Gabapentin Misuse Research Articles

Community pharmacists’ experience of gabapentin misuse and abuse: A quantitative study from Jordan

Gabapentin is an anticonvulsant that has an abuse potential. The aim of this study was to investigate the misuse and abuse of gabapentin in Jordan from the perspective of community pharmacists. A cross-sectional survey using a self-reported structured questionnaire was used with a convenience sample of pharmacists employed by various independent and chain community pharmacies. An online technique was used in this study using Google forms. A total of 215 questionnaires were completed, with 200 respondents (93%) reporting awareness of cases of gabapentin abuse in their pharmacies. Less than half of the respondents (n = 94; 43.7%) indicated that gabapentin requests were not accompanied by prescriptions. Almost two-thirds of respondents (63.6%) noticed an increased pattern of gabapentin abuse/misuse during the last 6 months. The study underscores the need for regulatory efforts and pharmacovigilance to manage potential gabapentin abuse, along with pharmacist and patient education at the community pharmacy, regarding potential abuse of gabapentin.

Gabapentin in drugged driving investigations.

The increasing use and misuse of gabapentin pose a major risk to public health and traffic safety. Gabapentin has been approved by the Food and Drug Administration (FDA) since 1993 for adjunctive therapy in the treatment of epilepsy and neuralgia but is increasingly being prescribed for numerous off-label uses including insomnia, anxiety, depression, and migraine. Reported side effects include blurred vision, drowsiness, and loss of coordination. Driving behaviors such as exiting the lane of travel and crashes have been reported in connection to drugged driving investigations concerning gabapentin. To further assist with the toxicological interpretation of gabapentin in driving under the influence of drugs (DUID) scenarios, a review of approximately 108,000 gabapentin-positive DUID cases was conducted. Of those, 858 cases met inclusion criteria and underwent additional evaluation. Blood specimens were screened via enzyme-linked immunosorbent assay (ELISA) and confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS) for quantitation of gabapentin. This review found an overall DUID gabapentin positivity of 7.9% between January 2020 and December 2022; 17 states from various geographical regions had at least one positive gabapentin DUID case. Observations in six driving and human performance cases where gabapentin was the only drug reported were consistent with the known adverse effects of the medication. Half of the case histories reviewed involved crashes where the driver was determined to be at fault. Additionally, 94% of the cases in this review involved gabapentin in combination with other drugs. The most prevalent drug combinations were opioids and gabapentin present in 64% of cases.

Nephrotoxicity after sub chronic misuse of gabapentin and the protective role of alpha-tocopherol, an experimental study

Nephrotoxicity after sub chronic misuse of gabapentin and the protective role of alpha-tocopherol, an experimental study

Management of gabapentin misuse in a patient with previous history of opioid use disorder: Case report.

We present a 37-year-old male who misuses 12g of gabapentin per day associated with dependence and withdrawal. He had a previous history of opioid use disorder (OUD) which has been in remission. An outpatient gradual dose reduction regimen was tried and failed and the patient decided to discontinue gabapentin abruptly. Symptomatic medication to relieve gabapentin withdrawal was also unsuccessful and resulted in the reinstatement of OUD. Finally, the patient was stabilized using buprenorphine maintenance treatment and discontinued opioids and gabapentin misuse. The clinical implications and significance of taking regulatory actions to control gabapentin misuse have been discussed.

Prenatal Exposure to Gabapentin Alters the Development of Ventral Midbrain Dopaminergic Neurons.

