Is anyone else here a rapid opiate metabolizer? Recently asked a sleep medicine doctor why my drug screens at work show no traces of opiates in my system even after taking opiates for severe unrelenting Restless Legs Syndrome the night before. He had been using them to manage my unrelenting RLS. He mentioned taking some sort of genetic test. Unfortunately, I had to sever my professional relationship with him due to his office management issues (having a 9:00 AM appointment and not being seen until 3:00 PM or later while he visited with his friends or took a 2 hour lunch break which happened 3 out of 4 visits before I finally decided this was intolerable, office staff bringing their toddlers into the office and yelling at them all day while they ran amok all over the office, and poor to no communication from the office on coordination of care issues.) Found out later that he received scathing reviews from others for these issues. It was a shame since he was knowledgeable.
Anyone else a rapid opiate metabolizer? - Restless Legs Syn...
Anyone else a rapid opiate metabolizer?
You were lucky to get any doctor to prescribe opiates at all.
Yes-- there is a cohort of patients who cycle medications faster than the normal population. The Oxycontin issue is a major case in point.
I have this problem with opiates. They simply don't last the full time that they are suppoed to. Luckily this is well documented, so I have not been classed as an addict, and have been given more opiates to bridge the gap.
I find this also relates to other medical scenarios, such as anaesthesia - which can be a problem on the operating table if I forget to warn the anasthesist. 🤕🙄
Thre does seem ti be a genetic component, since my father and daughter both have the same tendency.
Good luck.
I find the same during surgery. Recently I forgot to mention the opiates I take for RLS, and woke up during the procedure - luckily it was a minor op and was almost done!
Oooooops!🤕🙄
Yes, oops indeed! I came to and panicked and the doctor apologised, said she hadn't realised I'd need a stronger sedative. But it was my fault, not hers. I don't think I'll forget to mention it in future, though it's true that if she'd looked at my notes she would have seen for herself.
This is one of the things you have to be aware of if you take opiates. If you need surgery "normal" doses of opiates. e.g, for post surgical pain are not going to be sufficient.
Similarly for terminal disease.
Hi I am new to this site - I live in South Africa. Unfortunately I don't have anybody here to compare my RLS symptoms with so I hope you don't mind me asking the dosage and opiate you take. After augmenting on pramipexole I have tried every remedy in the book including soap in the bed with no relief except for Oxycontin which only lasts for a maximum of 5-6 hours (if I am lucky!) I am nervous to increase my dose although my GP would by happy to do so if I asked. I am taking 20mg 2 x day
That's a very high dose of Oxycontin for just rls. 20mg per day would be regarded as optimal. That is 10mg twice a day. Which is what I'm on.
I have to take a further 5mg of Oxynorm to allow for the shortfall.
The dangers of taking too much Oxycontin are well documented and are the subject of a major class action in the USA.
Since you are in SA, you should be able to procure good quality Zambian gold or suchlike, which might be a better option. If you can be sure of the source and quality.🤗😎 It would need to be personally recommended.
Good luck.
Thank you for the prompt reply. I have never heard of Zambian Gold but will google and try to track some down. At the moment I will try anything just for a few hours of peace.
Is that like Acapulco gold, only - - -
Zambian?
I chuckled this morning when I read the message that mentioned Acapulco Gold.. I thought of that spoof commercial by Cheech and Chong that went in a sing-song voice, [Acapulco Gold is.... (then another very deep voice) "bad-ass weed".] I had not though of this for years.
The version I remember is a little ditty that went
"No sticks no seeds
that you don't need
Acapulco gold
bad AS weed"
but my memory for that period isn't very good.
That's the one. Always enjoyed their humor
You seem to be between several rocks and several hard places.
I can see it's a problem if you are a rapid opiate metaboliser since you may not get sufficiently lasting RLS relief to get you through the night.
On the other hand, if you weren't then the opiates would show up in your drug screens at work. I can't imagine why your employer would wish to carry out drug screening nor what the consequences of a positive test might be?
