Personalized Oxycodone Dosing: Using Pharmacogenetic Testing

Discussion in 'Pain Medicine' started by lobelsteve, 05.21.14.

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  1. lobelsteve

    lobelsteve SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    [​IMG][​IMG]
    EDITORIAL

    You have full text access to this content
    Personalized Oxycodone Dosing: Using Pharmacogenetic Testing and Clinical Pharmacokinetics to Reduce Toxicity Risk and Increase Effectiveness
    1. Jeffrey Fudin BS, PharmD, FCCP Adjunct Assistant Professor of Pharmacy Practice, Adjunct Associate Professor of Pharmacy Practice & Pain Management, Clinical Pharmacy Specialist and Director1,2,3and
    2. Timothy J. Atkinson PharmD Resident3


    [​IMG]
    Pain Medicine
    Volume 15, Issue 5, pages 723–725, May 2014

    1. on the speakers' bureau for Millennium Laboratories, Inc. He is a consultant to Practical Pain Management in the development of the online Opioid Calculator. Dr. Atkinson has no conflicts to disclose.

    So this editorial is more an ad for Millenium labs. Fudin on speakers bureau for Millenium that does the testing.

    Pain Medicine: You suck for printing this crap. At least get someone else to write the editorial. And the article was written by the husband of an MD who is a JD/MBA. This whole thing stinks.
     
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  3. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor 5+ Year Member

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    Wasnt Fudin a member of the now defunct APF? definitely a member of PROMPT and AAPMedicine...
     
  4. ziggyziggy

    ziggyziggy 5+ Year Member

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    Is anyone using this pharmacogenetic testing? If yes, on what kind of patients are using? I haven't heard a very good argument in favor of its use, also I feel that its utility is limited with additional cost to patient.
     
  5. lobelsteve

    lobelsteve SDN Lifetime Donor Lifetime Donor 10+ Year Member

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    Money making scheme. No legitimate use in pain medicine. OIG needs to work on this fraud.
     
  6. Taus

    Taus . SDN Moderator 10+ Year Member

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    I figured as much when I saw more and more reps coming to talk to the office to talk to us about it....kinda like creams...
     
  7. Jcm800

    Jcm800 7+ Year Member

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    with amazing technology such as "Pharmacogenetic Testing" no wonder we are the laughing stock of the world of medicine and viewed as drug dealers and charlatans. yecchh. no thank you.
     
  8. Pacman27

    Pacman27 7+ Year Member

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    Isnt this AAPM journal

    I think I went to one of their conferences, never again.

    The problem with these articles is that other physicians read this and think its accurate. I can not blame them as they dont specialize in pain medicine

    Does anyone even know what the insurance companies pay for these tests?
     
  9. algosdoc

    algosdoc algosdoc 10+ Year Member

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    I blocked the email ads and asked the reps to stop calling. This speculative unproven technology has a long way to go before becoming clinically useful.
     
  10. emd123

    emd123 5+ Year Member

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    Are they giving kickbacks for these? They must be. One of the local orthos here, runs these on everyone and tells them to take their results to me or their PCP to figure out what to do with them. I can't find much use form them.
     
  11. pmrmd

    pmrmd SDN Lifetime Donor Lifetime Donor 7+ Year Member

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    I used this once to discredit a patient's thoughts that they were a rapid metabolizer and kept needing more medications. Showing people an official piece of paper that shows they are normal helps sometimes, I guess. It's cash only right now.
     
  12. ziggyziggy

    ziggyziggy 5+ Year Member

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    I don't know what they get but people around me are running on everybody too. I am sure that companies running these testing are making a lot.
     
  13. algosdoc

    algosdoc algosdoc 10+ Year Member

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    There are frequently a number of metabolic pathways for medications including opioids. The liver will frequently increase the metabolism by an alternative pathway when a major pathway is blocked. Some metabolites are active and each of these may have multiple pathways for metabolism. It would seem that the numbers of pathways available would preclude comprehensive testing, therefore it is not really known the pathway used by an individual patient.
     
  14. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor 5+ Year Member

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    i would also argue that the metabolic pathway does not necessarily correlate with clinical effect or incidence of side effects.
     
  15. 101N

    101N 5+ Year Member

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    Or risk of addiction/overdose/apnea.

    I wonder if there are heroin rapid metabolizers.
     
  16. hyperalgesia

    hyperalgesia member 5+ Year Member

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    I completely agree with you guys. I think clinically useless at the present time.

    I know some members of an organization that will remain unnamed are consultants and/or owners of some of these companies.

    Hmmm... Wait I'm supposed to be less cynical to avoid early onset dementia...
     
  17. Ligament

    Ligament Interventional Pain Management Lifetime Donor SDN Advisor 10+ Year Member

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    Has anybody changed their opinion on pharmacogenetic testing?
     
  18. Jigsaw

    Jigsaw 2+ Year Member

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    I don't know anyone that uses it. Where I am at now they seemed to have tried to use it but it was too expensive for the patient.
     
  19. Ligament

    Ligament Interventional Pain Management Lifetime Donor SDN Advisor 10+ Year Member

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    I think MANY docs should be making 7 figures, but ethically of course. Our work is valuable. Making a profit is good.

    (I make nowhere near that but am happy for those that do ethically)
     

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