Blog #99: Pharmacogenetic Testing
At 100 Million Ways, the approach to solving the opioid (overdose) crisis focuses on mental health and support for options and alternatives to standards of care, which must be considered in lieu of the limited success, to date, in managing the opioid epidemic and the mental health of people challenged by substance use.
The crossover for people with mental health and concomitant substance use challenges is significant. According to JAMA, "approximately 50% of individuals with mental disorders are affected by substance abuse. And 37% of alcohol abusers and 53% of drug abusers have at least one serious mental illness." Mayo Clinic’s Center for Individualized Medicine states, “Some genes are responsible for how the body processes medications. Pharmacogenomic tests measure variants in these genes that help determine whether a medication might be an effective treatment for an individual or whether that individual might have side effects to a medication.”
Chronic pain is one of the most common problems presented when seeing a healthcare provider. Use of prescription pain medications (especially opioids) was/is a significant contributor to the opioid crisis in America. In addition to the potential risk of overdose, opioids and other pain adjuvants can cause problematic drug-drug-interactions.
Individuals can be classified by their pharmacogenetic ability to metabolize a medication: a normal metabolizer (NM) responds as expected and has two normal or “wild-type” alleles; an intermediate metabolizer (IM) can have partially active alleles or one fully defective allele; a poor metabolizer (PM) has two abnormal alleles with minimal gene activity; a rapid metabolizer (RM) has at least one highly active allele, and an ultra-rapid metabolizer (UM) can have many copies of the normal gene, leading to activity many times the baseline level.
While pharmacogenetics is not yet an exact science, it is sufficiently advanced and our population is sufficiently interested for 100 Million Ways to run a Pilot Study. Participants will be given pharmacogenetic test kits, at no expense. Each participant will complete baseline validated instruments. Statistical analysis will determine correlations that exist between pharmacogenetic data and self-reported data from selected validated tools. Participants will also receive counseling as regards the implications of these tests.
Any tool that has the potential to help us understand the physiologic response to the medicines we take, especially for those with substance use challenges, is a tool worthy of further research.
Blog #98: A Mark of Disgrace
Public stigma comes from society as a whole and involves general attitudes about substance use challenges that can cause people to avoid seeking help because they feel embarrassed or ashamed about their problem. Social stigma occurs when people go to someone for help and encounter negative public attitudes about addictions. In some cases, even doctors or social workers see people with addiction as morally corrupt, manipulative, or violent - or believe a person with substance use challenges may not have the motivation and willpower necessary to change.
Self-stigma develops when a person with a substance use challenge internalizes negative messages from caregivers or society in general. This can lead to self-doubt about the potential success of treatment and self-questioning about whether treatment is even worth trying. In a study by the Recovery Research Institute, people who have resolved a significant substance use challenge, defined as recovered for at least five years, are, on average, 44 years old, 60% male, and 39% a racial/ethnic minority. And while the number of attempts at recovery ranged from 0-100 depending on the severity of the challenge (mental-illness, lack of social support, addiction severity), 50% of the people studied (median) needed two attempts to recover, with the average being five. Approximately 50 percent of adults who met diagnostic criteria for a substance use disorder—or about 25 million people—are currently in stable remission (1 year or longer). Data show that five years after substance abuse is stopped, the risk for relapse is no greater than for anyone else in the general population. A study published by CDC/NIDA in 2020 found 3 out of 4 people (75%) who experience addiction eventually recover. These numbers probably surprise most readers.
Reporting these data instead of, or, at least in addition to, the deaths, the pain, the associated crime…, is a step toward changing stigma associated with substance use challenges. People with substance use challenges can get better, be normal, be productive members of society - some even change the world. Stigma sucks. It’s not that hard to think about the positives. Give it a go.
The 100 Million Ways Fundraiser What an Event!
The evening included an engaging group of presenters including an industry CEO, a health-care provider, a peer support specialist, a tech entrepreneur, and an athlete/founder. They spoke from the heart about the experiences that shaped their lives, that developed their shared commitment to alternative and multi-modal approaches to mental and physical wellness. As a collective, we listened, and we were touched by how these stories resonated — they are not so different than many of our own stories, or the story of someone we know, or someone we love.
Our diverse, eclectic audience included executives, scientists, physicians, creatives, business leaders, industry advocates and colleagues, agencies, political action activists, artists, musicians, people who lived the life of substance use challenges, people who care about the overdose crisis, friends and family.
At a time when America is so divided about so many things, Wednesday night, amongst this eclectic group of people, there was commonality of purpose, an energy of hope, and even a sense of optimism.
It was a wonderful night on the lake at The Boathouse in Central Park. We raised almost $100,000. We can’t wait to share with you how it helps the populations we serve. Stay tuned for more!