811 - The Role of Catechol-o-methyltransferase and Cytochrome P450 2D6 in Opioid Consumption Patterns

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

RC

Rebecca Cox, BS

Medical Student
Emory University School of Medicine
Atlanta, Georgia, United States

Co-Author(s)

AC

Austin Collins, BA

Medical Student
Emory University School of Medicine
Decatur, Georgia, United States
GD

Gregory L. Darville, MD

Orthopaedic Surgery Resident
Emory School of Medicine Department of Orthopaedic Surgery
Atlanta, Georgia, United States
RH

Rebecca Haley, MD

Resident Physician
Cleveland Clinic Orthopaedic Surgery
Cleveland Heights, Ohio, United States
NG

Nicole Greene, BA

Medical Student
Emory University School of Medicine
Atlanta, Georgia, United States
ED

Emily L. DeMaio, MD

Orthopaedic Surgery Resident
McGaw Medical Center of Northwestern University
Chicago, Illinois, United States
EB

Emily Boss, BS, LAT, NREMT, ATC, OTC

Surgical Athletic Trainer
Resurgens Orthopedics
Atlanta, Georgia, United States
MG

Michael B. Gottschalk, MD

Associate Professor, Vice Chair for Clinical Operations
Emory Umiversity
Dunwoody, Georgia, United States
JX

John Xerogeanes, MD

Chief of Sports Medicine
Emory University Dept of Orthopaedics
Brookhaven, Georgia, United States

Objectives: As declared by the Centers for Disease Control and Prevention (CDC), the United States is in the midst of an opioid epidemic. There remains a paucity of research regarding how one’s individual genetic composition may affect opioid consumption patterns. This study aims to further the field of personalized medicine by analyzing pharmacogenomics to predict patient’s drug response in opioid consumption patterns post ACL reconstruction surgery.

Design: Patients aged 18-50 years old were divided into cohorts based on opioid consumption patterns. Cohorts are defined as non-, low, average, high, and maximum opioid users stratified based on the standard deviation of use. DNA was analyzed for the 100 total participants for genes relating to pharmacodynamics and pharmacokinetics such as CYP2D6, CYP3A5, OPRM1, and COMT.

Results: For CYP2D6, the coefficient “Tablets” was found to be a statistically significant (P < 0.05) contributing factor in the classification of the group 'Poor' when 'Normal' is used as the reference group. The relative risk ratio for a one unit increase of the variable “Tablets” is exp(0.4696) = 1.599. The COMT classification difference of "High" to "Low" was found to have a significant effect on the response variable “Tablets.” The CYP3A4, CYP3A5, and OPRMI classifications did not have a significant effect on the response variable “Tablets.”

Conclusions: Further research is required to better understand the effect of a patient’s individual genetic composition on opioid consumption patterns. COMT and CYP2D6 were found to have a statistically significant association between higher metabolism rates and higher opioid usage to manage pain post ACL reconstruction surgery. This knowledge will have the potential to shape the future of orthopedic care by guiding surgeons to create individualized postoperative pain management plans with unique drug regimens and educational content specific to each patient’s needs.