Background: Gabapentin is widely prescribed as an off-label drug for the treatment of various diseases, including drug and alcohol addiction. Approximately 83–95% of the usage of gabapentin is off-label, accounting for more than 90% of its sales in the market, which indicates an alarming situation of drug abuse. Such misuse of gabapentin has serious negative consequences. The safety of the use of gabapentin in pregnant women has always been a serious issue, as gabapentin can cross placental barriers. The impact of gabapentin on brain development in the fetus is not sufficiently investigated, which poses difficulties in clinical decisions regarding prescriptions. Methods: The consequences effect of prenatal gabapentin exposure on the development of ventral midbrain dopaminergic neurons were investigated using three-dimensional neuronal cell cultures. Time-mated Swiss mice were used to isolate embryos. The ventral third of the midbrain was removed and used to enrich the dopaminergic population in 3D cell cultures that were subsequently exposed to gabapentin. The effects of gabapentin on the viability, ATP release, morphogenesis and genes expression of ventral midbrain dopaminergic neurons were investigated. Results: Gabapentin treatment at the therapeutic level interfered with the neurogenesis and morphogenesis of vmDA neurons in the fetal brain by causing changes in morphology and alterations in the expression of key developmental genes, such as Nurr1, Chl1, En1, Bdnf, Drd2, and Pitx3. The TH + total neurite length and dominant neurite length were significantly altered. We also found that gabapentin could halt the metabolic state of these neuronal cells by blocking the generation of ATP. Conclusion: Our findings clearly indicate that gabapentin hampers the morphogenesis and development of dopaminergic neurons. This implies that the use of gabapentin could lead to serious complications in child-bearing women. Therefore, caution must be exercised in clinical decisions regarding the prescription of gabapentin in pregnant women.

An algorithm to identify gabapentin misuse and/or abuse in administrative claims data

BackgroundDespite gabapentin’s misuse and abuse potential and associated adverse events, few algorithms are available to detect gabapentin misuse and/or abuse in claims data. This study aims to develop an algorithm to identify gabapentin misuse and/or abuse in administrative claims data. MethodsWe developed an algorithm to identify gabapentin misuse and/or abuse over a 12-month period based on input from 21 clinical experts. We implemented the algorithm among 334,128 patients with at least one dispensed prescription of gabapentin between December 1, 2017 and December 1, 2018 in the IBM® MarketScan® Research Databases. We described the characteristics of patients who potentially misused and/or abused gabapentin and assessed factors associated with misuse and/or abuse using logistic regression. ResultsThe algorithm identified 17.6% of patients with gabapentin use who potentially misused and/or abused gabapentin. Factors associated with potential gabapentin misuse and/or abuse included men (adjusted odds ratio (aOR): 1.08; 95% confidence interval (CI): 1.06–1.10), comorbid conditions (e.g., drug and alcohol dependence (aOR: 1.31; 95% CI: 1.24–1.39); bipolar disorder (aOR: 1.34; 95% CI: 1.27–1.41)), and medication use (e.g., opioids (aOR: 1.23; 95% CI: 1.20–1.26), muscle relaxants (aOR: 1.24; 95% CI: 1.21–1.27), or serotonin-norepinephrine reuptake inhibitors (aOR: 1.33; 95% CI: 1.29–1.36)). ConclusionsApproximately one in six patients with gabapentin use potentially misused and/or abused gabapentin in a large commercial claims database. Multiple comorbidities and drug use were associated with gabapentin misuse and/or abuse. Monitoring requirements and individualized safety measures should be put in place for patients at elevated risks of gabapentin misuse and/or abuse.

State-level response to gabapentin misuse in the United States: Implications and future direction

Abstract Purpose Gabapentin misuse is on the rise and has forced many US states to mobilize policies to address this public health concern. The purpose of this manuscript is to update state-level gabapentin misuse–related policies in the US through September 1, 2021, discuss the benefits and risks of current measures, and highlight gaps in national response. Methods Identification of state and federal district policy changes and deliberations related to gabapentin were searched via internet for all 50 states and 1 federal district (n = 51). Only results from state regulatory bodies, such as the board of pharmacy, or state legislative bodies, such as the senate, were considered for inclusion. Results Results showed that 22 states and federal districts (43.1%) tightened regulation, while another 2 (3.9%) are considering doing so. Of the 22 states and federal districts with policy changes, 15 (68.2%) enrolled gabapentin into their prescription drug monitoring program, while 7 (31.8%) reclassified gabapentin as a Schedule V controlled substance (C-V). Conclusion Absent of federal guidance surrounding gabapentin misuse, the onus has fallen on individual states; thus, approaches have ranged from no intervention to reclassification as a C-V. These measures aim to reduce medication supply but fall short of addressing patient outcomes and reducing harm. Therefore, harm reduction–informed public health policies must be implemented to positively impact patient outcomes and enhance safety.

