Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update

Evoy, Kirk E.; Sadrameli, Sarvnaz; Contreras, Jillian; Covvey, Jordan R.; Peckham, Alyssa M.; Morrison, Megan D.

doi:10.1007/s40265-020-01432-7

Cited by 136 publications

(139 citation statements)

References 66 publications

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“…However, reports of gabapentin and pregabalin abuse are increasing, and evidence indicates concomitant use significantly increases ORO risk. [5][6]12 While the likelihood of substance use counseling did slightly increase with concomitant gabapentin use, it did not with pregabalin. This is surprising given that pregabalin is classified as a controlled substance by the Drug Enforcement Administration, while gabapentin is not.…”

Section: Discussionmentioning

confidence: 98%

Receipt of Substance Use Counseling Among Ambulatory Patients Prescribed Opioids in the United States

et al. 2020

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Background: As opioid-related overdose deaths climb in the U.S., risk reduction measures are increasingly important. One such measure recommended involves provision of proactive substance use counseling regarding the risks of opioid analgesics. This is particularly important in patients at increased risk of overdose, such as those with substance use disorders (SUD) or those receiving concomitant medications that further increase the overdose risk (eg, benzodiazepines, gabapentinoids, or Z-hypnotics). However, previous research regarding the likelihood that such counseling is provided during outpatient prescriber visits is lacking. Objectives: To determine the percentage of U.S. ambulatory care visits in which patients taking prescription opioids received substance use counseling, and whether counseling was more common in patients with concomitant GABAergic medication(s) (benzodiazepine, gabapentinoid or Z-hypnotic) or substance use disorder (SUD) diagnosis. Methods: A cross-sectional analysis was conducted of all patients aged ⩾18 years identified as having a prescription opioid on their medication list within the 2014-2015 National Ambulatory Medical Care Survey data. Results: Among 162.7 million visits in which patients were taking opioid medication(s), substance use counseling was provided in 2.4%. During visits for patients receiving opioid(s) plus GABAergic(s), substance use counseling was marginally more common (3.1% versus 2.0%, P < .0001). Substance use counseling was also more common among visits for patients taking opioid(s) with SUD (18.9% versus 1.5%, P < .0001). Among visits in which a patient was diagnosed with SUD and taking opioid(s) plus GABAergic(s), counseling was more common (23.1% versus 1.4%, P < .0001) compared to patients taking opioid(s) plus GABAergic(s) without SUD. Conclusions: Among national ambulatory care visits in the United States, substance use counseling is provided infrequently for patients taking opioids, even when significant risk factors are present. Increasing patient education may help reduce opioid-related overdose mortality.

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Section: Discussionmentioning

confidence: 98%

Receipt of Substance Use Counseling Among Ambulatory Patients Prescribed Opioids in the United States

et al. 2020

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“…We read with great interest the informative and well-conducted systematic review update by Evoy et al [ 1 ] about the risks of gabapentinoid (GP) use (and misuse). The authors concluded that evidence suggests that GP-misuse/abuse is growing and comprises a significant individual and public health threat [ 1 ]. However, as the authors stated in their Limitations section, the studies included offer limited generalizability [ 1 ] due to small sample sizes, mostly retrospective designs and homogenous cohorts of opioid- and other substance-dependent subjects [ 1 ].…”

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confidence: 99%

“…The authors concluded that evidence suggests that GP-misuse/abuse is growing and comprises a significant individual and public health threat [ 1 ]. However, as the authors stated in their Limitations section, the studies included offer limited generalizability [ 1 ] due to small sample sizes, mostly retrospective designs and homogenous cohorts of opioid- and other substance-dependent subjects [ 1 ]. Clinical studies focusing on individuals without past and/or present substance use disorders are clearly lacking.…”

