Does this still apply at these doses? How long would one have to wait before morphine conversion becomes efficient again?

 

[Lorne???]

Are you taking it for pain or euphoria or maintenance?

It has a 2nd active metabolite, btw

 

[Pickledlemons]

I understand that when taking large amounts of codeine, the enzyme used to convert to morphine becomes depleted and a recovery time is necessary before redosing.
I am currently taking therapeutic doses of 60-120mg per dose. Does this still apply at these doses? How long would one have to wait before morphine conversion becomes efficient again?

It was my understanding that codeine's ceiling doesnt approach until 1 gram +. You should be okay to redose whenever.

 

[Lorne???]

^ yeah it is a lot higher than that for most people; remember it will vary person to person, and most conversion is going to occur after Codeine itself peaks in blood(or roughly the same time; the role of CG whatever is uncertain, though IM codeine(quite enjoyed by the late Howard Hughes) is 1.5-2x as potent as P.O, and it skills first pass metabolism, and has no exposure to prehepatic extraction or conversion

 

[Dispersible]

I am taking it for pain. Post op complications have left a lump of nerve endings in a ball under the sole of my foot. In the past I have taken codeine mainly in an effort to achieve euphoria however in largely unsuccessful endeavours. I have dosed approx 800mg at the higher end but usual doses would be 300-450mg. I have found little correlation between doses ranging from 300-800mg and euphoria achieved. I have decided I’m a poor metaboliser.
I am aware of C6G however I believe it is much less active than morphine and understand that most euphoria is attributed to morphine concentrations. Although I don’t discount C6Gs role in euphoric side effects.
Back on track - I do notice when I take 90-120mg of codeine P.O., in the form of effervescent tablets, some slight warm waves I would associate with opiates but they are somewhat fleeting although still desirable hence my inquiry.

So so am I understanding the necessity for a prolonged break between doses only applies for large ceiling doses and not therapeutic dosing. If I took 120mg of codeine would taking 120mg again in an hour see little to no diminishment or metabolism?

 

[OpenGtuning]

As someone has mentioned earlier. Try tramadol. If that doesn't work too. Your a poor metabolizer.
I am and it sucks balls.
Strangely though dxm doesn't do much for me either though only tried quite low doses as afraid of a long disassociative trip.

 

[adder]

I am taking it for pain. Post op complications have left a lump of nerve endings in a ball under the sole of my foot. In the past I have taken codeine mainly in an effort to achieve euphoria however in largely unsuccessful endeavours. I have dosed approx 800mg at the higher end but usual doses would be 300-450mg. I have found little correlation between doses ranging from 300-800mg and euphoria achieved. I have decided I?m a poor metaboliser.

Considering the highest dose codeine-only instant-release pills come at is 60mg and I can't imagine a doctor would advise you to take 5 of these at a time, either your prescribed dose clearly doesn't help you or you're self-medicating your pain. Either way playing with codeine isn't the best way to go about this. You may need something stronger that doesn't rely on its metabolite to exert an effect like hydrocodone or oxycodone. On the other hand an opioid may not be effective for nerve pain no matter how strong it is, then its use only puts you at risk of addiction, although some atypical opioids like methadone or levorphanol may be more effective in some instances of neuropathic pain, you may need a completely different medicine.

^ yeah it is a lot higher than that for most people; remember it will vary person to person, and most conversion is going to occur after Codeine itself peaks in blood(or roughly the same time; the role of CG whatever is uncertain, though IM codeine(quite enjoyed by the late Howard Hughes) is 1.5-2x as potent as P.O, and it skills first pass metabolism, and has no exposure to prehepatic extraction or conversion

Codeine i.m. is indeed around 1.5x as potent as p.o., but no matter how it is taken, if you redose the same dose after 4-6 hours, the effect will be much weaker. I'm talking from experience about higher doses like 300mg and more which are definitely not therapeutic doses. With therapeutic doses like 60mg taken every 4-6 hours enzyme inhibition is insignificant. But, again speaking from my own experience, taking 150mg an hour after 150mg is a waste effect-wise.

 

[Backfromthebrink]

Seems to be an awful lot of threads about codeine at the minute...

