A biotech company says it has a new DNA test that can identify patients who are genetically predisposed to opioid addiction. The company is Proove Bioscience in Irvine, California. They’ve developed a DNA test that accesses samples via cheek-swab, then compares the data from the results to a the patient’s answers on a questionnaire. The results, Proove says, will identify the patients’ risk of become addicted to the opioids prescribed to them, according to CBS News.
Opioid addiction has grown to epidemic proportions. Nearly 2 million people were addicted to pain medication in 2014. Nearly 19,000 people died from overdoses of narcotic pain medications, says the American Society of Addiction Medicine. The U.S. Surgeon General, Vivek Murthy, sent a letter to 2.3 million healthcare providers outlining the problem and soliciting their help in gaining control over the problem. More people are dying from drug overdoses than ever before and 60 percent of those deaths are from opioids. Due to accidents, injuries and serious illnesses, there are times when the prescription of opioid pain medications are required. Unfortunately, however, physicians are unable to determine which of their patients are more at risk for addiction. The patients have no way of knowing whether they themselves are genetically predisposed to addiction.
— Proove Biosciences (@proovebio) October 19, 2016
Enter Proove Bioscience and its new technology. Their new testing is promising in that it could have a significant impact on the numbers of addicted patients and overdoses. CBS Los Angeles spoke with a patient who was recently tested at a doctor’s appointment. Su Henriquez was eager to receive her results. The findings indicated she has a low pain tolerance and is at moderate risk of becoming dependent on opioid pain medications. She was disappointed in her results because she has seen her mother’s addiction issues firsthand. Now she knows that because she is predisposed to addiction, her mother’s history could easily be her future.
“This is so important to me. This is the meaning of the rest of my life.”
It is rather fortunate that Su Henriquez’s doctor offers the testing in his practice as there are only about 300 doctors in the United States who offers the Proove test. Dr. Hooman Melamed, an orthopedic spine surgeon, told her he will use the test results to help individualize Henriquez’s treatment plan.
“You’re already at high risk to begin with, which means you can go down the wrong pathway very quickly.”
Opioid drug dependence is not a crisis that has been solved, not by any means. In many areas it continues to grow. Often the problem begins in the doctor’s office when physicians write prescriptions for patients who may have never had a problem with these medications in the past. The doctor has no reason to believe the patient is predisposed to addiction, nor does the patient in many cases. They don’t even realize they’re at any level of increased risk until it’s too late. They can often become dependent fairly quickly, once the damage is done. Proove CEO Brian Meshkin told the Daily Beast that he’s hoping to improve doctor-patient interactions with the new testing.
“We can imagine a day where a doctor will prescribe a medication actually knowing whether a patient is going to respond or not, rather than just guessing.”
Meshkin claims a 93 percent accuracy rate on the testing, but those results are tentative at this point. The results have not yet been published in a peer-reviewed scientific journal, so some experts have not as of yet climbed aboard. Dr. Richard Friedman, a clinical psychiatry professor at Weill Cornell Medical School, is one of those experts. He said Proove Bioscience’s claims “cannot be taken seriously by scientists, clinicians, and, most importantly, the public,” until they’ve actually been peer-reviewed.
James, 31, is a patient struggling with opioid dependence who is now in the throes of withdrawal symptoms. “Right this minute I’m detoxing like hell,” he said. On top of extreme fatigue while unable to sleep, he’s suffering from aching, weakened muscles. These are but a few of the awful symptoms of withdrawal, says the Daily Beast.
James’s problems began quite innocently, at the age of 13. He was run over by a city bus in Cleveland, Ohio. For nearly a week, doctors pumped him full of morphine to help ease his excruciating pain. That’s all it took, he said. All these years later, James is still addicted to painkillers. He’s on disability, and struggling.
“I’ve tried like hell to get help or quit by myself but I just keep falling back in.”
In James’s case, addiction runs in the family. His father died of a heroin overdose when James was a child. Four years later when he was run over by the bus, he already had two strikes against him: a family history of addiction and coping with the grief of losing his father. He was vulnerable to addiction, but the doctors weren’t aware that he was predisposed because they didn’t ask. James believes it is this lack of caring that allowed him to become addicted. Unfortunately, it’s difficult for physicians to take into consideration the external and family factors they’re unaware of. It’s not common for a doctor to ask a patient if he was grieving before he was hit by a bus or if there’s a family history of addiction. Often patients are not forthcoming with certain information that they feel might lead to judgement. The doctors caring for James at the time were dealing with a very young patient who’d been hit by a bus, so their primary concern was pulling him through the trauma and hoping to minimize his pain during the healing process.
What complicates the issue further is the fact that some patients might have a family history of addiction or other factors that would leave them vulnerable and still not develop any type of dependence on opioids. Twin studies have shown that genetics only account for about half the risk, and the rest is environment. Each case is so individual that it’s hard to make the determination. Proove is hoping their testing will make all the difference in such patients.
The Proove Opioid Risk is a test that doctors give to patients the combines their genetic profile with other findings the physician observes while assessing and interviewing the patient. Meshkin says the patient is asked six questions that have been found to be highly predictive of future opioid addiction. One of those factors is a personal history of substance abuse or a diagnosis of depression. A DNA sample is collected from a cheek swab, and the DNA is then sent to Proove where 12 different gene variants are analyzed. All 12 are part of the brain’s mesolimbic system, the pathway of the brain associated with addiction. Physicians often refer to it as the “reward circuit” because it is activated when behaviors like taking drugs are present. Meshkin explains.
“All of this information is combined in our software. The algorithm then provides a report to the doctor classifying a patient as low risk, moderate risk or high risk.”
One of the important benefits of the testing is that not only does it provide what might prove to be important genetic information, but it also helps facilitate discussion between doctor and patient about the potential risks of using opioids. While some experts remain skeptical about the new DNA testing, Meshkin maintains that once the peer-reviewed information is published, it will remove these doubts. If DNA testing can identify people who are predisposed to opioid addiction, it could change the face of the treatment of pain and the struggles of addiction.
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