The current opioid addiction epidemic has become a leading public health crisis worldwide. In addition to the significant morbidity and mortality associated with
The United States is in the midst of an opioid overdose epidemic. Between 1999 and 2010, prescription
Opioid deaths, particularly those involving illicit opioids, continue to increase. As described in a report of Morbid Mortality Weekly Report (MMWR), illicit opioids were detected in approximately three of four opioid overdose deaths compared with nearly four of 10 for prescription opioids, in the 11 states examined. Enhanced surveillance for opioid overdose deaths facilitates the classification of deaths involving prescription and illicit opioids as well as identifying missed opportunities for prevention/early intervention and response (https://www.cdc.gov/drugoverdose/index.html)
It is now established that the overall cost of the opioid crisis is north of one trillion dollars. While there are a number of proven strategies available to manage chronic pain effectively without opioids, as well as aberrant drug seeking, it is agreed by all the major agencies that as a unified community, we are being challenged to provide alternative non-addicting and non-pharmacological alternatives to assist in pain and addiction attenuation.
We the authors of this treatise are convinced that the older paradigm only keeping people maintained on for example opioids (buprenorphine/naloxone and naltrexone combinations) needs to change if we are to truly change the drug-embracing culture in chronic pain and addiction management. The missing link is to achieve dopamine homeostasis early on through risk identification with GARS.
In America, pain is a significant public health problem that costs society at least $560-$635 billion annually, an amount equal to about $2,000.00 for everyone living in the USA. This includes the total incremental cost of health care due to pain ranging between $261 to $300 billion and $297-$336 billion due to lost productivity (based on days of work missed, hours of work lost and lower wages).
In 2017, a total of almost 4 million babies were born in the United States of America. We are raising the question regarding the wisdom and competence of the existing treatment paradigm based on the estimate that
As a community of specialists in the United States, we are compelled to find alternative solutions to help reward deficiency victims overcome unhealthy and even dangerous excessive reward-seeking behaviors without promoting unwanted tolerance to analgesics that can induce the “addictive brain” by compromising the hard wiring in the medial forebrain bundle (MFB)
It is noteworthy that the brain reward center plays a key role in the modulation of many mood disorders, and at birth genetic polymorphisms may impact one’s ability to achieve pleasure from natural
Analytics of Genetic Addiction Risk Score (GARS)
To understand our goal involving the development of the USA patented Genetic Addiction Risk Score (GARS®) panel of reward gene polymorphisms and a clinical outcome, the rationale is provided herein. The interaction of neurotransmitters and genes that control the release of dopamine is the Brain Reward Cascade (BRC). Variations within the BRC, whether genetic or environment (epigenetic), may predispose individuals to addictive behaviors and altered pain tolerance. This concept has been established
by a group of concerned scientists and clinicians that examined the GARS, the first test to accurately predict vulnerability to pain, addiction, and other compulsive behaviors, defined as RDS with particular emphasis for OUD and SUD.
Innovative strategies to combat the epidemic of opioid, iatrogenic prescription drug abuse and death, based on the role of dopaminergic tone in pain pathways, have been proposed. Sensitivity to pain may reside in the mesolimbic projection system, where genetic polymorphisms associate with a predisposition to pain vulnerability or tolerance. They provide unique therapeutic targets that could assist in the treatment of pain and identify risk for subsequent addiction involving RDS and anti-reward symptomatology.
Test results show that if a patient carries any combination of
4 GARS risk alleles, it is predictive of drug severity, or any combination of 7 GARS risk alleles, the test is predictive of alcohol severity. It is of interest that it has been found that 100% of these patients from chemical dependency treatment programs carry at least one risk allele.
We are asking the scientific community to consider the benefits vs. the risk of identifying genetic predisposition of RDS through GARS testing early. Of significance, blood is not needed. Does this actually constitute “Emperor’s New Clothes”? Admittedly, this approach is outside the box of conventional dogma. It represents a technological advancement providing a very advantageous paradigm shift in the assessment of risk for addictive, obsessive, compulsive and impulsive behaviors. However, a number of clinics are adopting this new paradigm shift. The GARS test is ahead of its time and would certainly benefit by additional population genetic studies as well as public education to reduce the fear related to
Figure 1. This represents a Tree Analysis whereby we define the problem, parts of the problem, solution and results. In terms of
GARS and Precision Neuronutrient termed “Precision Behavioral Management” as well as other prevention strategies including education and awareness (e.g. Recovery High Schools, etc.) along with a pro-dopamine lifestyle (e.g. exercise, dopamine boosting foods, yoga,
Challenges of genetic testing include the impact that such knowledge can have on the individual, on one’s sense of self; misunderstanding of the consequences of genetic predisposition and discrimination; and using genetic information to deny
Possibly knowing a patient’s genetic addiction risk score (GARS), a confidential revelation, could help provide an
We are cognizant that genetic information is just one piece to prevention, and as such, it must be coupled with a national awareness campaign and mass education of the pitfalls of
One question that has been raised involves the suggestion
that genetic screening for addiction risk should occur at birth, following significant on-going research to support this
Kenneth Blum, B.Sc. (Pharmacy), M.Sc., Ph.D. & DHL; received his Ph.D. in Neuropharmacology from New York Medical College and graduated from Columbia University and New Jersey College of Medicine. He also received a doctor of humane letters from Saint Martin’s University Lacey, WA. Dr. Blum has authored over 600 medical articles, chapters, abstracts, journals, and sixteen professional books on a wide variety of psychiatric research subjects, including psychiatric comorbidity, detox, and addiction treatment and psychiatric genetics.
Dr. Siwicki is board certified in emergency medicine and is also certified in addiction medicine. Dr. Siwicki was the co-founder of Dominion Diagnostics LLC; North Kingston, RI which is now the largest privately held toxicology laboratory in the U.S. Dr. Siwicki is also the co – founder of Geneus Health, LLC. He serves as President of Geneus Health and Igene LLC and is a member of Board of Directors on Dominion Diagnostics.
Dr. Baron is a world recognized Psychiatrist specializing in Reward Deficiency behaviors including Sports Psychiatry, ADHD and Substance Use Disorder. He has been educated in a number of institutions of higher learning including Emory University, Temple University, Philadelphia College of Osteopathic Medicine, and residency programs at the University of Southern California. Currently he has accepted the position of Provost of Western University Health Sciences Pomona, California. Dr. Baron has been involved with Global Psychiatry for over 30 years. He is very active in international psychiatric education and collaborative research with global partners. He has also served as Associate dean of International relations at Temple University School of Medicine, Medical Director of Global Health and Assistant Dean of International Affairs for the Keck School of Medicine of USC. He served as Deputy Clinical Director of the National Institutes of Health (NIMH) and Chair of Psychiatry at Temple. His research has been displayed and published in numerous high tiered journals. Dr. Baron has received numerous awards and honors over the years including: Harry Stack Sullivan Award, Concussion in Sports research 2015, Charles Heath Award, Tulane University, Concussion in Youth Sports and 2017-18 Fulbright Distinguished Chair in Brain Science, Youth Concussion.