OPRM1 influence on and effectiveness of an individualized treatment plan for prescription opioid use disorder patients

Abstract

Screening for opioid use disorder should be considered in chronic non-cancer pain (CNCP) patients with long-term use of opioids. The aim of our study was to assess the effectiveness of an individualized treatment plan (ITP) for prescription opioid dependence that included screening of pharmacogenetic markers. An observational prospective study was performed using prescription opioid-dependent CNCP outpatients (n = 88). Patients were divided into nonresponders, responders, or high responders according to their response to the ITP. Genotyping of OPRM1 (A118G), OPRD1 (T921C), COMT (G472A), ABCB1 (C3435T), and ARRB2 (C8622T) was performed by real-time PCR. Our ITP achieved a significant reduction of the morphine equivalent daily dose (MEDD) in 64% of responders, including 33% of high responders. Nonopioid medication or buprenorphine use was significantly higher at final versus basal visit. 118-AA OPRM1 patients required significantly lower MEDD at basal and final visits. Our ITP showed effectiveness and security in reducing MEDD in opioid-dependent patients, with good conversion to buprenorphine that was more pronounced in 118-AA OPRM1 patients.

Genetic Contribution in Low Back Pain: A Prospective Genetic Association Study

“…It encodes an alternative isoform that affects incidence, intensity, or duration of chronic pain and the consumption of opioids 54,55 6 ¼ For patients carrying OPRM1 118-AG/GG and COMT 472GG or these genotypes alone, in cancer pain a significantly higher median percentage dose increase was observed (95.2% [32.8 to 345], P = 0.0016) 56 6 ¼ OPRM1 A118G-AA patients required significantly lower opioid dose in deprescription procedure in opioid use disorder 57 6 ¼ A118-GG allele is associated with decreased acute postoperative pain relief after piritramide and opioid dose requirements 58,59 6 ¼ Homozygous for OPRM1 A118G-A allele carriers needed significantly lower doses of morphine for pain relief (30% of differences) 58 6 ¼ Influences the analgesic effect of morphine for immediate acute postoperative pain in children 60,61 UGT2B7 A842G A842G-GG (final): more neuropathic component, depression and vomiting Increased conjugation for buprenorphine and morphine 6 ¼ Fentanyl sensitivity for cold pressor-induced pain was associated with the rs7439366, rs4587017, and rs1002849 SNPs of the UGT2B7 gene. Different dose of morphine.…”

Pharmacogenetics and prediction of adverse events in prescription opioid use disorder patients

“…Clinical interviews were performed to evaluate the physical health, the drug use and medical history of the patients. Patients were then enrolled in a deprescription programme, 9 which consisted of opioid rotation together with a tapering procedure. Physicians took account of the clinical conditions of each individual patient when performing this procedure, but the general procedure was as follows: removal of rapid delivery opioids; rotation to opioid patches (buprenorphine or, as an alternative, fentanyl); opioid dose tapering with the addition of tramadol and the progressive reduction in the buprenorphine dose.…”

“…), and individualized intervention was undertaken to prevent such events. 9 In addition, for monitoring purposes, patients received weekly phone calls from an occupational therapist.…”

“…The patients reported a total of 1659 AEs in a total of 359 visits (median of 7 [4][5][6][7][8][9] EAs/visit). The most frequent AEs classified by system were psychiatric (21%) and gastrointestinal disorders (20%; Figure 3A).…”

“…7 Once presented, an individualized opioid tapering or deprescription treatment plan should be applied, together with general recommendations that include monitoring, opioid rotation, discontinuation of therapy and prevention of suspected opioid adverse drug reactions (ADRs) or adverse events (AEs). 8,9 At present, there are only limited guidelines for prescribing opioids and other analgesics for CNCP patients. Given the large economic burden of opioid-related ADRs, the most effective strategy may consist of prevention rather than treatment.…”