There's always the obligatory 2 types of thread in OD....

"how can I abuse these fentanyl patches" and

"how can I inject this benzo"

But a shit ton about codeine at the minute for. some reason...

 

[Scrofula]

You forgot the sudden influx of cocaine bellringers.

Followed by poppy seed tea.


=>merged with "why doesn't codeine work for me" where we have much enzyme discussion in play.

 

[Slow_Mobius]

Seems to be an awful lot of threads about codeine at the minute...

There's always the obligatory 2 types of thread in OD....

"how can I abuse these fentanyl patches" and

"how can I inject this benzo"

But a shit ton about codeine at the minute for. some reason...

I don't think we've gotten many of either of those questions lately. It seems to me like we've been getting more benzo taper threads.

OD is sort of the default place for all things benzos and opioids.

TBH, it makes 0 sense for anyone to be prescribing codeine anymore. Some people are at risk of overdose, and others are at risk of receiving no benefit--all as a result of genetics that docs rarely know anything about (on an individual basis at least). There are just better options for analgesia.

 

[Scrofula]

When my dentist butchered my face trying to get my wisdom teeth out (novocaine only), the bastard had the nerve to prescribe Tyco #3.

He might as well have handed me a pack of Tic-tacs. If a coworker hadn't been one of those angelic "I don't like painkillers so i don't take them, here's 30 percocet," I would be doing time right now.

 

[isaaccain]

thanks for the advice. I'll try getting the water down to below 5C before putting the pills in, or should I put the pills in and then put it in the freezer?

does the amount of water matter? I settled on around 80-90ml which was enough for 20 pills to dissolve in. I read that too much water could be detrimental

Sorry for the late reply, but just for the sake of time put the pills in 30C water so that they dissolve faster, then chill it down to 3-5C. The amount of water does matter, but unless you're using less than 50ml or more than 300ml there's no risk of a) Not having enough water for the codeine to dissolve in, and b) Having too much water and dissolving too much acetaminophen.

Anyway, would be good to know if you'd felt anything after chilling the water further. If still no then I'd suggest trying to get some pure codeine tablets, if you take 300mg plus of them and feel nothing then you know you're just a poor metaboliser. Alternatively (and this is a long shot), you stomach could be too acidic and a lot of the codeine is getting destroyed before being absorbed. Like I said, that's not very likely.

 

[Lorne???]

^ Yeah though Antacids/raising stomach oh helps opioid absorption, sometimes dramatically-methadone T1/2 can be doubled by a modest increase in urinary PH, and messed with in so many other ways

Don't think OP understands that an opioid "buzz" is more subtle than people thinj(at least with codeine, when you aren't the most rapid metabolizer)

 

[Forever Changes]

^ Yeah though Antacids/raising stomach oh helps opioid absorption, sometimes dramatically-methadone T1/2 can be doubled by a modest increase in urinary PH, and messed with in so many other ways

Don't think OP understands that an opioid "buzz" is more subtle than people thinj(at least with codeine, when you aren't the most rapid metabolizer)

now I'm getting conflicting information

Where do you think I'm going wrong? I'd pretty much accepted that I don't metabolise Codeine. I've followed all the CWE processess and procedures to the best of my ability - amd I wasn't taking any antihistamines - so I think it's pointless persisting and getting nowhere

but I'm grateful to the advice people have given

 

[Lorne???]

^ No no don't misunderstand; still say try dihydrocodiene, as is not a prodrug

and when taking a quartergram, did you check your pupils?

Anyway try dihydro; removing APAP is easy, and frankly even a gram would be less harmful than a gram of Ibuprofen, if you have a healthy liver; and not all antihistamines inhibit 2D, although inhibiting 3A4 and another enzyme prevents/reduces your bodies ability to process the toxic metabolite of APAP, that is produced only when overtaken anyway((pretty much)

 

[Forever Changes]

CWE with Dihydro/APAP combo is bascially the same procedure as with codeine?

I will try it

 

[Scrofula]

The APAP will be just as insoluble in cold water as before. The question is how soluble dihydrocodeine is in cold water.

 

[Lorne???]

220mg per ml in cold water, according to one source, though not sure the salt