The phenomics and genetics of addictive and affective comorbidity in opioid use disorder

Freda, Philip J.; Moore, Jason H.; Kranzler, Henry R.

doi:10.1016/j.drugalcdep.2021.108602

Cited by 17 publications

(12 citation statements)

References 159 publications

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“…First, we found that the OUD group had unique characteristics compared to the other groups, the most salient of which included comorbid psychiatric (anxiety, depression) and substance use disorders, particularly tobacco use disorders, in line with previous findings (Barry et al, 2016;Edlund et al, 2010;Nazarian et al, 2021;Volkow et al, 2019). Prior studies estimated that 45-57% of individuals with OUD had at least one psychiatric disorder and reported that polysubstance abuse was exceedingly common (Freda et al, 2021), comparable to our findings. In addition, average age at first opioid prescription among the OUD group was approximately 10 years younger than that of other groups, highlighting the importance of age at first exposure to prescribed opioids and onset of OUD (Phillips et al, 2017).…”

Section: Discussionsupporting

confidence: 91%

“…Opioid use disorder ( OUD ) evolves from a series of opioid consumption transitions, starting with exposure and continuing through regular use, misuse, abuse, dependence, and relapse (Kaye et al, 2017; Strang et al, 2020). Prevalence estimates for these phenotypes vary widely, in part due to variation in ascertaining and defining them (Freda et al, 2021). Indeed, one key challenge to defining opioid use phenotypes is the need to differentiate individuals across this spectrum of overlapping features.…”

Section: Introductionmentioning

confidence: 99%

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Identifying high-risk comorbidities of short and long-term opioid prescription use

Jennings

Lee

Rocha³

et al. 2021

Preprint

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BackgroundElectronic health records (EHR) are useful tools for understanding complex medical phenotypes, but they have been underutilized for opioid use disorders (OUD). Patterns of prescription opioid use might provide an objective measure of OUD risk.MethodsWe extracted data for over 2.6 million patients across three health registries (Vanderbilt University Medical Center, Mass General Brigham, Geisinger) between 2005 and 2018. We defined three groups based on levels of opioid exposure: No Prescription, Minimal Exposure (2 prescriptions within 90 days at least once, but never 3 prescriptions <90 days apart), and Chronic Exposure (≥10 opioid prescriptions in a year), and compared them to the full registries and to patients with OUD diagnostic codes. We extracted demographic and clinical characteristics known to co-occur with OUD, including psychiatric and substance use disorders, pain-related diagnoses, HIV, and hepatitis C.ResultsThe prevalence of substance (alcohol, tobacco, cannabis) use disorders was higher in patients with OUD and Chronic Exposure than those with No Prescription or Minimal Exposure. Patients in the OUD and Chronic Exposure groups had more psychiatric (anxiety, depression, schizophrenia, bipolar disorder) and medical comorbidities (pain, hepatitis C, HIV) than those in the Minimal Exposure group. Notably, patients in the Minimal Exposure group had different comorbidity profiles (higher rates of substance use and psychiatric disorders, more pain conditions) than those in the Unscreened or No Prescription groups, highlighting the value of including opioid exposure in studies of OUD.ConclusionsLong-term opioid prescription use may serve as an additional tool to characterize OUD risk.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Identifying high-risk comorbidities of short and long-term opioid prescription use

Jennings

Lee

Rocha³

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…“Reward Deficiency Syndrome” (RDS) [ 9 ] is a genetically based hypodopaminergia known to affect about one-third of people in the United States [ 10 ]. It is understood that while a few people can tolerate powerful narcotics, and no longer want opioids after being treated for pain even after withdrawal, others, because of genetic and epigenetic insults, become enthralled with addictive-like behaviors after the pain is alleviated [ 11 ]. It is noteworthy that our group recently reported on a study utilizing the Genetic Addiction Risk Severity (GARS) test showing a high drug and alcohol risk in probands attending multipain clinics chronically prescribed opioids.…”

Section: Introductionmentioning

confidence: 99%

Hypothesizing in the Face of the Opioid Crisis Coupling Genetic Addiction Risk Severity (GARS) Testing with Electrotherapeutic Nonopioid Modalities Such as H-Wave Could Attenuate Both Pain and Hedonic Addictive Behaviors

Gupta

Bowirrat

Gomez

et al. 2022

IJERPH

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In the United States, amid the opioid overdose epidemic, nonaddicting/nonpharmacological proven strategies are available to treat pain and manage chronic pain effectively without opioids. Evidence supporting the long-term use of opioids for pain is lacking, as is the will to alter the drug-embracing culture in American chronic pain management. Some pain clinicians seem to prefer classical analgesic agents that promote unwanted tolerance to analgesics and subsequent biological induction of the “addictive brain”. Reward genes play a vital part in modulation of nociception and adaptations in the dopaminergic circuitry. They may affect various sensory and affective components of the chronic pain syndromes. The Genetic Addiction Risk Severity (GARS) test coupled with the H-Wave at entry in pain clinics could attenuate pain and help prevent addiction. The GARS test results identify high-risk for both drug and alcohol, and H-Wave can be initiated to treat pain instead of opioids. The utilization of H-Wave to aid in pain reduction and mitigation of hedonic addictive behaviors is recommended, notwithstanding required randomized control studies. This frontline approach would reduce the possibility of long-term neurobiological deficits and fatalities associated with potent opioid analgesics.

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“…To include the gene/locus information presented in Fig. 2 (blue bars), we integrated data from a literature search protocol implemented in a previous review [31].…”

Section: Review Methodsmentioning

confidence: 99%

“…Thus, capturing the greater phenotypic and environmental profile of an individual has the potential to greatly improve risk assessments for POU. The complexity of POU as a measurable trait presents many challenges from a data science perspective due to ambiguous POU-related terms and their complex, but poorly explored, root causes [6,7,28,30,31]. These issues make powerful digital approaches difficult to implement despite many recent advances in the fields of artificial intelligence, bioinformatics, and computational biomedicine.…”

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confidence: 99%

Novel digital approaches to the assessment of problematic opioid use

2022

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The opioid epidemic continues to contribute to loss of life through overdose and significant social and economic burdens. Many individuals who develop problematic opioid use (POU) do so after being exposed to prescribed opioid analgesics. Therefore, it is important to accurately identify and classify risk factors for POU. In this review, we discuss the etiology of POU and highlight novel approaches to identifying its risk factors. These approaches include the application of polygenic risk scores (PRS) and diverse machine learning (ML) algorithms used in tandem with data from electronic health records (EHR), clinical notes, patient demographics, and digital footprints. The implementation and synergy of these types of data and approaches can greatly assist in reducing the incidence of POU and opioid-related mortality by increasing the knowledge base of patient-related risk factors, which can help to improve prescribing practices for opioid analgesics.

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The phenomics and genetics of addictive and affective comorbidity in opioid use disorder

Cited by 17 publications

References 159 publications

Identifying high-risk comorbidities of short and long-term opioid prescription use

Identifying high-risk comorbidities of short and long-term opioid prescription use

Hypothesizing in the Face of the Opioid Crisis Coupling Genetic Addiction Risk Severity (GARS) Testing with Electrotherapeutic Nonopioid Modalities Such as H-Wave Could Attenuate Both Pain and Hedonic Addictive Behaviors

Novel digital approaches to the assessment of problematic opioid use

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