More states make gabapentin a Schedule V Controlled Substance

Gabapentin has landed on Schedule V Controlled Substance lists in 7 states over the last 5 years. During that same time period, 12 other states have placed the drug in their prescription drug monitoring programs (PMP). Three others are in the process of adding the prescription medication to Schedule V lists or state PMPs. “We’ve seen a significant increase in gabapentin prescribing over the last 10 to 15 years, but is it actually helping patients? The data suggest that it probably isn’t, and that’s a major concern for me,” said Jordan Covvey, PharmD, PhD, an associate professor in the School of Pharmacy at Duquesne University in Pittsburgh. While gabapentin is not a Federal Schedule V Controlled Substance, these recent actions taken by individual states should alert pharmacists about potential risks related to the drug and highlight the possible need for additional patient counseling in some cases. Gabapentin is the sixth most prescribed drug in the United States, and the vast majority of uses are off-label. Researchers believe that the increase in gabapentin prescribing over the last decade or more may be, in part, a reaction to the opioid epidemic. “It can be used as an opioid-sparing medication,” said Kirk Evoy, PharmD, a clinical assistant professor of pharmacotherapy at the University of Texas–Austin. Prescribers may recommend it in combination with lower doses of opioids. Prescribers also dole it out for numerous other off-label uses, including various types of pain, migraine, restless leg syndrome, hot flashes, insomnia, anxiety, and numerous other mental health conditions. “Many researchers are concerned about the level of prescribing that occurs in the setting where there is no evidence supporting its use,” Covvey said. “Some studies show it’s not effective for lots of indications that people continue to prescribe it for.” Among them, she names low back pain and radiculopathy. Research shows that gabapentin poses some risk for misuse and abuse. Some studies hypothesize that gabapentin releases excitatory neurotransmitters and affects the dopaminergic reward system, which plays a role in addiction. When used in combination with opioids, it can cause euphoria, which may lead to abuse. “Gabapentinoids have been shown to significantly increase the risk of opioid overdose when taken together,” Evoy says. The combination raises risks for central nervous system and respiratory depression, overdose, and death. That risk increases with use of sleep medications, benzodiazepines, antidepressants, or alcohol. The majority of gabapentin overuse, or even misuse, is likely not recreational. “Most of the misuse of gabapentin is likely driven by untreated pain or untreated conditions that may drive individuals, perhaps not having full relief from pain or other symptoms, to self-treatment with gabapentin,” Covvey said. Though some people may misuse gabapentin for recreational purposes, they likely do not represent the majority of misuse or overuse. “It’s very important that we don’t criminalize medication use,” Covvey said. Instead, she recommends, when patients pick up gabapentin, pharmacists should take the opportunity to check in with them to see how well it’s working, given the limited evidence for so many of its off-label uses. Check in every few months. If the medication isn’t helping patients, let prescribers know and make recommendations for alternatives. Pharmacists may need to provide extra counseling to patients who take both gabapentin and opioids or other high-risk combinations. Evoy suggests that pharmacists counsel on the increased risk of overdose and death. He also recommends that pharmacists advise patients to take these medications at home until they understand the way they will affect them. They shouldn’t drive right away, for example, until they are sure it’s safe to do so. “When a patient is prescribed opioids and gabapentinoids, pharmacists should not assume that they were ever counseled on the risks of these medications or the risk of overdose,” Evoy said. “Pharmacists should provide counseling, and we may also need to recommend they pick up a supply of Naloxone.” Gabapentin controlled status and monitoring in select states as of November 20, 2020▪States where gabapentin is classified as a controlled substance (AL, KY, MI, ND, TN, VA, and WV).▪States with mandated gabapentin reporting (CT, DC, IN, KS, MA, MN, NE, NJ, OH, OR, UT, and WY).▪States deliberating mandated reporting of gabapentin to controlled substance (DE, NY, and WI). ▪States where gabapentin is classified as a controlled substance (AL, KY, MI, ND, TN, VA, and WV).▪States with mandated gabapentin reporting (CT, DC, IN, KS, MA, MN, NE, NJ, OH, OR, UT, and WY).▪States deliberating mandated reporting of gabapentin to controlled substance (DE, NY, and WI).

Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability.

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.

Gabapentin prevalence: clinical and forensic experience in St. Louis, Missouri, USA

Gabapentin (Neurontin) is an anti-epileptic drug that has had wide off-label prescription use since market release due to presumed negligible abuse potential. However, trends in drug misuse have demonstrated that gabapentin misuse is occurring, particularly in those with a history of opioid misuse. This is concerning, because although gabapentin has no direct ligand activity at opioid receptors, it does potentiate the analgesic effect of opioids, and concurrent use of gabapentin and opioids may increase the risk of respiratory depressive effects of opioids. This study investigates the incidence of gabapentin detected in urine samples collected for clinical drug screening purposes in a local hospital emergency department and in postmortem samples submitted by medical examiners in the St. Louis metropolitan area. The prevalence of gabapentin and co-detected drugs in both populations is contrasted, compared, and discussed. This study found that 30% of urine samples collected from patients with suspected drug intoxication presenting to SSM Health Saint Louis University Hospital, a quaternary care medical center, were positive for gabapentin, and nearly two thirds of those were also positive for oxycodone. Over a 6-month period, the incidence of gabapentin positive postmortem cases increased from 18% to 20%. Nearly all gabapentin positive postmortem cases were also positive for an opioid, the most significant being fentanyl, suggesting that gabapentin misuse may be due to its potentiating effect of opioid drug action. This study also highlights the limited utility of immunoassay-based urine drug screens.

Abuse liability of gabapentin in the Saudi population after the pregabalin restriction: A cross-sectional study

ObjectiveFollowing the recently conducted local studies on the growing misuse of pregabalin, Pregabalin misuse has received national attention. These studies have led to the authorities restricting the availability of pregabalin to hospital pharmacies alone. While the recent epidemiological studies and case reports found gabapentin to be misused worldwide, it was previously presumed to be free of any abuse potential. This study assesses the likelihood of there being a diversion to Gabapentin abuse following the Pregabalin restriction in Jeddah, KSA. MethodsA cross sectional observational study was conducted between November 2017 and December 2017 using a self-constructed online survey via Twitter and WhatsApp. The survey items included participants’ demographics, additional history, Gabapentin for non-medical use (frequency, concurrent use with other drugs, and motivators), and how the participants knew about the Gabapentin misuse. The data was subjected to a descriptive analysis via the utilization of frequencies and percentages. The analysis was carried out by using SPSS V21. ResultsData of the 370 respondents who took the surveys were collected. Most of the respondents were women (n = 289; 78.1%) and below the age of 30 years (n = 300; 81.1%). A total of 72 respondents (19.5%) had a history of psychoactive drug abuse. Ten of the respondents reported Gabapentin misuse (2.7%). Half of the participants reported prior Pregabalin misuse, and were un-employed. Most of the misusers (n = 8; 80%) came to know about the psychotropic effects of Gabapentin from friends. The most common motives for using it were to ‘have fun’ and ‘peer pressure’ (n = 6; 60%). Half of the misusers used Gabapentin on a weekly basis. ConclusionThe findings of our study suggest a potential diversion from Pregabalin to Gabapentin misuse. Regulations and periodic reviews of the psychoactive prescription medications available in the community pharmacies are essential.

