Pharmacogenomics is a field of precision medicine that attempts to individualize medical treatment to a person or group by examining the way in which DNA impacts responses to drugs.
This guide examines the role of pharmacogenomics in treating drug addiction.
What Is Pharmacogenomics?
Pharmacogenomics is the scientific study of the role of genes in a person’s response to medications. The field combines the science of drugs (pharmacology) and the study of genes (genomics) in order to develop safe and effective medications that can be administered according to a person’s genetic makeup.
Many medications commonly prescribed are one-size-fits-all, but not all medications work the same way for all people. Predicting who may benefit from a medication, who may not respond to a medication, or who may experience ADRs (adverse drug reactions) can be challenging. According to the FDA, more than 2.2 million U.S. citizens experience ADRs in any given year, with over 106,000 dying as a result.
Researchers are still learning how gene variants can influence how the body responds to medications. Genetic differences can be used to predict the effectiveness and dosage of a medication for a specific person, and also to help reduce the occurrence of adverse drug reactions.
Pharmacogenomics is a new and growing field. Various innovative approaches are under clinical study. Future pharmacogenomic goals include the development of tailored drugs to treat:
- Cardiovascular disease
How Pharmacogenomics Works
Different drugs interact with your system in many ways, depending on the route of administration and where in the body the drug acts. After ingesting a drug, your body must metabolize it, breaking it down and getting it to the target area. Your DNA can influence several steps in the process and can affect your response to a drug. Examples of interactions include:
- Drug receptors: Some drugs attach to receptors – proteins on cells – in order to work effectively. Your DNA impacts the type and number of receptors you have, which can influence your response to a drug. You may require a higher or lower than average dosage, or you may need a different drug.
- Drug uptake: Some drugs must be actively absorbed into the cells and tissues on which they act. With certain drugs, your DNA may affect uptake. In the event of decreased uptake, the drug may not work effectively, and it may accumulate in other parts of the body, triggering complications. Your DNA may also influence the rate of elimination of a drug from the relevant cells. If drugs are removed from cells too quickly, they may not have time to work.
- Drug breakdown: Your DNA can impact the rate at which your body metabolizes a drug. If you break a drug down more rapidly than average, your body will expel the drug more rapidly, too. This might mean that you require more of the drug, or potentially an alternative drug. and you might need more of the drug or a different drug. If you break a drug down more slowly than average, you may be prescribed less of a drug.
Research on Pharmacogenomics
NIH-funded scientists, – PGNR (Pharmacogenomics Global Research Network) – have been studying the effect of genes on various medications for years. The medications being studied include those for the treatment of depression, cancer, heart disease, and asthma.
PharmGKB is a resource that outlines current research findings in the field of pharmacogenomics.
How Pharmacogenomics Can Influence Prescribing Guidelines
The FDA (U.S. Food and Drug Administration) monitors the safety of drugs in the United States. Today, the FDA includes pharmacogenomic data on the labels of 200 different medications. Physicians can use this information to tailor prescriptions for patients. Pharmacogenomic data can help doctors:
- Prescribe the most appropriate dosage of a drug.
- Predict the likely side effects of a drug.
- Calculate the probable effectiveness of a drug in those with gene variants.
Pharmaceutical companies also use pharmacogenomic data to develop and market drugs for individuals with certain genetic profiles.
How Can Pharmacogenomics Help Treat Addiction?
Genomic technology today has advanced to enable the personalized prescription of many medications. The FDA has expanded their list of accepted genomic biomarkers to include many SNPs (informally known as snips of DNA) and gene variants that can influence the effectiveness of drugs.
Pharmacogenomics for treating alcohol dependence
Naltrexone is an opioid antagonist used to treat alcohol dependence. This is the most studied pharmacogenetic association.
Alcohol dependence: naltrexone & topiramate
Naltrexone (a µ-opioid antagonist used to treat alcohol dependence) is perhaps the most researched pharmacogenetic association.
Research shows that individuals with variant Asp40 alleles are more than three times as likely to respond positively to naltrexone treatment than those with identical alleles.
Pharmacogenomics for treating opioid dependence
Methadone (an opioid agonist) and buprenorphine (a partial opioid agonist) are proven effective for treating opioid dependence with replacement therapy.
Both methadone and buprenorphine are influenced by CYP-regulated pharmacokinetics. This can impact the effectiveness of treatment in a person.
Today, there is a rapid SNP blood screen available to help identify those who may metabolize buprenorphine too quickly.
It is also widely accepted that dopamine D2 receptors help shape the reinforcing effects of many addictive substances. These receptors are decreased in those dependent on opioids.
Pharmacogenomics for treating cocaine dependence
There are currently no medications approved by the FDA for the treatment of cocaine addiction (stimulant use disorder).
Pharmacogenomic studies indicate that disulfiram (used to treat alcohol dependence) and dexamphetamine (used to treat ADHD) show promise in some genetically-selected subgroups.
What’s Next for Pharmacogenomics?
New generations of technology for genomic characterization have propelled the field of pharmacogenomics to date. Regrettably, it is not practical to immediately translate this enormous volume of genomic data in clinical practice due to the requirement for multiple studies to verify and confirm the data in a real world setting.
Professional organizations like ASHP (American Society of Health System Pharmacists) support widespread efforts to integrate pharmacogenomics into clinical practice. It is expected that the testing and consumerism of pharmacogenomic will grow exponentially in coming years.
ClinGen (Clinical Genome Resource) is another project funded by NIH that aims to further define how relevant genes and their variants are with a view to using this knowledge to guide research and precision medicine.
For now, it is vital that healthcare professionals receive ongoing education, enabling them to keep pace with the swiftly evolving field of pharmacogenomics.
Addiction Treatment in Southern California at Gratitude Lodge
Here at Gratitude Lodge in Southern California, we offer highly personalized treatment for addictions to alcohol, prescription drugs, and illicit drugs at the following locations:
All Gratitude Lodge treatment centers offer a pet-friendly and distraction-free environment in which to kickstart your recovery from addiction. Choose from a 30-day inpatient program or an intensive outpatient program once you have detoxed from drugs. Take advantage of our licensed medical detox center to streamline your withdrawal and to prepare yourself for ongoing treatment.
- Medication-assisted treatment
- Psychotherapy (CBT and DBT)
- Group counseling
- Individual counseling
- Holistic therapy
- Family therapy
- 12-step immersion program
Your treatment team will individualize your treatment plan, drawing from the above interventions. When you complete your program, you may choose to step down to a less intensive form of treatment, or you might be ready to embrace sober living. Either way, you will leave Gratitude Lodge equipped with a robust aftercare plan that includes relapse prevention strategies.
Take the first pivotal step by calling admissions today at 888-861-1658.