Researchers Find Link Between ABCB1 Gene and Long-Term Opioid Use

Newswise — As the perils associated with long-term opioid therapy become more widely known, efforts continue to better understand how opioid use affects individual patients. One of the ways researchers have found differences in how opioids affect certain populations is by looking at DNA. Genomic medicine is the study of how a person’s unique DNA profile can be used to personalize and improve their health care. For example, if providers can identify people who are more at risk for opioid dependency, resources can be used early on to educate those patients and provide alternate pain treatments.

Total joint replacement, including hip and knee replacement, is a common surgery in the United States. However, the moderate to severe pain after surgery can continue for months, resulting in up to a 40% incidence of chronic opioid use in these patients. Because differences in opioid pain relief related to DNA profiles have been found in surgical populations, a recent study tested the relationship between various genes and opioid use in patients who had hip or knee replacement, with promising results.

Rodney Gabriel, Kathleen Fisch, and Ruth Waterman of the University of California, San Diego, received a Best of Meeting Abstract Award from the American Society of Regional Anesthesia and Pain Medicine (ASRA) for its 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, being held May 13-15, 2021. The authors will present Abstract #1956, “The Association of ABCB1 Gene Polymorphism and Postoperative Chronic Opioid Use Following Lower Extremity Total Joint Arthroplasty” on Friday, May 14.

In their retrospective case-controlled study, Gabriel et al. identified patients who underwent total knee or hip replacement that either did or did not require opioid treatment for 3 months or longer after surgery. The patients were screened for numerous gene variations, including ABCB1, CYP3A4, CYP3A5, CYP2C9, and CYP2D6.

“In this study, we looked at hundreds of patients undergoing joint replacement and found that there was one particular gene called ABCB1 that may be predictive of long-term pain and opioid use,” Gabriel et al. said. The ABCB1 gene was associated with chronic opioid use (odds ratio [OR] 3.23, 95% confidence interval [CI] 1.36 – 7.68, p = 0.008). When controlling for patients’ age, sex, and body mass index, the association remained significant (OR 3.53, 95% CI 1.44 – 8.66, p = 0.006).

“This gene has been shown in the past to be related to opioid metabolism, so it makes sense that it is also related to long-term pain and opioid use,” Gabriel et al. said. “Future studies will need to validate these results and then apply it into clinical practice to help identify patients that are higher at risk for persistent opioid use.”