Prescription medication misuse among opioid dependent patients seeking inpatient detoxification

Abstract

Background and Objectives: Opioid related morbidity and mortality is heightened in context to the concomitant use of psychotropic medications. The aim of this project was to examine the extent to which opioid dependent patients seeking detoxification are using and misusing specific psychotropic agents. Methods: As part of a quality assurance/improvement project, we systematically assessed prospectively consecutive admissions to a public detoxification program using a self-report questionnaire to query for specific psychotropic medication use. Patients were asked about having a current prescription, appropriate use, and/or medical misuse (higher doses, using without prescription) of amphetamine salts, clonazepam, clonidine, gabapentin, and pregabalin. Results: We had data on 196 admissions including 162 patients with opioid dependency. Patients receiving detoxification from opioids compared to alcohol had statistically significant higher rates of medication misuse (30% vs. 0%, respectively; x 2 ¼ 12.8, p < .0003). Of opioid dependent patients receiving prescription medication, 28% reported using higher amounts of each medication than prescribed. Of opioid patients, 10% self-reported misusing clonidine, 22% gabapentin, 7% pregabalin, 25% clonazepam, 11% amphetamine salts, and 36% any of these medications. Discussion and Conclusions: Despite the "nonaddictive nature" of some medications (eg, gabapentin, clonidine), high rates of medication misuse in opioid dependent patients admitted for detoxification was found and appeared similar to rates of misuse among controlled substances such as clonazepam and amphetamine salts. These data suggest that opioid dependent patients should be queried for the appropriate use of prescribed medications and that practitioners need to monitor for medication misuse in opioid dependent patients. (Am J Addict 2015;24:173-177)

Rising pregabalin use and misuse in Australia: trends in utilization and intentional poisonings

“…Euphoria is a documented side effect of pregabalin, and tolerance and withdrawal have been reported [14,15]. Populations thought to be at risk of pregabalin misuse include people with prior or ongoing substance abuse, particularly opioid abuse [16][17][18][19]. Populations thought to be at risk of pregabalin misuse include people with prior or ongoing substance abuse, particularly opioid abuse [16][17][18][19].…”

“…In some studies, pregabalin misuse among people with opioid use disorder is as high as 68% [20]. Several studies have also reported higher rates of gabapentinoid abuse among people with psychiatric diagnoses [4,17]. Several studies have also reported higher rates of gabapentinoid abuse among people with psychiatric diagnoses [4,17].…”

Psychoactive medications and disengagement from office based opioid treatment (obot) with buprenorphine

“…Some of the other commonly prescribed medications— including antipsychotics, especially quetiapine (Reeves and Ladner, 2014), as well as tricyclic antidepressants (Seale et al, 2014)—have been reported to be used non-medically by patients receiving buprenorphine to enhance the euphoric effects of the opioid. Many medications that were commonly prescribed in our study—including clonazepam, clonidine, and gabapentin—are known to be misused by patients with OUD seeking detoxification (Wilens et al, 2015). These medications are sedating and could contribute to hypoventilation, hypoxia and accidental overdose, especially in combination with an opioid (Kotlinska-Lemieszek et al, 2015).…”

“…In a recent review of the rising national prevalence of psychoactive polypharmacy among outpatient psychiatrists, other researchers note that many of these medication combinations are not evidence-based and come with increased risk and unknown clinical benefit (Mojtabai and Olfson, 2010). In patients with OUD, potential additional risks of polypharmacy exist such as de-stabilization of OUD recovery (Caviness et al, 2013; Heikman et al, 2016; Wilens et al, 2015). However, these risks must be balanced with the need to manage patients’ mood, sleep and pain symptoms to continue to keep them engaged in buprenorphine treatment.…”

Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects

“…Following marketing authorization, observational studies, case reports and meta-analyses of clinical trials have reported euphoria (200), dependence (102,201), tolerance development and dose increases (202)(203)(204), use of supra-therapeutic doses (205), withdrawal symptoms (206), substance-seeking behaviour (132,207), non-prescribed use and diversion (110,132,208), as well as intoxications, drug-related deaths (110,187), and drug-impaired driving (209). Of patients dispensing pregabalin, a small proportion of the users account for a large part of the total drug expenditure (200,210), which might indicate misuse and abuse (79).…”