Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016.

Wei-Hsuan Lo-Ciganic,Joshua D Brown,Patrick J Tighe,Sandipan Bhattacharjee,C Kent Kwoh,Debbie L Wilson,Marion Slack,Daniel C Malone,Lili Zhou

doi:10.3390/jcm9010083

Abstract

Increasing gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million gabapentinoid-involved visits (aged 18–64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; Ptrend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the gabapentinoids. Most (96.6%) of the gabapentinoid visits did not have an approved indication for gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, gabapentinoid use increased substantially, commonly prescribed by primary care physicians.

Highlights

One-third of adults in the United States (US) have at least one chronic pain condition and seek care primarily in ambulatory care settings [1,2]
Characteristics of gabapentinoid visits were similar across years
Using National Ambulatory Medical Care Survey (NAMCS) data, our study found that gabapentinoid-involved visits nearly quadrupled in the US ambulatory care settings from 2003 to 2016 from 9.1 to 34.9 per 1000 visits

Summary

Introduction

One-third of adults in the United States (US) have at least one chronic pain condition and seek care primarily in ambulatory care settings [1,2]. A UK study of primary care medical records found the rate of patients newly treated with gabapentinoids tripled from 2007 to 2017 [5]. This increasing use has raised safety concerns of misuse and abuse of gabapentinoids, especially among individuals with opioid use disorder [6,7]. To better inform interventions and policies in general clinical practice, further investigation of the patient, prescriber and visit characteristics, and primary diagnoses associated with gabapentinoids in US ambulatory care settings, where chronic pain is primarily managed, is needed. We examined the trends of patient and prescriber characteristics and the primary diagnoses associated with gabapentinoids among US ambulatory care visits from 2003 to 2016

Experimental Section

Statistical Analysis

Results

53.7 Million

Discussion