Molecular Genetic Testing in Pain and Addiction: Facts, Fiction and Clinical Utility

Blum, Kenneth; Hauser, Mary; Fratantonio, James; Badgaiyan, Rajendra D.

doi:10.1515/addge-2015-0001

Cited by 6 publications

(6 citation statements)

References 29 publications

(25 reference statements)

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“…Starrels et al (257) argued that there is weak evidence to support the success of opioid treatment agreements and urine drug testing in decreasing opioid abuse by patients with chronic pain throughout treatment. In contrast, others suggest that urine drug testing is still an invaluable resource for primary care (258).…”

Section: Drug -Urine Testingmentioning

confidence: 99%

Neurogenetics of acute and chronic opiate opioid abstinence treating symptoms and the cause

et al. 2017

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This review begins with a comprehensive history of opioid dependence and treatment in the United States. The focus is an evidence-based treatment model for opioid/opiate dependent individuals. The role of reward genetic polymorphisms and the epigenetic modifications that lead to vulnerability to use and misuse of opiates/opioid to treat pain are reviewed. The neurochemical mechanisms of acute opiate withdrawal and opiate/opioid reward mechanisms are explored with a goal of identifying specific treatment targets. Alterations in functional brain connectivity based on neurobiological mechanisms in heroin dependence and abstinence are also reviewed. A new clinical model an alternative to merely blocking acute withdrawal symptoms as identified in the DSM -5 is proposed. Genetic diagnosis at the onset of detoxification, to determine risk stratification, and identify polymorphic gene targets for pharmaceutical and nutraceutical interventions, followed by the simultaneous initiation of Medication Assisted Therapy (MAT), to enable psychological extinction, and steady pro-dopaminergic therapy with the goal of developing "dopamine homeostasis" is recommended. The objective of these interventions is to prevent future relapse by treating all "Reward Deficiency Syndrome" (RDS) behaviors and eventually make an addiction-free life possible

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Section: Drug -Urine Testingmentioning

confidence: 99%

Neurogenetics of acute and chronic opiate opioid abstinence treating symptoms and the cause

et al. 2017

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“…The release of dopamine, the neurotransmitter responsible for motivation and stress reduction, is the neurological reward cascade's functional endpoint. Consequently, genetically predisposed people with a hypodopaminergia seek out substances and behaviors to overcome this trait by activating mesolimbic brain dopaminergic centers [18,20]. Lacking balanced dopamine function, an individual may have anhedonia, lack a sense of well-being, and may have difficulty with craving pleasure, lack of motivation, and coping with stress.…”

Section: Understanding Garsmentioning

confidence: 99%

High Genetic Addiction Risk Score (GARS) in Chronically Prescribed Severe Chronic Opioid Probands Attending Multi-pain Clinics: an Open Clinical Pilot Trial

et al. 2021

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Millions of Americans experience pain daily. In 2017, opioid overdose claimed 64,000 lives increasing to 84,000 lives in 2020, resulting in a decrease in national life expectancy. Chronic opioid use results in dependency, drug tolerance, neuroadaptation, hyperalgesia, potential addictive behaviors, or Reward Deficiency Syndrome (RDS) caused by a hypodopaminergia. Evaluation of pain clinic patients with the Genetic Addiction Risk Score (GARS) test and the Addiction Severity Index (ASI- Media Version V) revealed that GARS scores equal to or greater than 4 and 7 alleles significantly predicted drug and alcohol severity, respectively. We utilized RT-PCR for SNP genotyping and multiplex PCR/capillary electrophoresis for fragment analysis of the role of eleven alleles in a ten-reward gene panel, reflecting the activity of brain reward circuitry in 121 chronic opioid users. The study consisted of 55 males and 66 females averaging ages 54 and 53 years of age, respectively. The patients included Caucasians, African Americans, Hispanics, and Asians. Inclusion criteria mandated that the Morphine Milligram Equivalent (MME) was 30–600 mg/day (males) and 20 to 180 mg/day (females) for treatment of chronic pain over 12 months. Ninety-six percent carried four or more risk alleles, and 73% carried seven or more risk alleles, suggesting a high predictive risk for opioid and alcohol dependence, respectively. These data indicate that chronic, legally prescribed opioid users attending a pain clinic possess high genetic risk for drug and alcohol addiction. Early identification of genetic risk, using the GARS test upon entry to treatment, may prevent iatrogenic induced opioid dependence.

