Combating opioid addiction and abuse—2 ways to effectively intervene in the cycle of addiction through pharmacogenomics

Abstract

ObjectivesThe objectives of this commentary are to: (1) briefly describe the ongoing challenges of addressing opioid abuse, (2) examine codeine metabolism in terms of pharmacogenomics, (3) describe 2 points of patient contact where pharmacogenomics can be implemented to determine the appropriateness of opioid therapy, and (4) briefly explore the value of pharmacogenomics in opioid-abuse and dependency research. SummaryOpioid abuse is one of the most significant medical, social, and economic threats facing our country today. Yet for some patients, opioids are the only effective treatment option in achieving pain relief. Differentiating patients who are susceptible to abuse and addiction from those who are not has been absent in standard statistics-based medication prescribing. Pharmacogenomics (PGX) is a burgeoning science that examines how gene variations (variants) influence drug metabolism. With an estimated 23% of the U.S. population unable to properly metabolize codeine and related analogs, PGX could play an immediate role in the management of opioid therapy if applied (1) as part of regular pre-operative screening assessments and (2) prior to or in conjunction with pain-management referral. ConclusionUsing PGX to identify patients who should not begin or continue treatment with opioids because of abnormal metabolic pathways could (1) reduce the number of opioid prescriptions written; (2) reduce related costs; (3) guide more patient-centric, pain-management treatment plans, away from opioids as necessary; and (4) reduce the potential for opioid abuse and addiction.