Comment on “Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update”

Comment on “Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update”

Characterization of gabapentin use in Kentucky after reclassification as a Schedule V controlled substance

BackgroundOwing to increasing concern over the potential for gabapentin misuse, gabapentin was reclassified as a schedule V controlled substance in Kentucky (July 2017). ObjectiveThis study aimed to characterize gabapentin use among Kentucky residents in the first year after its scheduling. MethodsThis study used Kentucky All Schedule Prescription Electronic Reporting data (2018). Gabapentin use was defined as having at least 1 dispensed gabapentin prescription, and high-dose gabapentin use was defined as an average daily dose of more than 3600 mg at the patient level. The prevalence of gabapentin use, concurrent use of gabapentin with opioid analgesics (OAs) (gabapentin-OA), and gabapentin with OAs and benzodiazepines (BDZs) (gabapentin-OA-BDZ) were assessed. Estimated prevalence rate ratio and its 95% CI were reported to compare gabapentin use rates across different demographic groups. ResultsA total of 16% of all 2018 controlled substance prescriptions were for gabapentin, and approximately 20% of Kentucky residents with controlled substance prescriptions received gabapentin at least once in 2018. The overall prevalence of gabapentin use was 63 per 1000 residents, with the highest rates among residents aged 55-64 years (126.9 per 1000). The prevalence of gabapentin use was higher in females (74.6 per 1000) versus males (50.6 per 1000) and in residents living in the Appalachian region (88.57 per 1000) versus Central (51.78 per 1000) and Delta (66.41 per 1000) regions. Among gabapentin users, 1% were high-dose users; 27.4% and 11.9% received gabapentin-OA or gabapentin-OA-BDZ concurrently, respectively. As the average daily dose increased from less than 900 mg to high-dose, the percentage of concurrent gabapentin-OA use increased from 13.4% to 50.7%. ConclusionGabapentin is widely prescribed in Kentucky, with higher rates of use observed in females, those older than 55 years and individuals living in the Appalachian region. Concurrent use of gabapentin and OAs is common, especially in those receiving high-dose gabapentin. Future studies are needed to assess the risks associated with gabapentin use.

Patterns of Neonatal Co-Exposure to Gabapentin and Common Drugs of Abuse Observed in Umbilical Cord Tissue

Abstract Background Gabapentin is a structural analogue of gamma-aminobutyric acid approved by the U.S. Food and Drug Administration (FDA) for the treatment of postherpetic neuralgia and partial-onset seizures. Gabapentin is thought to have low abuse potential and is currently not scheduled as a controlled substance by the Drug Enforcement Administration (DEA). However, recent reports indicate that gabapentin is increasingly being abused by people with opioid use disorder in an attempt to potentiate the euphoric effects from opioids and other CNS depressants. (1) In 2018, Gabapentin was the sixth most commonly prescribed medication in the United States with 67 million prescriptions dispensed. (2) The frequency of non-prescribed gabapentin misuse reported at a reference laboratory increased by 40% between 2017 and 2018. (3) It is now recognized that combination of Gabapentin with opioids and other CNS depressants increases risk of respiratory depression. (4) Of particular concern are reports showing prolonged and more severe neonatal abstinence syndrome in infants with prenatal co-exposure to gabapentin and opioids. (5) Method This retrospective study evaluated the positivity rates of 13,609 umbilical cord tissues submitted for newborn drug testing at ARUP Laboratories. The umbilical cord drug detection assay is designed to detect 49 specific drugs and drug metabolites from commonly abused drug classes including opioids, stimulants, sedative-hypnotics and hallucinogens. Reverse phase liquid chromatography coupled with triple quadrupole mass spectrometry was used for semi-quantitative measurement of the drug analytes and metabolites. Results A positive result for at least one of the measured drugs or drug metabolites was found in 3,891 (29%) out of the 13,609 analyzed umbilical cord tissues. Norbuprenorphine had the highest positivity rate (874, 6%) followed by Amphetamine (764, 6 %) and Morphine (683, 5%). Gabapentin had a positivity rate of 2% with 302 positive results. Of the 302 positive Gabapentin samples, 216 (72%) also had a positive result for at least one other drug or drug metabolite. Co-positivity with Gabapentin was highest for Norbuprenorphine (105, 35%) followed by Amphetamine (41, 14%). The median Gabapentin concentration in umbilical cord tissues that were co-positive for Norbuprenorphine and Amphetamine is 3,762 ng/g (range = 13 - 40,997 ng/g) and 1,045 ng/g (range = 15 - 40,997 ng/g) respectively. Discussion This retrospective data analysis show that there is high neonatal co-exposure rate to Gabapentin and Buprenorphine / Norbuprenorphine. Buprenorphine is a partial mu-opioid receptor agonist and co-medication with Gabapentin might be used as a strategy to enhance the feeling of euphoria from Buprenorphine in pregnant women undergoing opioid substitution therapy.

