You’re in pain. Your doctor thinks that a prescription of an opioid can help you find relief, but you’re wary. You’ve heard the news reports about the opioid crisis and the addiction that has affected 1.7 million Americans. Your concern is understandable.
Part of the strategy to prevent opioid use disorder—which is defined as a problematic pattern of opioid use leading to clinically significant impairment or distress—is being an informed patient.
“Opioids are good for the treatment of acute pain, such as injury or post-surgery, but not chronic pain—like for low back pain that someone has had for years,” says Kathleen Brady, MD, PhD, Vice President of Research at the Medical University of South Carolina, and a Genomind Advisory Board member. But, as with any medication, they come with some risks.
If you’re prescribed an opioid medication, discuss the following with your doctor:
1. Go over your personal health history and risks.
There are a few reasons why you should do this. “In general, conditions that impair liver functions—such as alcohol dependence and hepatitis, might be expected to interfere with opioid metabolism, so lower doses are likely to be needed,” Dr. Brady says.
“Conditions that lead to the induction of liver enzymes, such as cigarette smoking or heavy caffeine consumption, might cause more rapid metabolism of opioids, so higher doses might be needed to achieve therapeutic effect,” she continues.
In addition, “many opioids have a low therapeutic index—what this means is the dose that can cause death through respiratory depression … are only four to five times higher than the dose to relieve pain,” Dr. Brady says. “This is especially a problem for people who have compromised respiratory function, like chronic obstructive pulmonary disease (COPD), or when used in combination with other drugs that suppress respiration, like the benzodiazepines or barbiturates.”
This is why it is best to be upfront with your doctor about all medications and dietary supplements you are taking, including alcohol use. They can then determine how your body will process an opioid and the effect that it will have on your body.
Another possible risk could be a gene-drug interaction. The FDA requires labeling on over 200 medications to include pharmacogenetic biomarker information, due to specific actionable gene-drug associations.
Genetic testing, like Genomind Professional PGx Express, can inform your doctor if such an interaction could be likely by identifying the pharmacokinetic genes that determine the effect that the body has on a drug via metabolism (basically, your Rx MetaTypeTM ) and, as a result, inform dosing decisions. Such tests can also provide information on pharmacodynamic genes, which play a role in determining a drug’s effect on the body, and can help inform drug selection.
Genetic testing can help your health care provider determine how you metabolize certain drugs and decide on the treatment that may be right for you.
READ MORE: What Determines Opioid Addiction
2. Ask whether a different type of medication, such as an over-the-counter pain reliever, can alleviate your pain.
For some pain, acetaminophen and ibuprofen may work just as well. For localized pain, lidocaine patches can be an effective alternative. When looking for a treatment to handle your pain, consider talking to your doctor about genetic testing to help pinpoint the right dosage, and possibly medication, for you.
3. Consider pain management strategies.
Therapies such as physical therapy or complementary ones—like yoga or massage—could help manage your pain. There is evidence showing that acupuncture, in particular, may reduce a patient’s need for opioids for chronic pain.
4. Ask your doctor to prescribe the lowest effective dose.
Higher doses increase your risk of addiction, overdose, and death. The Centers for Disease Control and Prevention (CDC) prescribing guidelines recommend that doctors prescribe “no greater quantity than needed for the expected duration of pain severe enough to require opioid pain relievers.” In most cases, that means that you may be prescribed an amount to last three days or fewer.
Genetic testing can help guide your doctor to what that dose may be. What your genetic makeup might explain is how you metabolize opioids. As Dr. Brady explains, some opioids require a particular enzyme to activate their metabolites. “Poor metabolizers might have reduced metabolite formation and minimal pain reduction while rapid metabolizers could be at risk for toxicity,” she says. “However, clinical translation of opioid genetics is difficult because many important pain and addiction phenotype factors contribute to the level of pain relief offered by any specific agent.”
5. Consider refills carefully.
If you do decide to take opioids for pain management, request an assessment and evaluation plan from your doctor to discuss the harms versus benefits of continuing to take the medication.
6. Safely dispose of any opioid medications once you are done using them.
Leftover opioids are a risk factor for teen abuse, with two-thirds of teens reporting that they got them from family and friends, including in the medicine cabinet at home. Many pharmacies and local municipalities have prescription drug take-back programs or drop-off boxes.