Gabapentinoid misuse, abuse and non-prescribed obtainment in a United States general population sample

Evoy, Kirk E.; Covvey, Jordan R.; Peckham, Alyssa M.; Reveles, Kelly R.

doi:10.1007/s11096-020-01217-8

Cited by 21 publications

(20 citation statements)

References 30 publications

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“…When comparing the five European countries, those who non-medically use gabapentinoids were estimated to have a higher likelihood of chronic pain, use of illicit substances, and history of substance abuse treatment compared to the general population. These results are in concordance with country surveys, reviews and metanalyses published previously ( 8 , 23 , 24 ).…”

Section: Discussionsupporting

confidence: 93%

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Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries

et al. 2021

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Background: Non-medical use (NMU) of prescription GABA analogs (pregabalin and gabapentin) has been reported especially in opiate dependent persons. However, by now the prevalence of NMU of gabapentinoids in the general population has not been sufficiently evaluated. The aim of this research paper is to determine the prevalence of prescription GABA analog NMU and associated demographics in five European countries with special detail of Spain.Methods: The RADARS Survey of Non-Medical Use of Prescription Drugs Program (NMURx) is a harmonized series of contemporaneous cross-sectional surveys of adults conducted in multiple countries. NMURx collects data from the general population in each participating country about NMU of prescription drugs, illicit drugs, and associated demographics. NMU was defined as “using a medication without a doctor's prescription or for any reason other than what was recommended by their doctor.” Responses from Spain (4Q2017, n=10,062) were analyzed in detail. Comparative data were available from France, Germany, Italy, and UK. Responses were collected using non-probability quota sampling and post-stratification population weighting was applied to reflect the national distributions of adults, based on age, gender, and census region. Rates of NMU and associated demographics were reported as rate of past 90-day NMU per 100,000 adult population with 95% confidence intervals.Results: Germany (1,197 per 100,000 adult population [95% CI: 1,004.3–1,379.1]) and United Kingdom (1,067 per 100,000 adult population [95% CI: 851.3–1,283.2]) presented the highest prevalence of gabapentinoids NMU. In Spain the prevalence of past 90 days GABA analog NMU was: 344.4, 95% (CI 204.8–484.0), with male predominance. Those who non-medically use GABA analogs had a higher prevalence of lifetime chronic pain, lifetime illicit drug use, and previous substance abuse treatment. In Spain, 20% of respondents who ever have used gabapentinoids, reported a lifetime NMU; the prevalence was higher for pregabalin 624 (6.2%) than for gabapentin 444 (4.4%). The main reasons for use were to self-treat pain and other medical conditions.Conclusions: The risk of NMU of gabapentinoids should not be neglected. Subjects with a history of chronic pain and lifetime substance use disorders had an increased risk of NMU of gabapentinoids.

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Section: Discussionsupporting

confidence: 93%

“…Another aspect to take into account may be the polymedication risk. Pregabalin and gabapentin are usually prescribed with other pain medications, mainly with opioids; among 50–70% were reported in a recent paper ( 23 ). This combination could increase the risk for overdose death ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries

et al. 2021

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“…Epidemiologic studies point toward regional trends in gabapentinoid misuse, with pregabalin misuse reported more commonly in Europe and gabapentin misuse more common in the United States, likely owing to more frequent and less regulated prescribing 13 . And although individuals may misuse gabapentinoids prescribed to them, reports of obtaining gabapentinoids from friends or family, on the internet, or from street dealers are also common 15,19–23 . These qualitative findings coincide with recent reports of increasing nonprescribed gabapentinoid obtainment 24,25 …”

Section: Epidemiology Of Gabapentinoid Use Misuse and Harmssupporting

confidence: 53%

“…The vast majority of these articles were published within the past few years and consistently identify signs that gabapentinoid misuse is increasing. Among the published literature, the prevalence of gabapentinoid misuse has been estimated at 1.6% to 6.6% in the general population and 3% to 68% among individuals with a substance use disorder 13–15 . Analysis of pharmacovigilance data from the FDA Adverse Event Reporting System identified more than 600 reports and an upward annual trend of misuse, dependence, and overdose events over an approximately 4‐year period, 16 whereas a similar study identified nearly 12 000 such reports to the European Medicines Agency's adverse event reporting system (EudraVigilance) from 2004 to 2015, with >75% of reports occurring between 2012 and 2015 17 .…”

