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Opioid Receptor Polymorphism A118G Associated with Clinical Severity in a Drug Overdose Population

  • Toxicology Investigation
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Abstract

Genetic variations in the human mu-opioid receptor gene (OPRM1) mediate individual differences in response to pain and opiate addiction. We studied whether the common A118G (rs1799971) mu-opioid receptor single nucleotide polymorphism (SNP) was associated with overdose severity in humans. In addition, we examined an SNP responsible for alternative splicing of OPRM1 (rs2075572). We assessed allele frequencies of the above SNPs and associations with clinical severity in patients presenting to the emergency department (ED) with acute drug overdose. This work was designed as an observational cohort study over a 12-month period at an urban teaching hospital. Participants consisted of consecutive adult ED patients with suspected acute drug overdose for whom discarded blood samples were available for analysis. Specimens were linked with clinical variables (demographics, urine toxicology screens, clinical outcomes) then deidentified prior to genetic SNP analysis. Blinded genotyping was performed after standard DNA purification and whole genome amplification. In-hospital severe outcomes were defined as either respiratory arrest (RA; defined by mechanical ventilation) or cardiac arrest (CA; defined by loss of pulse). We analyzed 179 patients (61% male, median age 32) who overall suffered 15 RAs and four CAs, of whom three died. The 118G allele conferred 5.3-fold increased odds of CA/RA (p<0.05), while the rs2075572 variant allele was not associated with CA/RA. The 118G variant allele in the OPRM1 gene is associated with worse clinical severity in patients with acute drug overdose. These findings mark the first time that the 118G variant allele is linked with clinical drug overdose vulnerability.

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Acknowledgments

Dr. Manini had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors would like to thank Ms. Allison Shaber for technical work performed as well as the entire Hurd Laboratory at Mount Sinai School of Medicine for supporting the overall conduct of the study. This study was funded, in part, by grant DA15446 (PI: YLH) from the National Institutes of Health. None of the authors have any connection with the tobacco, alcohol, pharmaceutical or gaming industries or anybody substantially funded by one of these organizations. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

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Authors and Affiliations

  1. Division of Medical Toxicology, Department of Emergency Medicine, Mount Sinai School of Medicine, Elmhurst Hospital Center, One Gustave Levy Place, Box 1620, New York, NY, 10029, USA

    A. F. Manini

  2. Departments of Psychiatry and Neuroscience, Mount Sinai School of Medicine, New York, NY, USA

    M. M. Jacobs & Y. L. Hurd

  3. School of Nursing, University of California, San Francisco, CA, USA

    D. Vlahov

Authors
  1. A. F. Manini
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  2. M. M. Jacobs
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  3. D. Vlahov
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  4. Y. L. Hurd
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Corresponding author

Correspondence to A. F. Manini.

Additional information

This work was presented at 32nd International Congress of the European Association of Poison Centers and Clinical Toxicologists, London, UK, June 2012.

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Manini, A.F., Jacobs, M.M., Vlahov, D. et al. Opioid Receptor Polymorphism A118G Associated with Clinical Severity in a Drug Overdose Population. J. Med. Toxicol. 9, 148–154 (2013). https://doi.org/10.1007/s13181-012-0286-3

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  • DOI: https://doi.org/10.1007/s13181-012-0286-3

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