Expand DNA Testing to Improve Precision MAT Therapies

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Introductory Paragraph

Genetics and genetic makeup impact how individuals respond to medications. Genetic and DNA testing can enhance personalized medicine to improve Medication-assisted therapies.[1]

  • Individuals all process and metabolize drugs in differing ways.[2]
  • Someone's genetic makeup, the amount of enzymes, and specific receptors they have contribute to how a person can metabolize medicine
  • A person's genetic makeup also impacts how certain foods will affect how drugs are metabolized.
  • Genetic testing reveals information that can help us accurately tailor medications on a patient-to-patient basis. This is called Precision or Personalized Medicine
  • In the past, physicians have had limited tools when it comes to evaluating options or dosages for Medication Assisted Treatment Plans
  • The result is that Medication Assisted Treatment plans usually rely on a series of "trial and error" doses that are adjusted based on response of the patient to the doses being tried without using insights from genetic tests to optimize the plan for each patient.
  • When the does of medication is not ideal, the patient either receives insufficient benefit from the medication or has side effects or adverse drug reactions.[3]
  • The inconsistent impact of medication used in MAT is a contributing factor to the high relapse rates in opioid addicted patients. Even for those receiving MAT, the relapse rate tends to be about 50%
  • Patients who abstain from opioids in the first two weeks have a good chance of good 12-week outcome. However, those who use opioids in each of the first 2 weeks (even in week 1 alone) have very little chance of abstaining by week 12

Key Information

"Precision medicine focuses on providing health care with increased resolution, accounting for aspects that are unique to the individual and their disease. By definition, precision medicine involves all phases of care: prevention, diagnosis, and treatment."[4]

The Opportunity with Precision MAT

With today's more refined analysis of the human genome map, their is a growing database of variability of gene alleles and how they account for changes in drug metabolism. A clinical genomic test can be performed and a report can be created that displays the expected benefits and risks the patient has if they receive any one of over 200 medications (in this case with a focus on the drugs being used to treat opioid addiction), and how the patient's dietary regimen can affect medications they may be taking or will take in the future to treat their addiction and potential related diseases.

  • This Webinar provides a good overview on Pharmacogenetics and MAT: [5]
  • Such dynamic, interactive reports can then be used by physicians and other medical providers such as nurse practitioners, pharmacists, therapists, dietitians and other social service professionals to develop more precise treatment plans of care for the individual patient.
  • An on-going research study is showing that more precise dosing in Medication Assisted Treatment, based on more accurate analysis of Gene allele variability| has decreased relapse rates in opioid addicted patients down to 25% over an 18 month tracking period.[6]

Genetic Tests

  • A genetic test is performed by obtaining a simple cheek swab that collects DNA from the cells on the inside of a person’s mouth. The specimen collection can be performed by an appropriately trained individual and the report results available in 1-2 weeks.
  • Using a cheek swab is one of the two most popular ways to do DNA tests[13] .
  • Insurance coverage varies for this test which costs approximates between $500 and $1,200 based on whether annual pharmacy consultative services are included.
  • Medicare is the most reliable payer and the commercial carriers range in reliability of payment. Few Medicaid carriers are currently paying for these tests today but with the significant funding being made available to individual states to address the opioid addiction crisis, the anticipation is that the state based Medicaid plans will begin to address this coverage gap.
  • Premier DNA is a genetics testing company that has created a integrated care model combining genetic testing, interactive genetic reporting, and pharmacy consultation. They offer this program under the registered trade name Med Op Rx. This service becomes a useful tool to guide the physician in terms of implementing the most precise MAT program given the individual patient's genetic makeup.

Relevant Research

There is ongoing research and funding around precision medicine across both mental and physical health including substance use and medication assisted therapy.

Genetic testing: Opportunities to unlock value in precision medicine[7]

Pharmacogenetic Testing: A Tool for Personalized Drug Therapy Optimization[8]

U.S. Department of Veteran Affairs Office of Research & Development Genomics & Mental Health[9]

Biomarkers in precision medicine for mental illnesses[10]

Precision Medicine & Global Mental Health[11]

Study design and implementation of the Precision Medicine In Mental health Care (PRIME Care) Trial[12]

Impactful Federal, State, and Local Policies

Precision Medicine Initiative 2015/2016 White House initiative to improve precision medicine. The mission is to enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized care.[13]

Personalized Medicine Coalition PMC engages on a number of key priorities in public and science policy to advance its mission. This site includes information on funding and appropriations for precision medicine.[14]

Department of Health and Human Services Grants Development of Psychosocial Therapeutic and Preventive Interventions for Mental Disorders (R61/R33)[15]

Available Tools and Resources

Genetic Testing and Precision Medicine- A personalized medical approach to improve outcomes.[16]

Personalized Medicine Coalition- Personalized Medicine Report [17]

Therapeutic drug monitoring: A patient management tool for precision medicine[18]

Therapeutic drug monitoring in the era of precision medicine[19]

Promising Practices

Precision Medicine's value - Includes promising practices and developments in the field of precision medicine and therapies.[20]

Personalized Medicine Coalition Promoting Innovation and Delivery of Cell and Gene Therapies[21]

Sources


  1. https://healthitanalytics.com/news/why-genetic-testing-is-key-to-advancing-precision-medicine
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447546/
  3. https://www.journals.elsevier.com/addictive-behaviors-reports
  4. https://ascpt.onlinelibrary.wiley.com/doi/full/10.1002/cpt.1622
  5. https://www.creighton.edu/events/PIPAN2022
  6. https://dnacenter.com/blog/swabs-vs-blood-samples-dna-testing/
  7. https://www.mckinsey.com/industries/life-sciences/our-insights/genetic-testing-opportunities-to-unlock-value-in-precision-medicine
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765968/
  9. https://www.research.va.gov/topics/genomics.cfm#research3
  10. https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13357
  11. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30406-6/fulltext
  12. https://www.sciencedirect.com/science/article/pii/S1551714420303256
  13. https://obamawhitehouse.archives.gov/precision-medicine
  14. https://www.personalizedmedicinecoalition.org/Policy/Research_Funding
  15. https://grants.nih.gov/grants/guide/rfa-files/RFA-MH-17-604.html
  16. https://healthitanalytics.com/news/why-genetic-testing-is-key-to-advancing-precision-medicine
  17. https://www.personalizedmedicinecoalition.org/Userfiles/PMC-Corporate/file/The_PM_Report.pdf
  18. https://ascpt.onlinelibrary.wiley.com/doi/full/10.1002/cpt.298
  19. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.13047
  20. https://www.managedhealthcareexecutive.com/view/exploring-precision-medicines-value
  21. https://www.personalizedmedicinecoalition.org/index.cfm