P erceptions regarding the use of gabapentin for alcohol use disorder (AUD) have shifted over time. 1-4 Early on, the drug was deemed to be benign and effective. 4-6 But more and more, concerns are being raised about its recreational use to achieve euphoria, 7 and the drug is often misused by vulnerable populations, particularly those with opioid use disorder. 7-9 Given the large number of gabapentin prescriptions written off-label for AUD, it is incumbent on providers to understand how to prescribe it responsibly. 7-9 To that end, this article focuses on the benefi tsand concerns-of this treatment option. We describe the effects of gabapentin on the central nervous system and how it may mitigate alcohol withdrawal and increase the likelihood of abstinence. In addition, we review clinical trials that evaluated potential roles of gabapentin in AUD, discuss the drug's misuse potential, and suggest a framework for its appropriate use in AUD management. ■ ALCOHOL USE DISORDER IS COMMON AND SERIOUS AUD affects about 14% of US adults and represents a signifi cant health burden, 1 often with severe clinical and social implications. It manifests as compulsive drinking and loss of control despite adverse consequences on various life domains. 10 It is generally associated with cravings, tolerance, and withdrawal symptoms upon cessation. Alcohol withdrawal is characterized by tremors, anxiety, sweating, nausea, and tachycardia, and in severe cases, may involve hallucinations, seizures, and delirium tremens. Untreated, alcohol withdrawal can be fatal. 10

The escalation of the opioid crisis has led to an increase in the treatment of opioid use disorder. In particular, recent legislation has allowed for office-based treatment with buprenorphine, a partial µ-opioid agonist that is believed to be safer than methadone due to a ceiling effect on respiratory depression in adults. An increasing number of children are being exposed to buprenorphine as more adults in US households receive take-home prescriptions. The ceiling effect seen in adults does not seem to apply to young children, and intoxication with severe symptoms including fatalities can occur. This article outlines the pharmacology of buprenorphine and reviews the current literature on overdose in children. We conclude with practical recommendations for limiting potential exposure and damage to children from accidental buprenorphine overdose.

No abstract