The clinical utility of opioids is limited by adverse drug effects including respiratory depression, sedation, nausea, and pruritus. In addition, abuse of prescription opioids is problematic. Gaining a better understanding of the genetic and environmental mechanisms contributing to an individual’s susceptibility to adverse opioid effects is essential to identify patients at risk.
A classical twin study paradigm provided estimates for the genetic and familial (genetic and/or shared environment) contribution to acute adverse and affective opioid responses; all secondary outcomes of a larger data set. One hundred and twenty one twin pairs were recruited in a single occasion, randomized, double-blind and placebo controlled study. The mu-opioid receptor agonist alfentanil and saline placebo were administered as target-controlled infusions under carefully monitored laboratory conditions. Measured outcomes included respiratory depression, sedation, nausea, pruritus, drug liking and drug disliking. Demographic information was collected, and aspects of mood and sleep were evaluated.
Significant heritability was detected for respiratory depression (30%), nausea (59%) and drug disliking (36%). Significant familial effects were detected for sedation (29%), pruritus (38%), dizziness (32%), and drug liking (26%). Significant covariates included age, gender, race, ethnicity, education, mood and depression. Covariates affected sedation, pruritus, drug liking and disliking, and dizziness.
This study demonstrates that large scale efforts to collect quantitative and well-defined opioid response data are not only feasible but also produce data that are suitable for genetic analysis. Genetic, environmental and demographic factors work together to control adverse and reinforcing opioid responses, but contribute differently to specific responses.