You may not be able to metabolize the medication, at all, for it to become effective. Pro-drugs must be converted into their active metabolite in order to work inside the body. Maybe, your body burns through the medication too quickly for it to be of help to you. How can you find out? A gene test for medications.
Most of us have experienced it ourselves or know of someone who has made the statement that a certain medication just did not work for them. What do you do then?
Call your doctor and tell them that it isn’t working? Continue taking the medication anyway? Just stop taking the medication and do not tell the doctor?
Those are the most common things that people do. So, let’s look at them and see what usually happens and how our health may be damaged. Hang on; it’s going to be a bumpy ride. Some of you will nod your head in agreement, some will begin to wonder how to be in better control of their situation and some will shrug their shoulders and just go, “Oh well, it is what it is.” Those of you that are the “shruggers” can stop reading now. This is not for you.
I know that ibuprofen works for me and I know that naproxen is like taking water, for me. Others may have the opposite reaction in their own bodies. That is a minor inconvenience on the scale of taking a medication for a need. What about when you have a surgery?
Pharmacogenomics for opioid metabolism would have made a difference for me
Yes, indeed. I had a surgery and was given a prescription for Percocet® (oxycodone & acetaminophen) for the post-op pain. Remember, we are on IV morphine (usually) before we are released. I was sore and in some pain, but that is just surgery. You will never be completely free of pain that is just not realistic. I am a pharmacist and I know this and am okay with it. I also know that the pain won’t last forever and I will do what I need to do to get better as fast as possible. That is just my nature. Now it is time for a pain pill. I take it and go on about my business. It gets to be about an hour later and I know that it takes 30 – 45 minutes to be absorbed, metabolized to the active drug and move on throughout the body. Something is wrong! I am hurting, really hurting. I take 800mg of Ibuprofen and another pain pill. An hour later, I am behind in pain management.
I call my surgeon and tell them that I cannot tolerate the Percocet®, to call in something else. Of course they think that I want another medication that is a Schedule II narcotic and would have to be written, picked up and then taken to the pharmacy to be filled. I told them no, just call in generic Vicodin®. They did. I could take 2 of them and the Ibuprofen and deal with the post-op pain.
Why didn’t I tell my doctor that the Percocet® was not working? I knew that it wasn’t working but at the time I had no proof as to why. This was the mid-1990’s. You know as well as I do, that when you tell your doctor a pain medication is not working and that you need “Your drug of choice, one that you know works for you.” You are viewed with skepticism and more likely than not a “drug seeker” or worse a “drug abuser.”
“What do you mean it is not working, it is one of the most powerful drugs that we have?” What you want to say versus what you do say is two different things. You want to say, “Dammit, I know that, but it is not working for me. I don’t care that you think it should work. It isn’t and I should not have to suffer because you are being stupid and not able to consider that not every drug works for every patient the exact same way!” Sometimes you have to help the doctors along in understanding drug metabolism and pro-drug vs active drug. The average person doesn’t know that and they should not be expected to know that. It is not their area of expertise.
Until you have had a treatment failure with pain management, you do not understand
Until a physician has experienced the lack of pain relief in their own life, they do not understand it and will not get it. Why? Because they have had one semester of pharmacology in medical school and most do not know how the medications work or do not work in certain populations. Don’t even get me started on drug reps and what they spout out about their products. Crap, we may be here all day on this one topic. That is okay, I will do other blogs on other topics. This is important to a lot of folks.
How is narcotic pain medication dosed? Guess what? It is based on morphine equivalents. Morphine is the standard. You aren’t even getting the morphine unless you are a cancer patient and then you will be given that reluctantly. Look, I get it we need to be more aware and mindful of pain medications. I agree with that. It has been proven that the more effective the pain relief at the beginning the less pain medication is used overall and the quicker the patient is off the narcotic and back to being normal. That is what we all want. I know some of you are worrying about drug addiction. There is a difference between drug addiction and drug dependence. Your body may be dependent upon a medication but that does not mean you are addicted.
There are some folks that are addicted and for them it is way beyond pain control. They have a mental and physical dependence with an uncontrollable desire/behavior in getting and using the substance. I have talked to folks that are addicted to substances. What I found out was that it wasn’t about getting high; it was about not getting sick while coming off the substance. All of the ones that I talked with all stated that you will never get back to the first high that you experienced your first time, but would still keep trying to achieve it. It is the pattern that we see over and over again. That and undiagnosed depression. Quite a few folks are self-medicating and that includes alcohol and nicotine too. Another topic for another time too, moving on to the rest of our story.
I always chase a few rabbits. Keep count. In one of my talks with a group we chased eight rabbits. Everyone had a good time and got the answers that they needed.
What type of metabolizer are you?
Back to the pain medication issues and the whys… We have known for some time that there were differences in pain relief for people, but why? What can we look at or find out to better help these folks without them being looked at as drug seekers or drug abusers. Everyone deserves a better quality of life. Is it in metabolism, absorption and excretion? Yes, yes it is. Now we have the genetic predictors of how you metabolize or do not metabolize certain drugs. This explains why some people get great relief from certain medications and others get no relief at all.
For myself, I am one of the 10% of the population that cannot metabolize Percocet® into the active metabolite (the one that causes the pain relief) nor can I convert enough Vicodin® (which is why I needed a much higher dosage) to get some pain relief. Now I have the proof that the medication that I do need is actually morphine.
I am not a chronic pain patient, but in my brief experience with surgery and other acute painful situations, I get why people will do almost anything to get some relief. I have had two migraines to where I would have taken anything that I could have gotten my hands on to get some relief from that pain.
What if by having the genetic tests done for yourself, you could find out what medications would work the best for you and your needs? What would your life look like? What could your family life actually be like?
I have had mine done and now have the reports to use the rest of my life. Whether I need antidepressants, blood pressure medications, heart drugs, chemotherapy drugs, Alzheimer’s disease medications or Parkinson’s medications, I have the list of medications that will work for me and those that definitely will not work for me and those that may work for me. Another thing to consider, the test will also help you figure out what medication(s) may be causing your terrible side effects and/or adverse reactions.
I researched this type of testing two years ago, but it was cost prohibitive. Over $2,000.00! Now, it is way more affordable. I am not posting the price here, but will be glad to share it with you via email or telephone. The one I am affiliated with was developed in connection with the Mayo Clinic.
Have your test done now and use it for years. Yes, I get a fee for providing this service. Even if I didn’t I would recommend it anyway. Invest in yourself and your health today. As a bonus, you get to talk with me when your test results are ready and we go over them and get you back in control of your healthcare needs.
Have a great day and pass this information along to those who may benefit from this information.
Pat Collins
Empowering Health Options
865-684-8771 (If I am unable to answer, please leave a message.)
Email pat@empoweringhealthoptions.com
