Pre-Collegiate Global Health Review
America’s Opioid Crisis: Causality of Genetics and Psychological Factors
Updated: Aug 18, 2021
Carolyn Colman, Jones College Prep, Chicago, IL
Opioid addiction is increasingly becoming a crisis throughout the world. In 2016, staggering statistics show “the opioid epidemic accounted for close to 80% of the 64,000 drug-related deaths in the United States and is now the country’s leading cause of accidental deaths” (Goodman-Meza). This problem is not exclusive to the United States: “Because of their capacity to cause respiratory depression, opioids are responsible for a high proportion of fatal drug overdoses around the world” (WHO, 2018). The issue of opioid abuse is especially significant because opioids are so widely used. In fact, “there were an estimated 53.4 million past-year [...] users of opioids...globally in 2017” (UN, 2019). This is not only a problem in the United States, as countries like Mexico and South Africa have shown worrying signs of a potential opioid crisis.
Although opioid addiction may seem like a random occurrence, the combination of one’s childhood and genetics is a significant factor. Scientists have discovered that those who have been brought up around people suffering from opioid addiction are far more likely to succumb to the devastating disease themselves (Center for Substance Abuse). After a certain period of exposure to opioids, any person will become dependent, but only a small percentage will become addicted. The difference between dependence and addiction lies inside the OPRM1 gene (National Institutes of Health). This gene defines one’s susceptibility to opioid addiction. The two variations of it are the A118 allele and the 118G allele. The rarest combination is the heterogeneous A118G gene variant (Drakenberg).
A study conducted by Katarina Drakenberg in 2006, “μ Opioid Receptor A118G Polymorphism in Association with Striatal Opioid Neuropeptide Gene Expression in Heroin Abusers,” showed high prevalence of the A118G variant within those affected by opioid addiction, which highlights the clear causality of this gene on one’s susceptibility to opioid addiction. The study concluded that 88% of those in the study with the heterozygous A118G allele were addicted to heroin. Additionally, the heterozygous A118G allele was present within 91% of heroin addicts included in the study. Barbara A. Hastie, in a study published in the “U.S. National Library of Medicine,” looked at the impact of ethnicity on one’s OPRM1 gene and discovered that the A118G allele is typically found in Caucasians of European descent. This information makes determining one’s potential risk of addiction even easier than ever before.
The most practical solution to the opioid crisis would be to implement preventative measures. Instead of restricting prescriptions, perhaps doctors should have mandatory pre-testing to scan for both genetic red flags and psychological testing to ensure that one’s mental state is stable enough to take prescription opioids. This testing would not only reduce opioid abuse and save people’s lives from the destructive impacts of opioid addiction, but also make opioids more accessible for those who are truly in need of them.
While the opioid crisis in America is unparalleled by any other country, other countries such as South Africa and Mexico have worrying indications of an opioid crisis. According to Lawrence A. Palinkas (PhD), “Mexico’s transition from a country of low opioid use to high opioid use is being fueled by a convergence of several factors…,” including, “...changing demographics...and stress and trauma related to forced migration…” (Palinkas). Additionally, the crisis is further along in South Africa where they have begun experimenting with “methadone maintenance therapy” (Scheibe et al). While these preliminary trials have shown success, it would be better if these crises are stopped before they can occur. Mandating genetic and psychological tests prior to the prescription of opioids could be helpful in this regard. These preemptive measures can help ensure that the opioid crisis does not continue to spread around the world.
Drakenberg, Katarina, et al. “μ Opioid Receptor A118G Polymorphism in Association with Striatal Opioid Neuropeptide Gene Expression in Heroin Abusers.” Proceedings of the National Academy of Sciences of the United States of America, vol. 103, no. 20, 2006, pp. 7883–7888. JSTOR, www.jstor.org/stable/30049351.
Goodman-Meza, D., Medina-Mora, M. E., Magis-Rodríguez, C., Landovitz, R. J., Shoptaw, S., & Werb, D. (2019). Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US–Mexico Border. American Journal of Public Health, 109(1), 73-82. doi:10.2105/ajph.2018.304767
Hastie, Barbara A, et al. “Ethnicity Interacts with the OPRM1 Gene in Experimental Pain Sensitivity.” Pain, U.S. National Library of Medicine, Aug. 2012, https://www.ncbi.nlm.nih.gov/pubmed/22717102/.
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“Opioid Addiction - Genetics Home Reference - NIH.” U.S. National Library of Medicine, National Institutes of Health, https://ghr.nlm.nih.gov/condition/opioid-addiction#genes.
Palinkas, L. A. (2019). Opioid Use Epidemic in Mexico: Global Solutions to a Global Problem. American Journal of Public Health, 109(1), 26-27. doi:10.2105/ajph.2018.304833
Scheibe, A., Shelly, S., Gerardy, T., Homeyer, Z. V., Schneider, A., Padayachee, K., . . . Marks, M. (2020). Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa. Addiction Science & Clinical Practice, 15(1). doi:10.1186/s13722-020-00186-7
Treatment, Center for Substance Abuse. “Chapter 2 Impact of Substance Abuse on Families.” Substance Abuse Treatment and Family Therapy., U.S. National Library of Medicine, 1 Jan. 1970, https://www.ncbi.nlm.nih.gov/books/NBK64258/.
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