Patients Needing High-Dose Opioids May Have Genetic Defects | Medpage Today | September 11, 2016 | by Molly Walker from Pain Week 2016
Chronic pain patients who require high-dose opioids seem to have genetic anomalies that impact their ability to metabolize drugs, researchers reported here.
In a small survey, 91% of patients taking opioids in excess of 100 morphine milligram equivalent (MME) per day had defects in cytochrome P450 enzymes, which are involved in drug metabolism.
This has been well known since at least 2012, so it seems quite outrageous that the CDC guidelines never took it into account in their supposed “scientific” guidelines.
Establishing arbitrary dose limits without accounting for significant individual genetic differences shows a disregard for scientific facts and is a sad display of the lack of medical knowledge at the CDC.
“Now everybody’s interested, because CDC regulations and state guidelines have established standard of care,” said Tennant. “Every pain practitioner, if they’re going to go [with a dose above 100 MME level should probably have their patients take genetic tests. This is a simple screen that is being offered by all genetic testing companies.”
“Genetic testing may allow us greater insight in to how these drugs behave in the bodies of individual patients, and may be able to explain why a subset of patients seem to require very high doses,”
“Exploiting genetic difference between patients may someday soon help us better target therapy so as to minimize risk to the patient while affording them optimal analgesia.”
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