Expand DNA Testing to Improve Precision MAT/MAR Therapies

Introductory Paragraph

• Individuals all process and metabolize drugs in differing ways.
• 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. See Addictive Behaviors Reports, June 2017
• 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

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 reporting is similar to what is being used in the cancer treatment programs that rely on genomic testing to help guide post-diagnostic clinical care.)
• This Webinar provides a good overview on Pharmacogenetics and MAT: Clinical Applications of Pharmacogenomic Testing in Opioid Use Disorder Management
• 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.

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 .
• 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

In this section, please capture any recent findings, reports, or data on the topic. Please also highlight any gaps or existing disparities. Please include references and links to the information so that we may add a footnote for the reader to find further information. Do we have any available research about discriminatory practices? Is there information about the value of access to educational opportunities?

Impactful Federal, State, and Local Policies

Please list any federal, state, or local laws, policies, or regulations that support this topic or ones that could be a possible barrier. Are there laws or policies other states should know about and replicate for success?

Available Tools and Resources

Oftentimes, there are already great resources in the field that have been developed, but they are not housed in a single place. Please use this section to share information about those resources and drive the reader to that resource. It may be a worksheet, toolkit, fact sheet, framework/model, infographic, new technology, etc. I suggest no more than 5 really good links and a corresponding description for the reader. We also can use this section to highlight some of the great resources and programs at SAFE Project.

Promising Practices

Please link to any best practice models or case studies that highlight creative/innovative or successful efforts in support of this strategy. Is there a community that does a really good job in this area that other communities should replicate? Please write a brief description and provide a link.

Sources

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11. This statistic is based on on a study of 175 people. The results are still being written up for publication.
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