CYP2D6 Expression in Veterans Experiencing Opioid Overdose: A Postmortem Review
Julia Boyle1,2, Christopher J Stock1
1Department of Pharmacy, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
This study found that 7% of opioid overdose deaths in veterans had the ultrarapid (UM) metabolizer phenotype for CYP2D6. However, the findings do not support the hypothesis that this phenotype is over-represented in opioid overdose deaths.
Area of Science:
- Pharmacogenetics
- Toxicology
- Genetics
Background:
- CYP2D6 enzyme metabolizes various opioids, influencing overdose risk.
- Ultrarapid (UM) metabolizers may face higher overdose risk due to rapid opioid metabolism.
Purpose of the Study:
- To determine if the CYP2D6 ultrarapid (UM) metabolizer phenotype is over-represented in opioid overdose deaths.
- To characterize CYP2D6 genotype and predict phenotype in opioid overdose decedents.
Main Methods:
- Analyzed blood samples from 75 US military veteran decedents of opioid overdose.
- Performed CYP2D6 genotyping and copy number variation testing.
- Predicted phenotype based on CPIC guidelines and reviewed toxicology and medical records.
Main Results:
- 75% of decedents were extensive (EM) metabolizers, while 7% were ultrarapid (UM) metabolizers.
- Other opioids and multiple substances (alcohol, benzodiazepines) were frequently detected in toxicology.
- Hydrocodone, oxycodone, or tramadol were present in 41% of opioid-positive samples.
Conclusions:
- 7% of veteran decedents exhibited the CYP2D6 UM phenotype.
- Small sample size limits definitive conclusions about UM phenotype frequency.
- The study does not support the hypothesis of UM phenotype over-representation in opioid overdose deaths.
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