'Treated like a drug seeker': Pharmacist's genetic test explained why painkillers failed

Have you ever taken a medicine and wondered why it was not working for you?

Christchurch pharmacist Kyra Sycamore often did and asking for an alternative painkiller left her feeling “terrible” as doctors thought she was seeking drugs.

Years later, a genetic test would explain why two commonly used painkillers provided her with no relief and eventually led her to set up a pharmacogenomic testing service for New Zealanders.

Sycamore was working in the United Kingdom in 2010 when she was admitted to hospital in severe pain.

She was offered codeine but told staff it did not work for her and asked whether she could have morphine, which she knew provided pain relief.

“They saw that as a red flag and then treated me like I was a drug seeker,” she said.

“It was really unpleasant ... a really awful experience.”

About two years later, Sycamore had her gall bladder removed in London and once again told medical staff codeine did not work for her.

This time she was offered tramadol, another painkiller she knew did not relieve her pain.

“They didn’t believe me ... I just stayed in pain,” Sycamore said.

“They sent me home with tramadol and I just had to recover from surgery the painful way.”

As a pharmacist, Sycamore suspected there could be a biological explanation but had no evidence.

That changed about a decade ago after she returned to New Zealand.

While presenting about mental health medicines at Christchurch Hospital, she met a scientist who suggested genetic testing could help some of her patients.

Before recommending it to others, she tried it herself.

The result identified reduced activity in an enzyme known as CYP2D6.

Sycamore said the enzyme was responsible for converting codeine and tramadol into substances that provided pain relief.

“If your enzyme doesn’t work, then you don’t get pain relief,” she said.

“So that completely explained my experiences.”

The finding is now recorded in her medical notes, meaning future prescribers can take it into account if she needs pain relief.

Sycamore’s experience prompted her to investigate whether genetic differences could help explain problems she had seen throughout her career in mental health pharmacy.

She said some of her patients had experienced unexpected side effects while others did not respond to medicines as anticipated.

Many underwent genetic testing.

“It came back with these genetic variants that explained why their medicines weren’t working or why they were having so many side effects.”

In some cases, she said the information helped clinicians prescribe doses markedly lower or higher than would ordinarily be used.

“Medicines are designed for the average person, but people aren’t average.”

Kyra Sycamore, director of PGx Health, is a specialist mental health pharmacist who conducts pharmacogenomic testing for people who have experienced medication side effects. Photo / Anna Heath

Sycamore stressed that genetic testing could not predict which medicine would work for a patient.

Instead, it could provide information about how their body processed particular drugs and help clinicians make prescribing decisions.

Sycamore has now launched Christchurch-based PGx Health, offering pharmacogenomic testing using a cheek swab.

People can approach the service without a referral and consultations can be held online, allowing testing to be accessed from elsewhere in New Zealand.

The service costs $795, which includes an initial consultation, laboratory testing, a simplified report and a follow-up consultation.

Sycamore said results generally return within two to three weeks of the test being sent away.

PGX Health pharmacogenomic testing involves a cheek swab and costs $795. Results are typically available within two to three weeks. Photo / Anna Heath

For her, having that information years earlier could have made a difference in her treatments and recovery, but she said her experience was minor compared with people living with chronic conditions who had repeatedly struggled to find medicines they could tolerate.

Over the years, she met people who had tried multiple antidepressants and experienced so many side effects that they became afraid to try another.

“Really heartbreaking stories of people living with mental illnesses that aren’t being effectively treated,” Sycamore said.

“There’s obviously no guarantee whatsoever that this testing would change that, but it certainly provides another piece to the puzzle.”

Rachel McLaren sought testing for her 15-year-old autistic son after he experienced reactions to several medicines.

One antidepressant led to a “psychosis event”, while another caused sweating and heart palpitations when the dose was increased.

McLaren said her son underwent the cheek-swab test with Sycamore about four weeks ago, using his individualised disability funding to cover the cost.

Results showed he generally metabolised medicines normally, but also identified potential issues with some pain relief and an antibiotic.

“It just means that we’ve got a little bit more knowledge on what he needs and maybe what he doesn’t need in terms of multi medications rather than just using the ones that are more effective for him,” she said.

University of Otago research professor Martin Kennedy, whose laboratory has worked on pharmacogenetics for about 30 years, said pharmacogenetic testing could help identify genetic variants that affect how people respond to medicines.

Kennedy said about one in 20 people worldwide completely lack activity of CYP2D6, a key liver enzyme.

“We call them poor metabolisers,” he said.

“That means they have increased adverse reactions to some drugs and to others, like codeine and tramadol, they are likely to have limited response.

“We also know about many other variants of CYP2D6.”

He believed routine testing for some key genes should be more widely available, but said cost and pressure on the public health system were barriers.

“For pharmacogenetics to really work in our health system, the results need to be effectively recorded in electronic medical records and connected such that anyone prescribing drugs to a patient receives immediate and clear decision support.

“That is the goal, although we are some way from that point, I’m afraid.”

Health New Zealand Te Whatu Ora national chief medical officer Dame Helen Stokes-Lampard said pharmacogenomic testing was publicly funded but generally limited to circumstances where it could directly inform treatment, such as some cancer treatments.

“Patients who experience unexpected side effects from a medicine or find that a treatment is not working as expected should first discuss their concerns with their GP or treating health professional.”

Stokes-Lampard said there was no established national pathway, with testing considered case-by-case, while Health NZ was considering how access could develop over time.

Rafaella Melo is a multimedia journalist with more than 10 years’ experience in Brazil. She spent two years reporting for Hawke’s Bay Today before joining the NZ Herald’s Christchurch team in 2026.