VISN 4 MIRECC Newsflash
Does genetic big data hold answers for safer, more effective opioid prescribing?
More than half of Veterans are living with some form of chronic pain. Meanwhile, PTSD, depression, alcohol use, and suicide attempts—all disorders that affect Veterans—are associated with high-dose opioid use, and Veterans are twice as likely to die from an accidental overdose than non-Veterans. Therefore, finding ways to precisely target opioid treatment for pain or addiction could improve safety and maximize benefits, thereby advancing care.
VA researchers are looking to the Million Veteran Program (MVP)—now the largest health care system-linked genomic database in the world with more than 750,000 participants—for answers. With his project, Pharmacogenetic Study of Opioid Agonist Treatments in MVP, addiction psychiatrist Kyle Kampman, M.D. along with Henry Kranzler, M.D. of the VISN 4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center are searching for genetic predictors of opioid sensitivity. Genetic variants can affect the way a person processes medication, so, for a person with a specific variant, one drug (or a particular dosage of the medication) may be more effective while another may carry less risk. Any new genetic discoveries from this study could potentially help predict a patient’s response to the drug buprenorphine for opioid addiction as well as help providers avoid over- or under-prescribing opioids for managing acute or chronic pain.
Dr. Kampman’s study—one of three MVP projects being conducted by VISN 4 MIRECC investigators—supports the Center’s thematic focus on Precision Mental Health Care by making use of big data (merging the power of the MVP database with the electronic health record) to predict treatment outcomes.
Click here for more information about the Million Veteran Program.
Following a presentation in late May, the VISN 4 MIRECC was renewed with full support for an additional five-year period. The reviewers recently provided written feedback, awarding the Center a final average rating in the “excellent” range. The report acknowledged the Center’s unique conceptual focus on Precision Mental Health Care, noting its potential impact for VA in ways not addressed by other programs. It also made note of the Center’s research efforts, which have been bolstered by strong faculty, dedication to high-risk and high-impact projects, successful pursuit of peer-reviewed funding, a high rate of scientific publication, and investment in fostering junior investigators.
Gretchen Haas, Ph.D. was recently recognized by the University of Pittsburgh Department of Psychiatry for excellence in teaching medical students.
Judith Callan, Ph.D., R.N. received VA Rehabilitation R&D Merit funding for her study, Does Adding a Tailored Cognitive Behavioral Therapy (CBT) Mobile Skills App Mediate Higher Rates of Depression Recovery, Adjustment, and Quality of Life in OEF/OIF Veterans Compared to Standard CBT?
Henry Kranzler, M.D. received notice of a P30 grant from the National Institute on Drug Abuse (NIDA) to support the Penn PET Addiction Center of Excellence, which is a collaboration between researchers in the Department of Radiology and the Center for Studies of Addiction at Penn and investigators at Yale University. The Penn PACE will support positron emission tomography studies of opioid use disorder (OUD). Its aim is to use this neuroimaging method to understand risk factors for OUD and co-occurring conditions (such as HIV infection) and their treatment. The researchers intend to extend the effort to include Veterans from the CMCVAMC as well as patients and healthy subjects from the Philadelphia community.
Mavandadi S, Ingram E, Klaus J, Oslin D. Social Ties and Suicidal Ideation Among Veterans Referred to a Primary Care-Mental Health Integration Program. Psychiatric Services. May 2019. DOI
Daly EJ, Trivedi MH, Janik A, Li H, Zhang Y, Li X, Lane R, Lim P, Duca AR, Hough D, Thase ME et al. Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients with Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. June 2019. DOI
Volk DW, Lewis DA. Insights into the Pathophysiology of Endocannabinoid Signaling in Schizophrenia. JAMA Psychiatry. June 2019. DOI
Boland E, Goldschmied J, Kayser MS, Gehrman PR. Precision Medicine for Insomnia. Sleep Medicine Clinics. June 2019. DOI
Rentsch CT, Edelman EJ, Justice AC, Marshall BDL, Xu K, Smith AH, Crystal S, Gaither JR, Gordon AJ, Smith RV, Kember RL, Polimanti R, Gelernter J, Fiellin DA, Tate JP, Kranzler HR, Becker WC; VACS Project Team. Patterns and Correlates of Prescription Opioid Receipt Among U.S. Veterans: A National, 18-Year Observational Cohort Study. AIDS and Behavior. July 2019. DOI
Klee A, Chinman M, Kearney L. Peer Specialist Services: New Frontiers and New Roles. Psychological Services. August 2019. DOI
EXPERTS IN THE NEWS
Isabella Soreca, M.D. was interviewed by U.S. Medicine about a recently published article in Psychosomatics, which she coauthored with Caitlan Tighe, Ph.D. and Adam Bramoweth, Ph.D. They found that Veterans with serious mental illness (SMI) have a greater risk of sleep apnea as well as increased rates of comorbid conditions like obesity, hypertension, smoking, and diabetes. Dr. Soreca explained that while sleep apnea is generally underdiagnosed, identifying it in Veterans with SMI can be particularly challenging due to overlapping symptoms and barriers to receiving care like transportation or financial issues. (May)
A blog post from the Recovery Research Institute at Massachusetts General Hospital featured a review article about contingency management recently published by Sarah Forster, Ph.D., Dominick DePhillippis, Ph.D., and Steven Forman, M.D., Ph.D. (May)
The Precision Medicine in Mental Health (PRIME) Care study’s Value Assessment Core published findings that were featured in a News Brief on the homepage of the VA Office of Research & Development. The authors of the paper recently published in JAMA Network Open analyzed six years of pharmacy records of more than 7.7 million Veterans, finding that nearly all have genetic variants that could impact their response to commonly prescribed medications and that more than half had been exposed to an affected drug. (June) Check out the latest PRIME Care publications and resources here.
Henry Kranzler, M.D. coauthored a paper with researchers at the VA Connecticut and Boston health care systems that was also featured in a News Brief on the homepage of the VA Office of Research & Development. Using MVP data, the team identified five new genetic variants linked to habitual alcohol use. (June) Dr. Kranzler also spoke to UConn Today about the recent renewal of the Alcohol Research Center at UConn Health, where he continues to serve on the scientific advisory board. (June)
Philip Gehrman, Ph.D. was quoted in a story on Thrive Global about how comfort objects can help with sleep. (June)
Vishwajit Nimgaonkar, M.D., Ph.D.’s recently published article in JAMA Psychiatry was highlighted on Healio.com with a summary of the findings of a genome-wide association study (GWAS) in India that identified a novel susceptibility gene for schizophrenia. (July)
Sign up for updates.