Hey @JustinMcClanahan, have you had pharmacogenomic (PGx) testing done?

Pain meds don't work for me because I'm a slower metabolizer (genotype status level Poor for the enzyme CYP2D6, which the body uses to fully- or partially-metabolize most pain meds).

Here are the metabolizer statuses for each enzyme:
Poor < Intermediate < Normal (Extensive) > Rapid > Ultra Rapid

I'm willing to bet you're a fast metabolizer by genotype (rapid or ultra rapid) for at least one of the enzymes that metabolizes Dilaudid. (Dilaudid is metabolized by five enzymes, three of which (CYP3A4, CYP2C9, and CYP2D6) are included in the standard PGx test sets like the ones provided by Mayo and Oneome.)

When doctors prescribe meds, they will assume that a patient is a Normal metabolizer unless they are provided with info like I have (and then they usually just become confused and somewhat scared, except for my Mayo doctors).