With the ability of pharmacogenomics to synthesize genetic information for the sake of personalized medical care, health professionals have ever expanding options that allow them to craft better treatment plans. Experts in the field discuss where pharmacogenomics is today, and where it's going.

What is your perspective on the current state of pharmacogenomics? 

Zeil Rosenberg: Pharmacogenomics, the ability to know which drugs are more rapidly or more slowly metabolized in any individual based on their own individual genetic information, has turned the corner due to the advent of new technologies which allow for lower test pricing, rapid turnaround times for test results and a new generation of doctors schooled in the importance of genetic information in individualized medical care.

Brady Millican: Pharmacogenomics is a very competitive market place. Providers of the service range from clinics to nationally recognized institutions to independent labs such as Admera. There are multiple business models being employed as well, and it is difficult to determine what model will be more successful given the regulatory and reimbursement landscape.

Where do you think the use of pharmacogenomics is the strongest and makes the most sense? 

ZR: Pharmacogenomics today can have the greatest impact in the accurate prescription of pain medications such as opioids, other mental health concerns such as use of psychotropic medications for depression and anxiety, and cardiology where the right dose of a drug can literally be the difference of life and death.

BM: Pharmacogenomic testing is most useful in many different situations. Sometimes medications have FDA warnings that require or recommend pharmacogenomic testing, for example.

If a patient has been prescribed multiple drugs, especially those that are polypharmic (taking more than five drugs) they are a great candidate for pharmacogenomic testing. They are also good candidates: when a patient has a history of poor medication compliance; if patients have chronic conditions and are taking multiple medications in attempt to treat these conditions; if a higher-than-standard dosage to achieve the desired result is required; or if trial and error prescribing has been unsuccessful.

If a patient has experienced a severe adverse drug reaction in the past they should also consider pharmacogenomic testing — or if they have had an unexpected or unexplained responses to medications. Especially, if they have been hospitalized for adverse drug events.

The specialists that are adopting the testing are psychiatrists, cardiologists, pain management specialists and oncologists.

How have you seen the use of pharmacogenomics advance treatment and care in the mental health field?

ZR: Use of pharmacogenomics in psychiatry to help patients get better more quickly and with less side effects is already a reality in psychiatry. Psychiatric patients experience a wide variation of drug efficacy, 42 percent of which is due to genetic variance in one study. They also experience a wide range of toxic effects from incorrect drug selection, including central nervous system effects and heart arrhythmias. Pharmacogenomic testing has been quite helpful in assessing medication intolerance, and helping patients break past the barrier of treatment resistant depression, reducing time to improvement in major depression significantly, per major published studies. It also has helped provide patients with a rational alternative to the usual time-consuming trial-and-error approach to selecting a drug for treating a psychiatric illness, the standard approach without pharmacogenomic testing.

BM: Yes, this is an area specifically utilizing pharmacogenomic testing. Getting the right prescription at intake is very beneficial to the patient.

What has been the biggest challenge for researchers and medical professionals who use pharmacogenomics in the mental health field?

ZR: The biggest problem facing medical professionals who use pharmacogenomics is understanding their importance in both alleviating pain better — but equally important is their own role they can now play in reducing the epidemic of over-prescription of pain medications which may lead to overdependence on opioids and the opioid epidemic we are facing as a nation. Indeed, the Surgeon General sent a letter in 2016 to all physicians nationwide about the devastation of opioid overuse and its contribution to the opioid epidemic that is devastating our communities. He cited that now nearly 2 million people in America have a prescription opioid use disorder. He called for evidence-based pain treatment to reduce over prescribing, for which pharmacogenomics can greatly facilitate by knowing which opioid will be sufficient to properly dose pain medication.

What do you see for the future of pharmacogenomics? 

ZR: Pharmacogenomics has a bright future. As more and more doctors realize the benefit of having personalized genetic information at the bedside as they prescribe drugs, the better and more quickly they will be able to pick the right medication at the right time for the right individual, reducing adverse medical effects that come with over prescription.

BM: Pharmacogenomic testing will be the standard of care for anyone taking prescription medicines.