Precision Medicine for Opioid Use Disorder: Insights From New Review

January is substance use disorder treatment month, and Psychiatric Times sat down with researchers of a new study on precision medicine and opioid use disorder. The study reviewed potential for innovation in treatment of opioid use issues with precision medicine and individualized treatment. Poorvanshi Alag, MD, lead researcher on the study, highlighted the genetic and biological aspects to enhancing treatment for opioid use disorder.

Psychiatric Times: Can you provide a review of the data and results from your recent study “Tailored Therapies in Addiction Medicine: Redefining Opioid Use Disorder Treatment with Precision Medicine”?

Poorvanshi Alag, MD: Our publication is a narrative review synthesizing current evidence on precision medicine approaches in opioid use disorder (OUD). The data reviewed reaffirm that medications for opioid use disorder, methadone, buprenorphine, and naltrexone, are the most effective treatments for reducing relapse, overdose, and mortality. However, treatment outcomes vary widely, and medications for OUD remain underutilized. The review highlights that biological variability, psychiatric comorbidities, and social determinants significantly influence treatment response. Precision medicine offers a framework to better align existing evidence-based treatments with individual patient characteristics, though most current approaches remain adjunctive and investigational.

Clinical takeaway: Precision medicine refines, not replaces, evidence-based medications for OUD by accounting for individual biological and psychosocial variability.

PT: Can you elaborate on some of the genetic markers thought to be involved in opioid use disorder?

Alag: Opioid use disorder is polygenic, with genetic factors contributing substantially to vulnerability but no single causative gene identified. The literature most consistently implicates genes involved in opioid signaling (OPRM1), inhibitory neurotransmission (GAD2), dopaminergic reward pathways (dopamine D3 receptor), and drug metabolism and transport (CYP2B6, ABCB1). Epigenetic mechanisms, including DNA methylation, have also been associated with OUD. Importantly, associations are often population-specific, and current evidence does not support routine clinical genetic testing for OUD risk or treatment selection.

Clinical takeaway: Genetic markers currently inform research rather than routine clinical decision-making in OUD treatment.

PT: How are technological advancements contributing to precision medicine and treatment of substance use disorder?

Alag: Technological advancements are increasingly used to integrate genetic, clinical, and psychosocial data in OUD care. Current evidence supports their role in risk stratification, relapse prediction, and treatment engagement monitoring using electronic health records and social determinants of health. Digital platforms such as telemedicine and remote monitoring improve access to care, particularly in underserved settings. These technologies function as clinical decision-support tools rather than independent treatment modalities. Ethical considerations, including privacy, bias, and equitable access, remain essential as implementation expands.

Clinical takeaway: Technology enhances personalization and access while supporting, not replacing, clinical judgment.

PT: How do you see pharmacogenomics impacting clinical practice?

Alag: Pharmacogenomics may help explain variability in medication response and dosing, particularly for methadone, which has complex metabolism and a narrow therapeutic range. Variants in metabolic enzymes and transport proteins have been associated with dose requirements in specific populations. However, pharmacogenomic testing is not standard of care for opioid use disorder and should not be used as a primary determinant of treatment choice. At present, its role is adjunctive and potentially most relevant in complex or treatment-resistant cases, alongside careful clinical monitoring.

Clinical takeaway: Pharmacogenomics may assist dose optimization but does not replace comprehensive clinical assessment.

PT: What do you hope the future of precision medicine research for SUD looks like?

Alag: Future precision medicine research in substance use disorders should prioritize integrated models that combine genetics, psychiatric comorbidities, social determinants of health, and longitudinal clinical data. Emphasis should be placed on validating biomarkers that meaningfully improve outcomes and are applicable across diverse populations. Equally important is ensuring equitable implementation so emerging tools do not widen existing disparities in care. The goal is not to replace established treatments, but to optimize how and for whom they are delivered in real-world settings.

Clinical takeaway: Integrated, equitable precision models should optimize delivery of existing evidence-based OUD treatments.

PT: Thank you!

Dr Alag is a psychiatrist affiliated with the Texas Health Presbyterian Hospital Dallas.