Recent research findings suggest that genetic testing might explain as well as predict clinical responses to opioid painkillers and thus help the pain clinician identify patients who are genetically predisposed to opioid use disorders. The variability of responses to pain treatment seen with opioid pain relievers (OPRs) has always been a challenge for clinicians, primarily due to differences in the bioavailability of various opioid medications and prior OPR use and tolerance. Whereas urine drug testing may offer clues about genetic issues with opioid metabolism, in recent years, cheek-swab DNA testing has become more economically viable.
Proove Bioscience, an Irvine, California- based biotech company has developed a cheek swab DNA test that, coupled with a specific questionnaire, serves to identify a patient's genetic risk of opioid misuse/use disorders. Proove Bioscience CEO Brian Meshkin claims the new DNA test has an accuracy rate of 93%. Per Meshkin, the biotech company's research will be published in scientific journals in the coming months.
This genetic test may help predict less hazardous and more effective pain medication choices as well as doses and thus influence pain clinicians' decisions involving their patients. In a recent interview, Brian Meshkin said that the newly developed cheek-swab DNA test will make the difference between clinicians knowing and guessing patients' response to opioid painkillers.
Per the American Society of Addiction Medicine, close to 2 million Americans were addicted to painkillers in 2014 and nearly 19,000 died from analgesic overdoses, with 6 out of 10 of those overdose deaths involving OPRs. The onset of an opioid use disorder typically occurs in the pain clinician's office and patients are not aware they are more genetically predisposed to this disease until it's too late.
Su Henriquez, whose mother has struggled with the disease for years, recently underwent the cheek-swab DNA test which revealed that she has a low pain tolerance level and is moderately predisposed to suffering from an opioid use disorder. Su Henriquez's clinician, orthopedic surgeon Hooman Melamed is one of nearly 300 pain clinicians already offering Proove Bioscience's DNA test in the US.The FDA classifies this DNA test as a laboratory developed test and this is why it's allowed on the market.
Dr. Richard Friedman, professor of clinical psychiatry at Weill Cornell Medical School is skeptical about the newly developed DNA test, claiming that although predictive biomarkers are very promising, they provide little advantage over pain clinicians' assessment of patients' response to pain treatment and symptoms. Dr. Friendman also said that Proove Bioscience's claims cannot be taken seriously by the public and medical community until they are published in peer-reviewed journals. Dr. Friedman's statement regarding the new cheek-swab DNA test is echoed by experts in the genetics of addiction.
Per Mary Jeanne Kreek, PhD of Rockefeller University in NYC, genetic predisposition to opioid use disorders involves dozens of genetic variants or SNPs, which encode for the kappa and mu opioid receptors, for serotonergic and dopaminergic receptors as well as for the COMT enzyme responsible for breaking down neurotransmitters. Addiction genetics expert Zena Samaan, PhD of McMaster University claims that genetics account for nearly half of an individual's risk of dependence on pain medication, with the other half of dependence risk coming from social, cultural and environmental factors.