What role do genetics play in the nation’s growing opioid addiction crisis? That question is the focus of a new research initiative funded by a $4 million grant from the National Institutes of Health.

To seek answers, Florida Atlantic University scientists and colleagues are assessing clinical and genetic characteristics of people suffering from chronic musculoskeletal pain who are taking prescription opioids. The five-year study aims to figure out if unique genetic characteristics may make certain patients more susceptible to addiction.

The work could help in the development of an “addiction risk score” to identify people more likely to fall victim to prescription opioid-use addiction who may benefit from additional counseling and access to other treatment options.

“The overall goal of this project is figuring out if there is a unique genetic signature of patients who are most susceptible to addiction,” says Dr. Janet Robishaw, Ph.D., professor and chair of the Department of Biomedical Science in FAU’s College of Medicine, who will help lead the research with colleagues from Geisinger Health System and the University of Pennsylvania.

“In the first part of our study, we are looking at the clinical characteristics of these patients to understand the cause of their pain and how prescription opioids are affecting their outcomes.”

Opioids commonly prescribed for pain – such as morphine, Oxycontin, Viocodin – can lead to increased risk of addiction problems that afflict an estimated 2 million Americans each year and are a primary cause of overdose deaths.

Currently, efforts to combat the opioid crisis target faulty prescription practices and patients who engage in “doctor shopping,” to fill their scripts. But the FAU researchers believe the new study could help drive more proactive approaches to limiting addiction risks and deaths and move beyond what experts call a one-size-fits-all approach to prescribing opioids for chronic pain.

Chronic pain is a big public health issue in the U.S., striking an estimated 100 million Americans. It is a leading cause for doctor visits and President Donald Trump has declared prescription addiction a national emergency.

Experts say the challenge is how to provide effective pain treatment for the four out of five pain patients who are least likely to face addiction risks, without endangering the 20 percent who are at most risk.

That’s where the new FAU study could be most effective. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder.

Researchers will mine data from Geisinger’s electronic health record (EHR) database in an effort to identify those who are at low risk and high risk for opioid abuse.

Robishaw – along with Dr. Wade H. Berrettini, a professor of psychiatry at the University of Pennsylvania, and Dr. Vanessa Troiani, Ph.D., assistant professor at Geisinger – will survey patients and track their genetic profiles.

The research team expects it will take two years to analyze the data to divide the patient population into cases and controls in order to complete a genome-wide association study, which is the second part of the research project.

“There is an urgent need to develop clinical, genetic and neural characteristics of patients who are at moderate- to high-risk of becoming addicted to prescription opioids,” notes Dr. Phillip Boiselle, dean of FAU’s College of Medicine. “The National Institutes of Health grant awarded to Dr. Robishaw and her collaborators will help them to identify the genetic factors that increase the risk of addiction in patients, which then become targets for new drug development.”

The investigative team suggests a multipronged approach may be most effective in addressing this national crisis, which should involve research, education and engaging patients so that they understand their susceptibility to risks and empower them in their health care decisions.

“Prescription opioid-use disorder is a lifelong problem that requires a thoughtful approach that is not going to be solved just by curtailing prescriptions of these narcotics,” says Robishaw. “We have to employ more rigorous prescribing practices and provide alternative treatments for moderate to severe pain that don’t involve opioids.

“And, we need to improve access to medication-assisted therapy for those patients already dependent on prescription opioids. Currently, only 7 percent of patients with prescription opioid-use disorder have access to such treatments and this is because of a variety of services.”