Some people are “ultra-fast metabolizers” to the opiate codeine. A team of researchers at the University of Auckland believes they are more likely to abuse and become addicted to the drug. Tony Wall reports.
Amy Putman was standing at a bus stop in Auckland when she saw an advertisement for Nurofen Plus, a pain reliever containing codeine and ibuprofen that was available at the time over-the-counter in pharmacies.
She is from the United States, where opioid products are available by prescription only. “I was like, ‘Oh my God, can you buy something at the drugstore that’s an opiate? Holy…’.”
Putman came clean after becoming addicted to a similar drug, hydrocodone, in the 1990s, but he had recently relapsed on alcohol and was vulnerable.
She bought some Nurofen Plus and took two tablets for the euphoric effect. Before you knew it, she was taking 12 full cans at once.
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Then it wasn’t enough. They also sold it in 30 packs – it got to the point where I was taking 30 whole pills at once.”
Putman has long suspected she has a genetic predisposition to addiction – “I come from a family of alcoholics and drug addicts” – and was intrigued by a study launched by a team of researchers at the University of Auckland looking at codeine users.
Unlike other opioids, codeine It is a “prodrug”, which means that it is inactive when ingested, but is then modified by the liver to form morphine.
The amount of morphine produced depends on the type of liver enzymes the person has inherited – slow, medium or ultrafast.
Ultra-fast metabolizers will get you a much larger dose of morphine from a dose of codeine than other people, which will probably give them a high feel.
The research team, led by Dr. Rhys Bunton of the university’s School of Pharmacy, hypothesizes that these people are more likely to have problems with the drug.
By looking at the types of enzymes found in people who abuse or depend on codeine, they hope to determine if this is the case.
In theory, it could help doctors know if a person is at risk of developing a dependence or experiencing an accidental overdose.
The research team invites volunteers who take codeine recreationally or who think they may become dependent on the drug Register to study, which they say is the first of its kind in the world. They will be asked to conduct a telephone interview and submit a saliva sample by mail.
There is so much shame and stigma associated with opioid abuse, Putman says, that it would be “surprising” to establish a genetic link.
“It would be great to be able to show this evidence to others and be like, ‘Look, I’m not morally disadvantaged, there’s a natural and physical reason why. “
Codeine removed from over-the-counter saleswhich became prescription-only, in November 2020, due to concerns about the misuse of the drug.
Opioid maker Purdue Pharma has pleaded guilty to its role in the opioid epidemic, paying $634 million in fines and pleading guilty to contributing to thousands of opioid deaths.
But Bunton says only a small percentage of people — somewhere between 1 and 5% — are ultra-rapid metabolizers of codeine.
He says that if this group can be shown to be the most likely to develop problems, it would prove that there is little risk of selling codeine over the counter to the general public.
Bunton says this would remove the need for people to have to book appointments with GPs to access codeine, which, due to cost, has led to unequal access to pain relief.
But Puttman says removing codeine from over-the-counter sales was a good move.
“Organizing around it was really lenient. I could go to the same pharmacy once a week and get 30 pills. I’d like to shop a drugstore—I’d pretty much know where every pharmacy in the area is.”
“I like the idea of the most powerful pain medication being more accessible to people, but it had to be better regulated.
“Putting the burden on the pharmacist to organize this was too much, they already have a lot of tasks.”
The boat’s abuse of codeine continued for nine years, and she kept it a secret from his wife. She lost her job when it was discovered that she had been asking co-workers to buy her codeine, and she was “unemployed”.
She has chronic stomach problems caused by the ibuprofen in the products she was taking.
Her dismissal was the catalyst she needed to clean herself, and in 2019 she returned to her family in Texas for three months.
“I was 51, and I had to go back and live with my parents. It was the humbling experience I needed.”
She did a 12-step program and is now sober.
“There is a tremendous amount of shame. It is as if there is someone else in your body doing these things – you can’t stop yourself.”