Pain Killers Can Be A Prescription For Disaster

A metabolite is the substance that is left after the body breaks down (metabolizes) a medication.

  

Everyone in this picture know that oxycontin — read “morphine” — has lots of addiction-type problems.  Synthesized by the Germans in 1914, it has been around for quite a while, although not terribly commercially exploited until the folks at Endo Pharmaceutical started pushing it.

I have seen a lot of folks on it recently.There are a lot of pain-killing drugs, potentially wildly addictive, out there and being used for “benign” pain.  It has long been proven that if you think about something you don’t hurt so much, but even I will admit there is nothing faster and easier than a pain pill, especially if you don’t take time to read or don’t take seriously when it comes to reading warning labels and such.

This is oxymorphone – sold under the commercial name Opana.  Me, I would be scared of anything that even sounded that much like morphine.  But well, that’s me, who thinks the best treatment for pain is dancing.It is available in every imaginable route, but outpatient prescriptions are going to be oral and go through the liver.  Half-life 7 to 9 hours or so, but it can be longer.  Analgesia to 8 hours, little gel bits formed at the pH in the duodenum; variable metabolites — let’s just say the stuff can be around for a while and it is fairly unpredictable.

I try not to be sexist, but I’ve got to admit I did not think of this as a “Men’s” health issue deserving of being featured in Men’s Health magazine.  I suppose guys go out to party more, and I suppose “party” really is a synonym for excessive alcohol consumption in times and places where I could not be expected to hang out.

Okay, so men are more likely to abuse this stuff, although we have known for a long time women, even in Ohio, are more likely to walk out of a doctor’s office with a pain medicine.  Poor, dear, little help-seeking women.

Deaths from opioids, often in higher than expected doses, are a national problem written up in a lot of places.

But wait, there’s more.

This drug, in the liver, is metabolized through the cytochrome group CY2D6.

 

I am even willing to assume for the moment that people who have a congenital absence of this way to breakdown drugs are known and eliminated from consideration here, which may or may not be true.

If someone is taking drugs that are metabolized through this same system, and/or inhibit it, we are maybe going to toxic levels.Nobody thanked me very much when, during a very brief tenure at an HMO, I noticed someone was getting toxic on oxycontin (morphine) taken simultaneous to Prozac (fluoxetine).  I cut her dose of morphine and thus her analgesia (pain relief), although I probably saved her life as her respirations were on the slow side of normal.  I was glad she did not own a weapon, for she had thought of suicide for herself at one point, and was figuring out what to do to me. She was a little too disorganized to file a complaint.

No good deed goes unpunished.People with chronic pain problems are often depressed — the relevant fibers cross in the frontal lobe.

I think women get depressed when men drink.

 

Although they are chemically different, amazingly enough, Zoloft (sertraline) and Paxil (paroxetine) are also CYP2D6. Then there is Tamoxifen used first in breast cancer but, now, it seems to me, in everything but the kitchen sink, which can be rendered ineffective by antidepressants, because of this interaction.

Be afraid — be very afraid.

The only possible advice I can give is to consult a pharmacist, more likely to know about these things than a physician.

 

Remember that whether it is a free sample or a prescription from another doc, they all go in the same place, and it is the only tummy you have got.
 

You should make a complete list of all the drugs you take and either ask a pharmacist to check it out or look up possible interactions yourself on-line.

 

Then bring the results to your primary health care provider.Oh yes — and don’t drink.  On painkillers this strong, you should not have to, anyway.