Gabapentinoid Benefit and Risk Stratification: Mechanisms Over Myth

Abstract

Introduction: Recent years have seen a dramatic escalation of off-label prescribing for gabapentin and pregabalin (gabapentinoids) owing in part to generic versions of each being released over the past two decades, but also in part as a response to increasing calls for multimodal and non-opioid pain management strategies. In this context, several recent articles have been published alleging widespread misuse, with speculations on the unappreciated addictive potential of the gabapentinoid class of Digital Features To view digital features for this article go to

Letter to the Editor: Comment on “Gabapentinoid Benefit and Risk Stratification: Mechanisms Over Myth”

“…The authors also describe that the benefits of gabapentinoid therapy far outweigh the risks [1]. While we concur this is true for many patients, it may not be the case for all.…”

“…Blinded studies have identified that gabapentinoids produce similar drug-liking effects to diazepam [7] and tetrahydrocannabinol (the psychoactive component of cannabis) [8] in patients with a history of substance use disorder. The authors also state that studies indicate that the ''vast majority of misuse events appear to occur in an attempt to ameliorate opioid withdrawal symptoms'' [1], which is simply not borne out in the current literature. Several studies have assessed motivators for gabapentinoid use.…”

“…the assertions that gabapentinoids are ''remarkably safe'' and that the literature is ''sensationalized'' and fraught with ''liberal conjecture'' [1] is a personal opinion, and an inaccurate representation of the current literature. We concur that the mechanism of these medications (both therapeutically and abuse-related) is not fully elucidated.…”

“…The authors downplay the potential for misuse/abuse by stating there is little documented evidence of true physiologic addiction to the gabapentinoids in the literature [1]. While this may be true, the evidence clearly shows that these medications can produce desirable effects that may motivate a person to misuse or abuse them.…”

Response to Comment on “Gabapentinoid Benefit and Risk Stratification: Mechanisms Over Myth”

“…We would like to thank Peckham et al [1] for their critique of our review [2] outlining the benefits and risks of gabapentinoids (GPNs) in the context of general medical, specialty pain management, and addiction medicine practice. Our targeted narrative review of this subject is intended to present a balanced perspective of salient issues to, and ameliorate current confusion regarding the class of drugs among clinicians, pharmacists, and public health workers alike.…”