This is a consideration since it seems logical that you might benefit from an extended release opiate. A slow release version woud have 2 benefits. One is that the total dose may actually be lower than a one off immediate release version because the latter requires a higher initial dose to enable it to last longer The extended release means a lower dose which is sustained at an effective level. The second benefit is that, it lasts longer.
This is true for other drugs, I'm not familiar what extended release opiates are available. I do read that extended release versions of oxycodone and methadone, sometimes used for RLS, are available.
The next problem might be that the opiate would then be detected in your drug screens at work.
The next problem may be that if you switch doctors, your new doctor might not be willing to prescribe ANY opiate for RLS.
I hope you find a solution.
Hi again! We seem to be two peas in a pod after your last msg about pain during RLS and having to give up work due to the condition. I am also a fast opiod metabolizer! I had a DNA cheek swab done at a chemist in Australia. Cost $100 and showed I was a super fast metabolism of opiods. This would explain why I get withdrawals symptoms very quickly before a new dose is due - and also perhaps why the oxycodone I am on for RLS/PLMD is no longer effective.
My experience with was slow onset of pain control and very short management of the symptoms. I was also an RN and subject to drug testing when I changed jobs, etc. I took 20 mg of oxycodone the night before a drug test and thought about it later. I figured it would be OK since I had an Rx for it. The test came back and it was negative. I then checked the last couple of tests through previous employers and found that they were all negative. I was puzzled.
I was almost not hired for one job because I tested positive for Darvon (propoxyphene). I guess it was banned in the USA about 5 years prior. I grew up in the era where Darvon was passed out like candy. Since I was professionally an infection control RN, rather than a Medical-Surgical RN, I had not been aware of its ban. I had been working in the yard the day before and had a backache. I had been prescribed Darvocet-N100 about 6 years prior for last of my 7 hernia surgeries (the surgeon who did the last one finally corrected the issue). I had two tablets in the medicine chest. I took one. I got the nastiest call from testing firm that I failed the test. I said I had an Rx for oxycodone and put that on the form. She told me it was for propoxyphene. She then lectured me about using illegal drugs and that I would not be hired. I could not remember what propoxyphene was. When she told me what it was (Darvon), I explained that I had a Rx for it. She accused me of lying and told me it has not be prescribed for years. I was as calm as I could be (I do not respond well to rudeness) and explained that it was not illegal when I got it for surgery. I had to take a picture of the bottle. Because it was a round bottle, all the pictures I took of it were unacceptable. I finally, in exasperation if she wanted an MRI of the bottle which did not sit well with her lack of humor. I was finally able to get an acceptable picture from my camera phone. I was always under a cloud of suspicion as someone at the lab told my job I failed the drug test initially. It was a job at the most f***** up place I ever worked at and walked out after 8 weeks. I am so grateful that I had not followed up the first Darvocet N-100 with another one the next morning. It was garbage day and I would have discarded the Rx bottle in the recycle bin. It would have been lost forever and I never would have passed their test. They would not talk to the pharmacy, their staff or the physician. They had to have a high-quality picture of the bottle, PERIOD.
Super metabolism has become an big issue with our pain management physicians in this country (USA). They require a drug test at each visit and will discharge patients who have illicit drug use such as marijuana or cocaine use. What was happening was people who are super metabolizers of opiates would have a negative test. They were being discharged and, in some cases legal authorities were notified, because their physicians were under the mistaken impression that they were not using the drugs but were selling them instead. There have been cases of little old ladies being discharged from their practices on the suspicions that they were supplementing their retirement by selling their drugs.
Finally, (and thankfully), this issue has come to the awareness of medical practitioners in the USA and they are being treated differently. My neurologist told me their was no specific test for this and that it is diagnosed by patient history. Can you tell me the name of the test that you had done to determine this. I would consider having this done for future reference.
Jerold in Citrus Park, Florida, USA
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