Suicide by Gabapentin Overdose

Middleton, Owen

doi:10.1111/j.1556-4029.2011.01798.x

Cited by 45 publications

(19 citation statements)

References 25 publications

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“…More than half of the case report papers ( n = 14) arose from patients presenting to a hospital or general clinic with overdose or withdrawal‐like symptoms ; two came from substance abuse clinics , three from psychiatric facilities , two from the penal system , one from postmortem toxicology findings and one from poison center reports .…”

Section: Resultsmentioning

confidence: 99%

“…Published reports came from the United States (67%, n = 22), the United Kingdom (12%, n = 4), Germany (3%, n = 1), Finland (3%, n = 1), India (3%, n = 1), South Africa (3%, n = 1), France (3%, n = 1) and two analyzed websites not specific to a particular country (6%). While all the papers in this review described gabapentin misuse/abuse, 12 (36%) were documented reports of overdose involving gabapentin .…”

Section: Resultsmentioning

confidence: 99%

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Gabapentin misuse, abuse and diversion: a systematic review

2016

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Background and Aims Since its market release, gabapentin has been presumed to have no abuse potential and subsequently has been prescribed widely off-label, despite increasing reports of gabapentin misuse. This review estimates and describes the prevalence and effects of, motivations behind, and risk factors for gabapentin misuse, abuse, and diversion. Methods Databases were searched for peer-reviewed articles demonstrating gabapentin misuse, characterized by taking a larger dosage than prescribed or taking gabapentin without a prescription, and diversion. All types of studies were considered; grey literature was excluded. Thirty-three articles met inclusion criteria, consisting of 23 case studies and 11 epidemiological reports. Published reports came from the USA, the UK, Germany, Finland, India, South Africa, and France, and two analyzed websites not specific to a particular country. Results Prevalence of gabapentin misuse in the general population was reported to be 1%, 40–65% among individuals with prescriptions, and between 15–22% within populations of people who abuse opioids. An array of subjective experiences reminiscent of opioids, benzodiazepines, and psychedelics were reported over a range of doses, including those within clinical recommendations. Gabapentin was primarily misused for recreational purposes, self-medication, or intentional self-harm and was misused alone or in combination with other substances, especially opioids, benzodiazepines, and/or alcohol. Individuals with histories of drug abuse were most often involved in its misuse. Conclusions Epidemiological and case report evidence suggests that the antiepileptic and analgesic medication gabapentin is being misused internationally at a rate of about 1%, with substance abuse populations at special risk for misuse/abuse.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Gabapentin misuse, abuse and diversion: a systematic review

2016

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“…In fact, as the number of PGB prescriptions increased, more frequent reports of PGB abuse, misuse or diversion emerged . For these reasons, PGB was recently added to the psychoactive substances list to be reviewed by the World Health Organization (WHO) 39th Expert Committee on Drug Dependence (ECDD) held in Switzerland from 6 to 10 November 2017 .…”

Section: Introductionmentioning

confidence: 99%

“…9 In fact, as the number of PGB prescriptions increased, more frequent reports of PGB abuse, misuse or diversion emerged. 2,8,[13][14][15][16][17][18] For these reasons, PGB was recently added to the psychoactive substances list to be reviewed by the World Health Organization (WHO) 39th Expert Committee on Drug Dependence (ECDD) held in Switzerland from 6 to 10 November 2017. 19 Individuals with a past or current history of drug abuse described pleasant PGB-related experiences, which were often obtained with much higher doses are recommended for medicinal use, such as euphoria, improved sociability, a marijuana-like high, and relaxation.…”

