Briefly Noted

Abstract

A recent study, “Toward precision prescribing for methadone: Determinants of methadone deposition,” shows that methadone dosing could be better individualized, focusing on the characteristics of different races. “The issue with methadone prescribing is that it is very difficult to accurately predict what the correct dose is, and the outcomes can be catastrophic,” said Andrew H. Talal, M.D., lead author of the study, published April 17 in PLoS One. “If too much is given, it can be fatal, and too little can lead to withdrawal symptoms and potentially the need to use illicit drugs, such as heroin, to diminish the symptoms.” Talal's comments came in a press release from the University of Buffalo, where he is with the Jacobs School of Medicine and Biomedical Sciences. Trying to determine the appropriate dose is “laborious and time‐consuming,” he said, noting that it usually starts with a low dose and is titrated up as needed. Instead, he is focusing on genetic and nongenetic differences on how methadone is metabolized. “Methadone prescription has really not changed in the past 50 years since the medication was originally discovered,” said Talal. “This is a time‐consuming and complex process from both the patient and provider standpoint.” The study was conducted on 97 participants, most African‐American or Hispanic. “According to the study's findings, gender, body mass index and ethnic background through encoding of different metabolizing enzymes can all affect how a patient metabolizes methadone,” Talal said. The study found that different ethnicities may encode different forms of the enzyme that metabolizes methadone so that some people metabolize it quickly while others are slow metabolizers, he said. “In this study, we found that the individual genotype of the liver enzyme that is responsible for methadone metabolism can have a direct effect on whether a patient is a slow or rapid methadone metabolizer.” The next step, of course, is larger studies in more diverse patient populations, with the ultimate goal of developing a methadone‐dosing algorithm that can be applied clinically. “Our ultimate goal is to decrease the incidence of deaths due to opioid overdoses, improve symptom control and increase patient satisfaction,” said Talal. Sometimes called “personalized medicine,” precision medicine is aimed at doing biometric tests of individuals to find out what medicine or treatment would work best for them, instead of doing trial and error. Psychiatric medications are a key target for this. One co‐author is the well‐known methadone treatment clinician and researcher Lawrence S. Brown of START Treatment and Recovery Center.