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PHARMACOGENETICS IN PHYSICIAN PRACTICE
BY KEVIN PAUZA, MD Chronic pain is a significant problem in the United States as more than 100 million Amer- icans suffer from chronic pain, ac- cording to the book Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Re- search. Opioid medications have been used to help those who suffer. Use of these medications has come under scrutiny. Although these medications can give patients pain relief, increase their function, and improve their qual- ity of life, their use can be risky and life-threatening. Opioid use has led to epidemic levels of unintentional over- doses in the United States. The U.S. Food and Drug Adminis-
tration, aware of the situation, acted by adding new warnings on overdose and death with the use of prescription, short-acting opioids. I applaud their efforts. I wonder if we can do more and
take another approach to helping these patients while battling the opi- oid epidemic.
I believe the use of pharmacoge-
netics in pain treatment practices could help physicians identify which opioids and dosages would be safer for the patients we treat. Pharmaco- genetics is the study of inherited ge- netic differences in drug metabolic pathways that can affect individual responses to drugs, in terms of thera- peutic effects and adverse effects. Armed with the information we
gain from each individual patient’s pharmacogenetic profile, we can minimize side effects and eliminate adverse events. I think this approach could help significantly reduce the opioid epidemic caused by the legiti- mate prescription of opioids. Within the scope of my practice,
I prescribe medications that far too often have puzzling effects on my patients. I frequently have patients present with the same health condi- tion who respond differently to an identical dosage of an identical medi- cation. One patient may experience tremendous benefit while another
experiences none. Worse, that second patient will experience adverse reac- tions to the medication, causing harm and making that patient’s situation dangerous and even life-threatening. During medical school, residency,
and my pain management fellowship, I never received pharmacogenetic training. Partnering with a local phar- macist trained in pharmacogenetics is an important component to success- fully integrating pharmacogenetics into a prescribing regimen. The integration of a licensed phar-
macist into pharmacogenetics adds expert support for physicians who have neither the time nor expertise to fully implement this new practice. Using a pharmacist as a counselor and interpreter of pharmacogenetic data provides physicians with professional medication guidance and customized patient medication preferences. All schools of pharmacy have incor-
porated pharmacogenetics into their core curriculum. Recent PharmD graduates possess a strong knowledge base. Physicians can consult with the progressive pharmacists in their com- munities who are experts in pharma- codynamics (the study of what a drug does to the body) and pharmacokinet- ics (the study of the time course of drug absorption, distribution, metabo- lism, and excretion). There is a strong chance they have received continuing
More than 100 million Americans suffer from chronic pain.
September 2016 TEXAS MEDICINE 15
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