Abstract
BackgroundPharmacists possess a skillset suited to provide evidence-based guidance to current and potential users of cannabis. Clinical pharmacogenomics research has made significant progress in defining which genetic variations are important for influencing inter-patient variability in response to cannabis. This study aims to evaluate the practicality and impact of pharmacogenetic testing in the community pharmacy to help guide in the safe use of cannabis.MethodsThe pilot program was designed as open-label, non-randomized, and observational. Two busy, urban community pharmacies, operating under the brand Shoppers Drug Mart, in Toronto, Ontario, Canada offered pharmacogenomic testing to cannabis users as part of their professional services program over a period of 2 months. Eligible patients received buccal swabs using a DNA cheek swab kit. De-identified, barcoded samples were then sent by regular mail to an off-site CLIA-certified laboratory for analysis in Mississauga, Canada. A pharmacogenetic testing platform from Lobo Genetics® was utilized for translation of participants’ DNA with respect to CYP2C9, AKT1 and COMT genetic polymorphisms. Following genomic data translation, personalized, evidence-based recommendations were generated. Pharmacists provided a cannabis pharmacogenetic consultation to patients via telephone or in-person.ResultsTwenty patients enrolled in the study. Pharmacogenetic screening identified 95% as having the CYP2C9*1/*1 genotype (suggesting normal THC metabolism); 35 and 25% had AKT1 genotypes suggesting intermediate risk (C/T genotype) or high risk (C/C genotype), respectively, for cannabis-induced psychosis; and 45 and 10% had COMT genotypes suggesting intermediate risk (Val/Met genotype) or high risk (Val/Val genotype), respectively for cannabis-induced neurocognitive impairment.After the pharmacogenetic consultation, 65% of patients reported an increased comfort level in choosing a specific strength/strain of cannabis for use in the future; 75% considered the consultation of high value providing information potentially vital to their health and wellbeing.ConclusionAlthough the study did not find any CYP2C9 variants associated with highly diminished THC metabolism, most of these patients do carry genetic variants that may potentially predispose them to the development of psychosis and memory impairment. Similar initiatives can potentially improve patient safety and empower individuals to make informed decisions about cannabis use and possible complications.
Highlights
As cannabis use becomes more prevalent, it is critical for the public to be educated on its potential therapeutic benefits, but more importantly, on the associated risks and variability in individual responses (Government of Canada n.d.-a; Government of Canada n.d.-b)
Consistent with epidemiological studies, pharmacogenetic screening identified that the majority of the study population (95%) had the Cytochrome P450 2C9 (CYP2C9)*1/*1 genotype
Analysis of the AKT1 and COMT genotypes revealed that over half (> 55%) of the participants had gene variants that significantly increased their risk of potentially developing psychotic symptoms and/ or cognitive impairment
Summary
As cannabis use becomes more prevalent, it is critical for the public to be educated on its potential therapeutic benefits, but more importantly, on the associated risks and variability in individual responses (Government of Canada n.d.-a; Government of Canada n.d.-b). Pharmacists are highly accessible health care professionals who are trained to provide evidence-based guidance to current and potential users of cannabis (Dattani and Mohr 2019). Pharmacists’ involvement in cannabis education has been limited by their training and cannabis-related experience This is further made difficult from the lack of standardization of cannabis products and availability of tools to predict individual response and tolerance from genetic variability (Hryhorowicz et al 2018). Clinical pharmacogenetic research has made significant progress in defining which genetic variations are important for influencing inter-patient variability in drug response including cannabis (Hryhorowicz et al 2018) (Hirota et al 2013). Clinical pharmacogenomics research has made significant progress in defining which genetic variations are important for influencing inter-patient variability in response to cannabis. This study aims to evaluate the practicality and impact of pharmacogenetic testing in the community pharmacy to help guide in the safe use of cannabis
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