mentioning

confidence: 99%

GC‐MS/MS detects potential pregabalin abuse in susceptible subjects’ hair

Ianni

Aroni

Gili

et al. 2018

Drug Testing and Analysis

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Pregabalin, a GABA analogue, binds to the alpha 2 delta subunit of voltage-dependent calcium channels. It is recognised as efficacious in pathologies such as epilepsy, neuropathic pain, and anxiety disorders. Since pregabalin prescriptions have increased worldwide, reports of its abuse have been accumulating, mainly in patients with opioid abuse disorders. The present study investigated potential pregabalin abuse by means of hair analysis, a matrix that provides valuable retrospective information. Half of the pool of 280 susceptible patients had been occasional drug users and were being monitored for driving licence renewals. The other 140 patients had a history of opiate dependency and were monitored to assess compliance with methadone therapy. In view of determining pregabalin in hair samples, it was extracted in methanol, successfully derivatised to give the ethyl chloroformate derivative, and finally pregabalin was analysed by gas chromatography-tandem mass spectrometry. Selectivity, linearity, limit of detection, limit of quantification, recovery, intra- and inter-day precision, and accuracy of the quantification procedure were appraised. Pregabalin limits of detection and quantification were 30 pg/mg and 50 pg/mg, respectively. We found 10.7% of hair samples from methadone patients and 4.29% from occasional drug users were positive to pregabalin without medical prescription. The mean pregabalin concentration in hair was higher than in consumers with medical indications (1.45 ng/mg vs 0.74 ng/mg). These results suggest that pregabalin possesses a significant abuse potential particularly among individuals attending opiate dependence services and that pregabalin abuse is a serious emerging issue, which should be carefully monitored.

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“…One early description of gabapentin diversion in a prison was noted in Florida in 2004 [15], and diversion of the drug is widespread in the community for anxiolysis and euphoria [16,17]. However, gabapentin, even in massively supratherapeutic blood concentrations, is unlikely to cause death [18], as only rare deaths have been definitively attributed to it [19], and its side effects are primarily related to drowsiness [20]. As an example of the degree of controversy around gabapentin prescribing, a lay publication described widespread diversion of gabapentin and then criticized the restriction of access to it in prisons for an off-label indication (anxiety) [21,22].…”

Section: Commentarymentioning

confidence: 99%

How Should a Health Care Professional Respond to an Incarcerated Patient's Request for a Particular Treatment?

Peteet

Tobey

2017

AMA Journal of Ethics

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Incarceration complicates the ethical provision of clinical care through reduction in access to treatment modalities and institutional cultures that value order over autonomy. Correctional care clinicians should expand their guiding principles to consider autonomy and health justice for their patients, which in turn should prompt development of processes and care plans that are patient-centered and account for the inherent restrictions of the setting. CaseDr. François is the medical director of a prison where more than 200 women are incarcerated. Over the past week, several nurses have contacted her both in person and through the prison's electronic health record to report that Jane, a woman with insulindependent type II diabetes who is incarcerated at the facility, has refused her insulin injections during the past week. Blood sugar measurements taken three times each day have been in the 300 to 500 range. Several of the nurses with whom Dr. François talks face-to-face report they feel anxious about the persistence of Jane's refusal. Dr. François reads Jane's electronic health record and sees that she experienced a motor vehicle accident five years ago, which resulted in a two-week hospitalization. Jane has chronic neck and back pain as a result of the accident and reported that she was prescribed gabapentin by a primary care clinician in the community to control her pain. Clinicians at the prison are discouraged from prescribing gabapentin unless other pain control options have been tried due not only to this drug's risk for cultivating dependence, but also to the diversion risk within the prison [1]. As a result, Jane has not been prescribed gabapentin at the prison and instead has a prescription for ibuprofen.Dr. François requests to speak with Jane to try to better understand her situation. When Jane arrives at the prison's medical ward, she tells Dr. François that her pain is unbearable and, specifically, that it keeps her from sleeping or moving comfortably. She states, "I need my gabapentin, this is torture!" When Dr. François asks her about her adherence to her insulin regimen, Jane tells her, "The only thing you people care about is whether I take my insulin. Why doesn't anyone care about my pain?" Dr. François tries to

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Suicide by Gabapentin Overdose

Cited by 45 publications

References 25 publications

Gabapentin misuse, abuse and diversion: a systematic review

Gabapentin misuse, abuse and diversion: a systematic review

GC‐MS/MS detects potential pregabalin abuse in susceptible subjects’ hair

How Should a Health Care Professional Respond to an Incarcerated Patient's Request for a Particular Treatment?

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