Switching from one opioid to another - does your body prefer a specific drug?

[LadyKalma]

It depends on the opiates in question for me. For example, I was addicted to oxy a long time ago and when i got some h it for sure made me feel great, it wasn't like cause I was used to the oxy that I would prefer it. However, my husband did prefer the oxy, still would if it was available. Also, I have always been able to be ok with a small amount of methadone, and despite us having similar sized habits, my husband is still sick seeming with twice as much methadone. Dilaudids seem to work just fine too even though they are something ive gotten rarely so not "used" to them either.

Morphine seems the least preferable to me anyway, way to much histamine reaction. So for me personally I think it dosent seem to work as well cause i can't tolerate doing very much in one setting, face turns super red and everything too. But dosen't h get converted into morphine soon in the body anyway? So maybe it dosen't work as well to make you feel great cause its missing part that happens before its converted? Idk

[Snout]

Wait! You mean other people like heroin also?!?! I thought I was weird.

[Wildcat]

@Wildcat Could you explain a little bit more about why you can't metabolize methadone? What exactly is your body missing? How did you find out that you had this issue with methadone?

I'm sorry if that's too personal a question, but I'm very interested in the medical side of how we metabolize things.

@Lolleedee - No, I don't mind ; )-

I had genetic testing to determine which medications I respond normally or best to, and which ones I don't.  For example;
For Methadone, the enzymes that bind to the gene I carry are unknown-so I am sensitive to it, and it is recommended not to take it.

I am prescribed Oxycodone, however the enzymes(CYP2D6) that bind to that gene I carry do not metabolize this drug normally-I have an altered response, meaning  need more of this drug than a normal metabolizer or it's recommended that I be rx'd a drug not metabolized by CYP2D6=like morphine, oxymorphone, fentanyl

I am also rx'd Fentanyl(Duragesic is the one I use 100mcg) - I have above normal response because I carry the gene/enzyme combination that targets at least 3 opioid receptors- so it's a very good drug for me!

The report I have is very valuable and contains this type of info for all sorts of medications(heart, seizure,anti-depressants, muscle relaxers, etc)

If your ins will pay for this-you should have it done-especially if you have a lot of medical problems and take multiple medications.  It could save your life.

I can't take Naltrexone either(not that I'd want to, lol)for the same reasons. But if I were to OD I'd be in deep shit because I don't respond to it.

From now on, I make sure any doc I see and wants to Rx me anything, I have this report for her/him.

Be well!  ; )

wildcat

[mickeyaye6989 (OP)]

That's interesting that our genes affect the enzymes that metabolize these drugs in such a dramatic way. Had no idea that some people who lack a certain enzyme may get almost no effect from a certain drug - seems that our body chemistry is still quite a mystery to us all! I always figured that if I had not had a drug before, it would be more effective as my body wouldn't have encountered it and this wouldn't quite know how to metabolize it right away (given what I've read now, this seems like it's probably bs) but it would be really cool to have the enzyme testing done.

Where/how exactly did you get set up with the lab/doc who did the testing for you? Was it ordered by a pain doc, or done on your own initiative?

[Dopeless Hopefiend]

@Wildcat Could you explain a little bit more about why you can't metabolize methadone? What exactly is your body missing? How did you find out that you had this issue with methadone?

I'm sorry if that's too personal a question, but I'm very interested in the medical side of how we metabolize things.

@Lolleedee - No, I don't mind ; )-

I had genetic testing to determine which medications I respond normally or best to, and which ones I don't.  For example;
For Methadone, the enzymes that bind to the gene I carry are unknown-so I am sensitive to it, and it is recommended not to take it.

I am prescribed Oxycodone, however the enzymes(CYP2D6) that bind to that gene I carry do not metabolize this drug normally-I have an altered response, meaning  need more of this drug than a normal metabolizer or it's recommended that I be rx'd a drug not metabolized by CYP2D6=like morphine, oxymorphone, fentanyl

I am also rx'd Fentanyl(Duragesic is the one I use 100mcg) - I have above normal response because I carry the gene/enzyme combination that targets at least 3 opioid receptors- so it's a very good drug for me!

