Nearly 116 people die every day from opioid-related drug overdoses. Declared a public health emergency by the Department of Health & Human Services in 2017, the opioid crisis has taken the country by storm with misuse of prescription painkillers on the rise. Today, a large number of patients prescribed opioids for chronic pain abuse the drugs in some way. Opioids, the highly addictive class of drugs used to treat pain, are often exploited for the sense of wellbeing or euphoria they elicit. As with any addiction, opioid addiction is known to affect patients from all walks of life.
Unfortunately, opioid addiction is widespread, and it is not unlikely to have already affected someone you know. Whether it be in a friend, neighbor, or coworker, the dependence that stems from abuse has the ability to permanently ruin lives and relationships. Aside from the clear detriment to public health, this national crisis wreaks havoc on social and economic welfare. To date, the economic cost of the opioid crisis is an estimated $1 trillion. Through 2020, the crisis is projected to cost the United States an additional $500 billion if the burden continues at current rates.
The opioid crisis has been known to effect each region of the nation to varying degree. The rural Midwest (Ohio, Michigan, Indiana, Kentucky, and West Virginia) has suffered greatly. Ohio, in fact, ranks as one of the top five states for opioid-overdoses. However, there is hope. According to Ohio Department of Health, in 2017, Ohio experienced an 8-year low in prescribed opiate-related deaths. Ohio has also seen a drop in opioid prescriptions for a fifth straight year, and a 28 percent fall in the number of opioids dispensed to Ohio patients. The reduction in opioid prescription noted in Ohio is due in part to the integration of alternative therapies for pain.
For some time, there’s been talk of pain management with various natural remedies. Electrical stimulation therapy, aroma therapy, stress management, food therapy, and magnetics have all been explored with varying levels of validity and success, but these therapies have not answered the call of the crisis. The true innovation in pain management lies in a new approach to opioid prescription. Pharmacogenomics, the study of how genes affect a person’s response to drugs, is an excellent tool to individualize the prescription of medications for pain. Just as one’s genetics influence, for example, eye, skin, and hair color, so too do genetics determine an individual’s ability to metabolize drugs effectively. The field of pharmacogenomics seeks to apply an individual’s genetics to lead to the most rational and tailored administration of medication.
As an example, codeine is metabolized by most individuals into morphine, thus providing pain relief. Individuals whose genetic makeup, however, is such that they will metabolize codeine rapidly may suffer an adverse, possibly fatal, drug reaction. Furthermore, those whose genetics dictate that they are poor metabolizers of codeine will get inadequate pain relief. They may therefore use up their prescriptions too quickly and be labeled as “drug-seeking” when they return for a prescription too early. Or, perhaps worse, they may stop taking the codeine that is ineffective for them, their pain persists, and the unused drugs may find their way to the streets. The same gene that controls codeine metabolism also controls the metabolism of tramadol, hydrocodone, and oxycodone – other opioid drugs.
In these examples, pharmacogenomics can be used to guard against potentially dangerous adverse drug reactions, to eliminate the stigma that may be ascribed unfairly to some based solely on their genetics, and to uncover an effective treatment for each patient’s pain. These different metabolizer states can be tested for quickly in the clinical laboratory before a prescription is written for a patient with pain. Test results can then be used to write a prescription more specifically suited to that patient based on his/her pharmacogenetics, an excellent example of precision medicine.
In 2019, with increased access to genetic testing, pharmacogenomics is poised to make significant inroads into precision medicine. Since its inception, pharmacogenomic testing has seen modest integration into clinical practice. But with its applications for pain, an uptick is expected in the wake of the crisis. Nationwide, healthcare professionals are working hard to make pharmacogenomic testing an integral part of caring for patients and their pain, so we may do all we possibly can to one day vanquish the opioid crisis.