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Fighting the Opioid Epidemic with Genetic Testing

Posted by Larry Saunders on July 25, 2018 at 9:16 AM

Sometimes the effectiveness of a drug depends on how our bodies process it.  A lot of drugs are inactive until our liver enzymes transform them into an active form. Opioids (Vicodin, Percocet, OxyContin) work in this manner.  Someone whose body has little or no ability to process opioids into their active form receives very little or no pain relief. They are also more likely to take a higher dose than was prescribed in their quest for pain management.

At the other end of the spectrum is a patient whose body is very efficient at processing opioids into their active form. They can experience higher levels of sedation, addiction and other systemic side effects at lower doses than patients that process opioids normally.

Since there are other pain management medications and therapies besides opioids, it would make sense to avoid prescribing opioids to patients that have a reduced ability to change them into their active form.  In addition, an adjustment of dosage would be in order for patients whose bodies process them very efficiently. These points beg the question: Since over 80% of opioid addictions begin with prescription opioids, would more accuracy in prescribing have an impact on outcomes? 

If only science had evolved to the point that we could do away with the antiquated trial and error method of prescribing. If only we knew what liver enzymes are used to process opioids. If only we could tell how effective that enzyme was from a patient’s DNA. If only there was a simple, affordable, noninvasive test that could be administered to patients prior to or shortly after they are prescribed an opioid that would provide this type of information to their clinician. If only it was 2018!

The liver enzyme that opioids rely on is CYP2D6. Just as some genotypes produce brown eyes and some genotypes produce blue eyes, we can tell how effective a patient’s CYP2D6 enzyme will be based on their DNA. A specimen collected using a simple cheek swab, not only provides information about how a patient will process opioids, but also over 135 other commonly prescribed medications.

The population frequency of abnormal metabolizers of opioids is about 20%. For the cost of one inpatient addiction treatment ($20,000), 50 patients that are prescribed opioids can be tested.  This allows clinicians to identify the 10 that may be better served with other treatment methods.

Drug claims management that employs precision medicine reduces drug spend by eliminating time and money spent on drugs that simply don’t work in patient’s bodies. In addition, medical claims are reduced by preventing adverse drug reactions and addictions. Better information produces better outcomes and improves overall population health.