Category: Fellows Posters
The opioid epidemic is an ongoing public health crisis with over 100 million people in America suffering from chronic pain. According to Annals of Internal Medicine an average of 19.1 million opioid prescriptions are written each month. New York State’s Public Health Law Section 3331 states opioids shall not be prescribed for more than three months for chronic pain unless there is a documented treatment plan. Pharmacogenomics aids in predicting responses to specific medications and optimizing drug regimens. The study aims to reduce patients’ opioid usage by utilizing pharmacogenomics testing to design treatment plans in accordance with state regulations.
The Admera-Allure fellowship program in collaboration with All Med Medical Group used pharmacogenomics to assess the appropriateness of current chronic pain treatment regimens. This institutional review board approved evaluative study assessed patients that underwent pharmacogenomic testing between January 1, 2019 to August 31, 2019. In order to be included in the study, the patients’ samples must have been successfully analyzed. Further inclusion criteria emphasized that patients must have been on opioids for over three months while currently seeing a provider at the All Med clinic. Patients provided consent to undergo pharmacogenomic testing as well as to be included in this study. The pharmacist and physician, under the scope of a collaborative practice agreement, identified patients by reviewing medical charts. The patients provided buccal swabs, which were used to extract DNA and generate a personalized report of respective genotypes and phenotypes. Samples were analyzed using Admera Health’s Next Generation Sequencing technology. Morphine milligram equivalents were calculated to standardize the dosing across the study population. The pharmacist recommended treatment plans based on pharmacogenomic testing and reviewing diagnoses defined by the International Classification of Diseases tenth revision codes. Plans consisted of a reduction up to 50% in morphine milligram equivalent.
A total of 24 patients were included. The mean baseline morphine milligram equivalent value was 54.16 per day. The mean change in morphine milligram equivalent reduction was 28.33 per day (52.3%). 70.8% of patients were changed from a high dose of opiates to a lower dose of opiates. 29.2% of patients were switched from a narcotic to a non-narcotic. Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients. The goal is to emphasize the importance of allocating resources toward non-opioids and non-pharmacological options in order to minimize addiction and dependence.
In managing the opioid crisis, pharmacogenomics can serve as a guide for more targeted drug selection and dosing while maximizing efficacy and minimizing adverse events. Pharmacogenomics plays an important role in clinical pain management as variants in individual genes can be predictive of how patients can respond to specific medications. Collectively, these results show that reactive pharmacogenomics testing has the potential to reduce chronic opioid usage. Future studies should be done to emphasize the importance of preemptive pharmacogenomics testing in tailoring a safe and effective therapy. Moving forward pharmacogenomics can play a prominent role in pain management.