QHI Improves Pain Management with YouScript
Quadra Health Institute is one of the Southwest’s leading Sports Medicine and Acute Pain Management clinics. Known for taking a multidisciplinary, biopsychosocial approach to treating pain, Quadra Health Institute (QHI) integrates four components: an Evidence-Based Musculoskeletal Clinic, Physical Therapy, Graded Exercise, and a Behavioral approach to help individuals learn how to better manage and cope with behavioral issues related to pain.
Located in Albuquerque, New Mexico, QHI is a very busy clinic. Medical Director Dr. Pamela Black oversees three Physician Assistants—Kay Heaphy, PA-C, Fernando Vigil, PA-C and Bitu Sheth, PA-C—to treat about seventy patients a day and perform nearly sixty interventional procedures a week.
Dr. Black’s interest in pharmacogenomics stemmed from the high amount of opioid use she sees. Opioid medications, such as morphine or Oxycontin, are powerful painkillers often prescribed for chronic pain. This chemical power, however, can be dangerous. Adverse effects and addiction can be common, so opioids must be prescribed carefully, especially since many go through the highly polymorphic CYP pathways.
Dr. Black had considered pharmacogenomics in the early 2000s, but a lack of commercially available services deterred her. Nevertheless, the idea that a person’s genes and medication regime could conflict stayed with her. A 2012 meeting with YouScript’s Mike Marra and Fred Mady introduced her to Genelex.
Integrating pharmacogenomics into her practice “is changing the way I’m practicing,” says Dr. Black. By using YouScript®, Dr. Black has been able to tailor dosing strategies and more quickly identify when patients need to be switched from one medication to another.
Dr. Black cited a recent example of a patient on large doses of oxycodone whose testing revealed they were a CYP2D6 poor metabolizer. “I can say to them, unequivocally, this is not the medicine for you to be using,” she said. The patient was switched to morphine, and while they needed help with their psychological addiction to oxycodone’s euphoric effects, the patient ultimately benefited from the change with improved pain relief at a smaller dose. Dr. Black says she appreciates the concrete data that YouScript provides, “I know I’ve got the data to back me up.”
This type of opioid addiction is a recurrent problem in the region and using YouScript has helped Dr. Black identify suspicious cases, such as when a normal metabolizer returns multiple times requesting more medication. By monitoring them more closely and scheduling pill counts, she is more equipped to detect possible addiction or medication diversion. When unusual doses have been necessary, Dr. Black says YouScript has helped her provide better justification for her medication choices during medical board review.
In addition to screening for pharmacogenetic effects, Dr. Black also uses YouScript to detect drug-drug interactions. Most of her patients are referred by other physicians and many arrive already on CYP2D6-inhibiting drugs. This can cause major problems for opioid patients, so Dr. Black frequently contacts other prescribers and talks to them about changing their recommendations. Where it was challenging in the past, most have been more receptive after seeing the data from YouScript. Regarding YouScript’s usability, Dr. Black had a lot to say. “I really like the program. I love being able to enter a drug and see if it changes the profile or not, or if I need to try something else...YouScript makes it easy to learn more about the pathways. And that’s helped my general knowledge about the area as well. It’s a good education tool.”
Dr. Black believes pharmacogenomics has a bright future and is looking forward to better EMR integration and greater prescriber use. “I hope that you guys get more doctors on board. It’s really the wave of the future in terms of prescribing medications,” said Dr. Black.
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