By R Carter
Estimates are as high as 30% of the general population has a genetic variant in their genome that causes them to be either a high or low metabolizer of most prescription and over the counter medications. And as many as 10% have variants which cause them to be high or low metabolizers of opiates.
For years I’ve wondered if I’m not part of this 10% because I have never responded to opiates like the average person. And for more than ten years now I’ve tried to get insurance to cover the cost of pharmacogenetic testing to either rule in or rule out this concern. I finally got fed up with the insurance companies and found a cheaper solution which won’t break the bank and can shine some light on this subject.
I subscribed to 23andMe to get my genome sequenced, at the time the cost was about $300.00, it has come down since then to $200.00 and with that you can get a text file copy of your genome which documents your variants. Then for $12.00 you can submit that text file to a tool called Promethease and a report will be generated showing you if any of those variants are associated with a disease process or have a medication warning associated with them. While not medical grade testing and while not covering all the genes associated with identifying high or low metabolizers of opiates, it can give you a hint and some odds that may convince you to at least talk to your doctor about getting the real deal done.
This is what happened to me, after getting my report back from Promethease, it identified variants on CYP2D6 which has a high probability of being a low metabolizer of codeine type pain meds and since my doctors have prescribed Oxycodone for years this started making sense for why a pill designed to last six hours only lasted four. I may not be converting all of the medication into the active form needed to provide pain relief. Promethease also showed that the same low metabolizer trait applied to Methadone but was related to a different gene variant. In fact Promethease showed that I have 7 suspect variants in all, with two being related to high metabolizers but not necessarily for opiates.
That’s part of the catch, you could have variants that offset one another or don’t apply to opiates at all, or there could be other genes that pick up the slack of your variants and metabolize these drugs normally. This is why you need to have medical grade testing and the test results reviewed by a doctors who specializes in genetics.
Still, for the cost, its a good way to get some insights you might not otherwise have.