Thursday, October 13, 2016

A Different Way Of Looking at Heroin Addiction

Many people still look at heroin addiction as a moral issue. There are certainly moral and legal issues involved in addiction, but the underlying cause may be genetic--and knowing that cravings for more and more opiates are related to genetic variations in liver enzymes points to some ways of controlling them that doctors don't yet tell their patients about.

There's a doctor named Forrest Tennant of the Veract Intractable Pain Clinic in West Covina, California who says that there are three liver enzymes in particular that dictate a patient's need for higher and higher doses of Vicodin, Oxycontin, morphine, and, when people run out of doctors who will give them all the pills they need for pain relief, heroin. These mutant genes control the production of liver enzymes CYP2C9, CYP2C19, and CYP2D6.

It wasn't easy for Tennant to get insurance companies to pay for genetic testing, but when he finally got his chronic-pain patients tested, he found that  96 percent had a mutation in a gene that codes at least one of these enzymes. The patients who were most at risk for addiction had mutations in the genes that code all three enzymes. Every one of his chronic-pain patients had at least one gene that breaks down opioid and opiate pain medications more quickly than normal, so they need higher and higher doses with greater and greater likelihood of addiction.

Genetics isn't a moral issue. But genetics can inform better choices. Here are some suggestions:
  • Are you someone who's hooked on Vicodin or Oxycontin and constantly needing more? Then you need to ask your doctor about genetic testing for these three enzymes. These tests do more than just prove that you need your medication.
  • With genetic testing, your doctor can avoid giving you other drugs that increase your need for opiates. For example, the enzyme CYP2D6  breaks down opiates and opioids so you need more. This enzyme is made more active when you take certain kinds of corticosteroid drugs for joint inflammation (such as dexamethasone). It's activated when you take certain antibiotics for painful, chronic infections (such as rifampicin). 
  • If you have a test that shows you have super-active CYP2D6, then your doctor will realize that you need to avoid certain other drugs to avoid addictions to opiates and opioids. If you have a mutation in the gene that codes CYP2C9, then you  need to stay away from St. John's wort. It can make you crave Vicodin, Oxy, and even heroin. Also your physician should not give you certain medications for vomiting and nausea--because they ironically would increase nausea and vomiting. 
  • If you have the mutation for CYP2C19, you can't have aspirin or prednisone, because these medications will cause that enzyme to break down your main forms of pain relief so you need more, more, more.
Most people who become addicted have these genetic mutations. And nearly everyone who becomes addicted to drugs like Oxy and heroin has at least one other substance abuse problem that also is tied to genetics. 

For decades, doctors have tried to help with drugs that actually wind up making the situation worse. There are many moral choices that are made by addicts, but these choices may be forced by their genetics. Knowing your genes can give you the room to take more control over your pain and over your addiction.

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