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confidence: 99%

“…From a standpoint of scale, not only are reported outcomes (frequently surrogate in nature as admitted by the authors [ 1 ]) relatively rare, we are aware of only a miniscule number of patients worldwide seeking treatment for GP misuse/addiction. The emergence of a substantial sample seeking detoxification and other addiction medicine services should be a conditio sine qua non for a widely used/misused, allegedly strongly addictive, and thereby potentially socially harming substance; and yet we have not yet witnessed this phenomenon despite years of opportunity for its development.…”

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confidence: 99%

“…We would like to provide some further information aimed at balancing the assessment of GPs’ risk:benefit profile. As mentioned above, there is a glaring paucity of clinical studies about the addictive power/harms potential of GP—apart from the studies utilizing limited cohorts of people with other substance-use disorders [ 1 ]. Into this dearth we can add a clinical cross-over study showing that GP-dependence (assessed by face-to-face DSM-IV-based SKID-I interview) was quite rare in the elderly population of a German metropolitan general hospital: among 400 randomized patients, of whom 28 (7%) demonstrated dependence on other non-opioid analgesics (NOA, primarily non-steroidal anti-inflammatory drugs (NSAIDs) and metamizole), two patients (0.5%) reported de novo GP dependence (mild to moderate) along with concurrent NOA dependence [ 7 ].…”

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confidence: 99%

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Comment on “Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update”

Bonnet

McAnally

Scherbaum

2021

Drugs

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Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder

Ellis,

Xu,

Tardelli

et al. 2023

JAMA Psychiatry

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ImportanceGabapentin prescriptions have drastically increased in the US due to off-label prescribing in settings such as opioid use disorder (OUD) treatment to manage a range of comorbid conditions and withdrawal symptoms, despite a lack of evidence.ObjectiveTo assess the purpose and associated risks of off-label gabapentin use in OUD treatment.Design, Setting, and ParticipantsThis retrospective recurrent-event case-control study with a crossover design used administrative claims data from MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Individuals aged 12 to 64 years with an OUD diagnosis and filling buprenorphine prescriptions were included in the primary analysis conducted from July 1, 2022, through June 1, 2023. Unit of observation was the person-day.ExposuresDays covered by filled gabapentin prescriptions.Main Outcomes and MeasuresPrimary outcomes were receipt of gabapentin in the 90 days after initiation of buprenorphine treatment and drug-related poisoning. Drug-related poisonings were defined using codes from International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.ResultsA total of 109 407 patients were included in the analysis (mean [SD] age, 34.0 [11.2] years; 60 112 [54.9%] male). Among the 29 967 patients with Medicaid coverage, 299 (1.0%) were Hispanic, 1330 (4.4%) were non-Hispanic Black, 23 112 (77.1%) were non-Hispanic White, and 3399 (11.3%) were other. Gabapentin was significantly less likely to be prescribed to Black or Hispanic patients, and more likely to be prescribed to female patients, those with co-occurring substance use or mood disorders, and those with comorbid physical conditions such as neuropathic pain. Nearly one-third of persons who received gabapentin (4336 [31.1%]) had at least 1 drug-related poisoning after initiating buprenorphine treatment, compared with 13 856 (14.5%) among persons who did not receive gabapentin. Adjusted analyses showed that days of gabapentin use were not associated with hospitalization for drug-related poisoning (odds ratio, 0.98 [95% CI, 0.85-1.13]). Drug-related poisoning risks did not vary based on dosage.Conclusions and RelevanceGabapentin is prescribed in the context of a myriad of comorbid conditions. Even though persons receiving gabapentin are more likely to have admissions for drug-related poisoning, these data suggest that gabapentin is not associated with an increased risk of drug-related poisoning alongside buprenorphine in adjusted analyses. More data on the safety profile of gabapentin in OUD settings are needed.

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Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update

Cited by 136 publications

References 66 publications

Receipt of Substance Use Counseling Among Ambulatory Patients Prescribed Opioids in the United States

Receipt of Substance Use Counseling Among Ambulatory Patients Prescribed Opioids in the United States

Comment on “Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update”

Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder

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