Editor's Note: As part of its effort to facilitate responsible opioid prescribing, the American Academy of Addiction Psychiatry (AAAP) hosts a listserv where clinicians can submit clinical questions and receive responses from a rotating panel of pain experts. In conjunction with the AAAP, Medscape has selected 10 of the most common questions or topics related to opioid use that have been submitted, and asked Charles E. Argoff, MD, Director of the Comprehensive Pain Management Center at Albany Medical Center, and Roger Chou, MD, Professor of Medicine and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University in Portland, to provide responses. For additional resources on appropriate opioid prescribing and opioid addiction treatment, please see the AAAP's PCSS-O and PCSS-MAT programs, which provide guidance on the safe and effective use of opioid medications and on the treatment of opioid addiction.
The Genetic Risk for Substance Abuse
What is known about the genetic risk for substance abuse, and is there a statistical risk calculator for abuse that is based on a patient's family history?
Dr. Chou: Unfortunately, there is no simple estimate for risk for substance abuse based on genetics or family history. Twin studies suggest that the degree of heritability of addictive disorders ranges somewhere between 40% and 70%, depending on the substance being evaluated. The risk appears to be higher with first-degree relative than more distant relatives, but I am not aware of consistent or reliable estimates of the degree of risk with more distant relatives.
In addition, there is no simple mendelian inheritance pattern with addiction, and it is likely that the genetic relationships are complex. The risk for substance abuse is also dependent on environmental (eg, exposure) and other factors.
The bottom line is that in a patient being considered for opioids, a personal history of substance abuse is the strongest risk factor for future abuse, and a family history is also an important risk factor, though to a lesser degree.
Dr. Argoff: Although there is no simple answer to this question, at least one of the tools currently available to screen for risk for opioid misuse and abuse, the Opioid Risk Tool, incorporates family as well as personal history of substance abuse into risk stratification.