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Section: Precision Behavioral Managementmentioning

confidence: 99%

“…The genetic identification of RDS behavior risks, especially in groups with an increased percentage of genetic vulnerabilities, may be an important early technique to assist government agencies in improving the distribution of available financial resources. 29,30 Blum et al was the first group to report a genetic association with severe alcoholism 10 and later, cocaine. 11 Although there was disagreement within the scientific community in the 1990s, the Dopamine D2 receptor (DRD2) gene, located on chromosome 11 q22q23, 31 was the first gene identified to be associated with not only severe alcoholism, but more importantly, non-specific dopaminergic reward system impairment/ inadequacies (anhedonia), which are central to all addictive behaviors.…”

Section: Genetic Addiction Risk Severity (Gars)mentioning

confidence: 99%

A Review of DNA Risk Alleles to Determine Epigenetic Repair of mRNA Expression to Prove Therapeutic Effectiveness in Reward Deficiency Syndrome (RDS): Embracing “Precision Behavioral Management”

Blum¹,

Steinberg²,

Gondré–Lewis³

et al. 2021

PRBM

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This is a review of research on “Precision Behavioral Management” of substance use disorder (SUD). America is experiencing a high prevalence of substance use disorder, primarily involving legal and illegal opioid use. A 3000% increase in treatment for substance abuse has occurred between 2000 and 2016. Unfortunately, present day treatment of opioid abuse involves providing replacement therapy with powerful opioids to, at best, induce harm reduction, not prophylaxis. These interventions do not enhance gene expression and restore the balance of the brain reward system’s neurotransmitters. We are proposing a generalized approach called “Precision Behavioral Management”. This approach includes 1) using the Genetic Addiction Risk Severity (GARS, a 10 candidate polymorphic gene panel shown to predict ASI-alcohol and drug severity) to assess early pre-disposition to substance use disorder; 2) using a validated reward deficiency syndrome (RDS) questionnaire; 3) utilization of the Comprehensive Analysis of Reported Drugs (CARD™) to assess treatment compliance and abstinence from illicit drugs during treatment, and, importantly; 4) utilization of a “Pro-dopamine regulator (KB220)” (via IV or oral [KB220Z] delivery systems) to optimize gene expression, restore the balance of the Brain Reward Cascade’s neurotransmitter systems and prevent relapse by induction of dopamine homeostasis, and; 5) utilization of targeted DNA polymorphic reward genes to direct mRNA genetic expression profiling during the treatment process. Incorporation of these events can be applied to not only the under-considered African-American RDS community, but all victims of RDS, as a demonstration of a paradigm shift that uniquely provides a novel putative “standard of care” based on DNA guided precision nutrition therapy to induce “dopamine homeostasis” and rebalance neurotransmitters in the Brain Reward Cascade. We are also developing a Reward Deficiency Syndrome Diagnostic Criteria (RDSDC) to assist in potential tertiary treatment.

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Molecular Genetic Testing in Pain and Addiction: Facts, Fiction and Clinical Utility

Cited by 6 publications

References 29 publications

Neurogenetics of acute and chronic opiate opioid abstinence treating symptoms and the cause

Neurogenetics of acute and chronic opiate opioid abstinence treating symptoms and the cause

High Genetic Addiction Risk Score (GARS) in Chronically Prescribed Severe Chronic Opioid Probands Attending Multi-pain Clinics: an Open Clinical Pilot Trial

A Review of DNA Risk Alleles to Determine Epigenetic Repair of mRNA Expression to Prove Therapeutic Effectiveness in Reward Deficiency Syndrome (RDS): Embracing “Precision Behavioral Management”

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