The report I have is very valuable and contains this type of info for all sorts of medications(heart, seizure,anti-depressants, muscle relaxers, etc)

If your ins will pay for this-you should have it done-especially if you have a lot of medical problems and take multiple medications.  It could save your life.

I can't take Naltrexone either(not that I'd want to, lol)for the same reasons. But if I were to OD I'd be in deep shit because I don't respond to it.

From now on, I make sure any doc I see and wants to Rx me anything, I have this report for her/him.

Be well!  ; )

wildcat

Hey Wildcat, this is really interesting. Is there a specific name for the test that I could ask my doctor to order? I would love to have this information for myself. I know that Morphine just doesn't work for me. Like, I get close to no pain relief from it, but I have no idea if this could be related to genes.

[DreamerOnTheRun]

Yeah, I was curious about that myself.  Somebody suggested that something very similar may be the cause of my RIDICULOUS tolerance to benzos.  Yes, I've "built" up a tolerance as well but even if I go months without it still takes 10mg of alprazolam to give me the same effect 2mg seems to have on most people. Obviously totally different receptors but you get my point.

For me, when I switch from one to the other it's usually from Dilaudid to Oxycodone (& vice versa)  and the biggest difference from my experience is how much I miss the rush Dilaudid give me, or miss the sedative/nodding properties of the roxicodone.  Also sometimes forget how quickly I seem to start WDing after my Dilly shot versus the Roxi shot.  But when switching the other way I find the rush from the Dilaudid sometimes pleasantly surprises me with its intensity (and I never get the nasty histamine reaction pins & needles from either dillies or roxies, none whatsoever).

I totally feel you on the morphine.  I can't STAND it. The pins & needles, the hives, the itching overwhelm me to the point it drowns out any relief/rush I may have gotten otherwise.  Never made much sense to me because I thought Dilaudid broke down into morphine once in you, unless it's just from contact before it has a chance to be metabolized?  Idk if that makes sense though.

[Chip]

funny thing, benzo tolerance ... i have never suffered from any benzo withdrawal as i was effectively treated by a Methadone clinic for Diazepam addiction.

BUT i have a perpetual high tolerance to benzos ... maybe not always the first time but straight after.

the benzo tolerance behaves a bit like the opioid mechanism where once you build it up, it remains with you for life.

maybe all tolerances behave like this ... it means less bang for your buck but at least your body is protecting itself.

[makita]

I def experience moderate WDs when switching from one opioid to another even if the doses are supposed to be equipotent.  It's gotten worse over the years with the more I've used.  Part of this is because opioids don't all have the same molecular "shape" so one drug will affect receptors slightly differently than another.  Think of 2 dif puzzle pieces that are close to the same shape, but not identical; what happens if you have a finished puzzle where one piece fits perfectly, and then you decide to take it out and try to replace it with the other (the empty space is the tolerance you built up to a specific opioid).  It might fit 90% of the way, but still be off by 10%, causing your body to react on behalf of that missing 10% the same way it would if there was no replacement piece at all (ie withdrawal)...just only at 10% severity.   The bigger the difference between the two types and how they affect your receptors, the more intense the withdrawal will be even if you take way more of the new med then you would need to.

The most dramatic difference I've seen w this has been when switching from fentanyl to anything else.  To make it painless I have to basically treat myself as if I were in cold turkey withdrawal and take multiple types of supportive meds like clonidine and gabapentin for the first 4-5 days alongside the other opioid (and usually jack up my dose of it as well if possible). 

I've also heard this is common when going from PST or opium (which has multiple types of opioid alkaloids in each dose, some of which you couldn't get anywhere else like thebaine) to a single opioid like morphine or methadone...even heroin. 

[Wildcat]

@mickeyaye6989


It was done by a lab called Alpha Genomix; and was ordered by my PM doc-it's now part of a new protocol in his practice before any medications are prescribed-most insurances pay for it.  They take a simple cheek swab.

The results report is really in depth and quite informative.

@Dopeless Hopefiend -  it's Genetic testing for drug sensitivities/effectiveness/side effects.

***It's especially useful when insurances' require prior authorization or step therapy***You have scientific proof of why you must have one medication over another.

wildcat