Observational Study to Calculate Addictive Risk to Narcotics Due to Genetic Predisposition in pain patients

Genetic factors contribute to prescription narcotic pain medication abuse or misuse but are generally not evaluated in clinical practice. Pain, especially for a patient genetically predisposed to neurochemical deficiencies in the mesolimbic dopamine system of the brain, often presents an epigenetic dilemma in which the patient shows greater susceptibility to Prescription Drug Dependence (PDD) or other Substance Use Disorders (SUD). The study was done to evaluate a scoring algorithm of single nucleotide polymorphisms affecting neurochemistry of the    mesolimbic reward system to determine whether it is predictive of prescription drug dependence and/or chronic pain syndrome. Subject were Chronic pain patients diagnosed with prescription drug dependence (PDD) (n=10), diagnosed with chronic pain syndrome (CPS) (n=3), both prescription drug dependence and chronic pain syndrome (n=35) and chronic pain patients without either diagnosis (n=24) for a total of 72 patients. Subjects were genotyped with the Proove Narcotic Risk Genetics Profile using TaqMan SNP genotyping assays (Life Technologies, Carlsbad, CA). A scoring algorithm, the Dependence Risk Index (DRI) score was calculated to determine elevated risk based on genetic predisposition. For the results, subjects with a DRI of greater than or equal to 20 had a positive predictive value (PPV) 80% of having either PDD or CPS versus those subjects without either diagnosis (p<0.028, chi2 of 10.87, sensitivity of 77%, specificity of 63%). In conclusion, with a Dependence Risk Index (DRI) score, clinicians may be able to identify patients at greater risk for prescription pain narcotic medication abuse or misuse due to genetic predisposition. Further research with larger patient population is required to stratify low, moderate and high risk, as well as variations between ethnicities and gender.