What if genetic test could alert you to future addiction to opioids?
COLUMBUS, Ohio – A doctor faces an impossible choice every time she must decide whether to give an emergency room patient a painkiller.
"I'm faced with this battle. How do I decide how much pain medication to give someone?" asked Caroline Freiermuth of the University of Cincinnati Medical Center.
Freiermuth wants to treat their pain. She doesn't want them to suffer or purchase illicit opioids or heroin on the street. But she doesn't want to contribute to an opioid addiction.
She's largely left on her own to make that decision. There are few tools or guidelines she can use to guide her path.
What if there was a genetic test that could determine whether certain people were more likely to develop opioid use disorder?
That's the goal of a year-plus study that the University of Cincinnati and Ohio State University will launch in January 2020 – the most comprehensive look into how our genetic makeup might affect addiction.
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The $1.6 million study will recruit up to 1,500 emergency department patients – some diagnosed with opioid use disorder and others with little experience with opioids – swab their cheeks and send the genetic information to Michigan-based Genemarkers for testing.
Patients' DNA won't be linked to their names and won't be used by police – a potential concern if patients are treated for overdoses.
Ohio Attorney General Dave Yost's office oversees the project, hoping to use science to inform opioid addiction prevention. That could ease the burden on police and addiction counselors who have become the front lines of Ohio's opioid crisis.
Fatal overdoses declined in 2018 for the first year since the opioid epidemic started, according to early data from the U.S. Centers for Disease Control and Prevention. Nearly 68,000 people in the USA died of drug overdoses that year.
Yost said he wants to know why he was able to take painkillers after a back surgery without becoming addicted to the drugs, but his friend, a U.S. Marine, had his life upended by opioids.
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"This is not a guy that lacks willpower," Yost said. "Why am I standing here today drug-free and he is struggling to maintain, years later, his sobriety?"
Dr. Jon Sprague, who leads the Attorney General's Future of Forensic Sciences at Bowling Green State University, said Ohio's study will be the most comprehensive. A similar effort in Michigan included about 200 patients.
If researchers could predict who might be predisposed to opioid addiction, that could be an invaluable tool for doctors, Freiermuth said.
Someone facing a back surgery with a genetic predisposition toward opioid use disorder might get more counseling or more regular follow-up visits. Someone in the emergency room might receive a different dose.
"I hope the day comes when you don't have to make that decision anymore without guidance," Yost said.
Follow Jessie Balmert on Twitter: @jbalmert