Section: Epidemiology Of Gabapentinoid Use Misuse and Harmsmentioning

confidence: 99%

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Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability

Evoy

Peckham

Covvey

et al. 2021

The Journal of Clinical Pharma

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This article will review the epidemiology and pharmacology of gabapentinoids (gabapentin and pregabalin) relevant to their emerging misuse potential and provide guidance for clinical and regulatory management. Gabapentinoids are γ‐aminobutyric acid analogues that produce their therapeutic effects by inhibiting voltage‐gated calcium channels and decreasing neurotransmitter release. Recently gabapentinoid prescribing and use have increased tremendously. Although traditionally thought to possess a favorable safety profile, gabapentinoid misuse has also risen significantly. Gabapentinoid misuse generally occurs in combination with other substances, most notably opioids, and may be for purposes of eliciting euphoric effects, enhancing the effects of other substances, or self‐treating conditions such as withdrawal, pain, anxiety, or insomnia. Given its faster onset, increased bioavailability and potency, and nonsaturable absorption, pregabalin's pharmacokinetics theoretically enhance its misuse liability versus gabapentin. However, gabapentin can produce similar euphoric effects, and epidemiologic studies have identified higher rates of gabapentin misuse in the United States, likely because of greater availability and less regulated prescribing. Although adverse events of gabapentinoid‐only ingestion are relatively benign, a growing body of evidence indicates that gabapentinoids significantly increase opioid‐related morbidity and mortality when used concomitantly. In addition, significant withdrawal effects may occur on abrupt discontinuation. As a result of these trends, several US states have begun to further regulate gabapentinoid prescribing, reclassifying it as a controlled substance or mandating reporting to local prescription drug‐monitoring programs. Although increased regulation of gabapentin prescribing may be warranted, harm reduction efforts and increased patient and provider education are necessary to mitigate this concerning gabapentinoid misuse trend.

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The impact of regulatory restrictions on pregabalin use in Saudi Arabia: An interrupted time series analysis

Althunian

Alomran

Alsagri

et al. 2022

Pharmacoepidemiology and Drug

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Purpose: The Saudi Food and Drug Authority (SFDA) added pregabalin to the list of controlled substances in December 2017 to minimize the risk of its possible abuse and misuse. This study was aimed at assessing the impact of this decision on the overall use of pregabalin in Saudi Arabia and in comparison with drugs prescribed to treat neuropathic pain (i.e., vs. gabapentin, tramadol, duloxetine, and amitriptyline).Methods: This was an interrupted time-series analysis of the Saudi quarterly sale data of the study drugs from October/2015 to September/2020. These data were obtained from IQVIA and were converted into use estimates (defined daily dose per 1000 inhabitant-days [DDD/TID]). Segmented regression models were conducted to assess the direct (level) and prolonged (trend) changes in use data after the decision.All analyses were completed using RStudio Version 1.4.1103.Results: Before the SFDA's decision, there was an increased quarter-to-quarter use of pregabalin (DDD/TID: 0.16; 95% confidence interval [CI] 0.04 to 0.28). Pregabalin overall use dropped sharply by À1.85 DDD/TID (95% CI À2.71 to À0.99) directly after the decision with a prolonged quarter-to-quarter declining effect (DDD/TID: À0.22, CI to À0.37 to À0.05). The decision was associated with a direct increase in the use of gabapentin by 0.62 DDD/TID (95% CI 0.52-0.72) without any impact on the use of other drugs. Conclusions:The results of our study showed that the SFDA decision was associated with a decrease in the overall use of pregabalin, which may help minimize the risk of its abuse and misuse.

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Gabapentinoid misuse, abuse and non-prescribed obtainment in a United States general population sample

Cited by 21 publications

References 30 publications

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries

Non-medical Use of Prescription Gabapentinoids (Gabapentin and Pregabalin) in Five European Countries

Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability

The impact of regulatory restrictions on pregabalin use in Saudi Arabia: An interrupted time series analysis

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