Recognize genetics’ role in opioid cases

PHOTOGRAPHER: Letters to the Editor

I would like to commend you for printing a copy of the editorial on “Bloomberg View” in the Oct. 28 Gazette. You had printed my letter to the editor on Jan. 1, 2015, concerning the opioid problem in this country and my recommendations for helping to reduce it.

Until recently, I hadn’t read any articles or editorials which supported my recommendations. More recently, that has been changing, including the editorial mentioned above.

I have been treating Opioid Use Disorder for over 14 years and it’s obviously a genetic illness. I have had many patients who were siblings, cousins and parent/child. My most recent new patient had a grandmother, as well as a sister, who were heroin addicts. Now we have a genetic test which may predict opioid addiction risk with 88 to 97 percent certainty. The test, called LifeKit Predict, uses an algorithm to calculate a patient’s addiction risk score based on 16 genetic variants in brain reward pathways.

This is in addition to the gene, OPRM1, on chromosome number six, which encodes the opioid receptors in the brain. The protein Delta FosB accumulates in the nucleus accumbens with opioid use and is one of the causes of addiction, but decreases with time during treatment.

The difference between addiction and physical dependence needs to be recognized. The person taking buprenorphine has a physical dependence, but not an addiction. There’s no “high” or cravings from buprenorphine, and the person feels “normal.” It’s similar to treating someone with diabetes or hypertension.

Treating pain is important, but now with this test the doctor can know how careful they need to be with a particular patient. The next problem will be its cost and whether insurance companies will cover such an order by the doctor to obtain this test, as they would for other medical lab tests.

If not, will the federal government be willing to pay for this test, which can give the prescribing doctor the information needed? I would hope they would, in view of the fact that they have wasted so much money on worthless programs from ignorance.

Jack L. Underwood

Schenectady

The writer is a psychiatrist.