Geographic Variation in the Use of Gabapentinoids and Opioids for Pain in a Commercially Insured Adult Population in the United States

Abstract

Background Gabapentinoids have been prescribed off-label for almost all types of pain. The geographic variation in the use of gabapentinoids as analgesics remains unknown. Objective To describe the geographic variation in gabapentinoids, opioids and concurrent use of both for pain by US state and metropolitan statistical area (MSA). Methods We conducted a cross-sectional study on December 1, 2018, among commercially insured adults aged 18–64 years without epilepsy or opioid use disorders using IBM ® MarketScan ® Research Databases. We described the geographic variation in the analgesic regimens (gabapentinoids, opioids and concurrent use of both) by state and MSA, and assessed factors associated with the geographic variation using multilevel logistic regression. Results We included 9,314,197 beneficiaries; 1.4% had gabapentinoids, 1.5% had opioids and 0.3% had concurrent use of both. The majority of gabapentinoid use lacked an FDA-approved indication. Use of the analgesic regimens varied across states (gabapentinoids (median (interquartile range)): 1.4% (1.2–1.7%); opioids: 1.5% (1.2–1.9%); both: 0.3% (0.2–0.4%)) and MSAs (gabapentinoids: 1.6% (1.3–2.0%); opioids: 1.8% (1.3–2.3%); both: 0.3% (0.2–0.5%)). Demographics explained the largest proportion of the between-state and between-MSA variation. The pattern of the geographic variation in gabapentinoids was similar to that of opioids across states and MSAs. Conclusion Gabapentinoids were as commonly used as opioids for pain in a commercially insured population (mostly off-label). The geographic variation in gabapentinoids was similar to that of opioids, which suggests that gabapentinoids may be widely used as alternatives or adjuvants to opioids across the US.

Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data

“…Seventh, gabapentin prescriptions were temporally but not deterministically linked to rLBP diagnoses; therefore, it remains possible that their prescription may have been for another condition. This possibility was minimised by our strategy to exclude patients with potential on-label gabapentin indications (eg, seizure disorders, diabetic neuropathy), and account for patients with potential off-label uses of gabapentin via exclusion (eg, fibromyalgia)59 70 or propensity matching (eg, anxiety, irritable bowel syndrome) 66 70…”

“…64 Key variables present within 365 days of the index diagnosis of rLBP were propensity matched. Covariates with a positive or negative association with gabapentin use or prescription63 65–69 or conditions which are common off-label indications for gabapentin59 70 were selected for matching based on the available literature:…”

“…Adjuvant analgesic use (positive): 66 antiarrhythmics, antidepressants, benzodiazepines, corticosteroids, muscle relaxants, serotonin-norepinephrine reuptake inhibitors, other anticonvulsants (ie, topiramate, pregabalin), tricyclic antidepressants.…”

“…64 Key variables present within 365 days of the index diagnosis of rLBP were propensity matched. Covariates with a positive or negative association with gabapentin use or prescription 63 65-69 or conditions which are common off-label indications for gabapentin 59 70 were selected for matching based on the available literature: ► Adjuvant analgesic use (positive): 66 antiarrhythmics, antidepressants, benzodiazepines, corticosteroids, muscle relaxants, serotonin-norepinephrine reuptake inhibitors, other anticonvulsants (ie, topiramate, pregabalin), tricyclic antidepressants. ► Anxiety, bipolar disorder and depression (positive).…”

“…67 ► Chronic pain (positive). 66 ► Demographics: age, sex and race/ethnicity (positive or negative). 65-67 71 ► Diabetes (positive).…”