Factors Associated with Gabapentin Misuse among People Who Inject Drugs in Appalachian Kentucky

Aims Gabapentin is misused to potentiate the euphoric effects of opioids, self-treat physical pain, and moderate opioid withdrawal symptoms. Because examinations of gabapentin misuse among people who inject drugs (PWID) are scant, the aim of this study is to identify factors associated with gabapentin misuse among this population. Methods: Data are drawn from a study examining the uptake of syringe service programs (SSPs) in Appalachian Kentucky. The sample includes 324 PWID who were age 18 and over and reported past month drug injection. Logistic regression models were constructed to examine recent (past 90 days) gabapentin misuse. Results: Participants are female (50.0%); Hispanic (2.2%), Black (1.5%), white (90.7%), and other race/ethnicity (4.6%). Mean age is 37. Participants reporting gabapentin misuse had higher odds of reporting (mis)use of marijuana, cocaine, methamphetamine, prescription opioids, benzodiazepines, prescription stimulants, fentanyl, and buprenorphine (p < .042); severe substance use disorder (p < .000); and recent physical pain (p < .003). In multivariable models, findings related to misuse of prescription opioids and buprenorphine; severe substance use disorder; and recent physical pain or discomfort, remained significant (p < .042). Conclusions: This is one of the first studies to examine gabapentin misuse among PWID. It is possible that individuals reporting recent gabapentin misuse are attempting to self-treat physical pain when healthcare is limited. Gabapentin may also be misused to achieve desired central nervous system effects and to potentiate opioid highs. Syringe service programs can educate PWID about the potential dangers of polydrug use involving gabapentin and to connect PWID with needed healthcare services.

A Qualitative Examination of Gabapentin Misuse Inside of Treatment and Recovery Settings

Gabapentin, an anti-convulsant medication used to treat seizures and neuralgia, is also prescribed off-label for the treatment of substance use disorders and withdrawal symptoms in treatment settings. Yet, reports of gabapentin misuse are increasing in the United States. The present study examines the misuse of gabapentin in treatment and transitional living facility settings. Data are drawn from a study examining gabapentin misuse in South Florida. The sample includes 34 adult participants who reported past-year use of illicit opioids and/or the misuse of prescription opioid medications, as well as histories of gabapentin misuse and treatment for substance use disorder. Data analyses included descriptive and in vivo coding schemes and used a descriptive qualitative approach. Participants were female (26.5%), White (67.6%), African American/Black (5.9%), Hispanic (20.6%), Asian (2.9%), and other race/ethnicity (2.9%). Mean age was 31.6 years. Findings indicate that inside of treatment and recovery settings, gabapentin misuse occurs as individuals attempt to get high or cope with withdrawal or mental distress symptoms, and one quarter of participants perceived no benefit in misusing gabapentin. Participants also described the concept of "freelapse" (i.e., justifying the misuse of prescribed gabapentin and still considering oneself to be sober). Gabapentin misuse inside of transitional living facilities is common because of limited supervision and screening. Continued research is needed to understand the risk factors for gabapentin misuse and any potential benefits for continued gabapentin administration among treatment patients. Efforts to mitigate gabapentin misuse, including increased supervision and screening in treatment facilities, appear warranted.

Current Evidence on Abuse and Misuse of Gabapentinoids.

This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.

Descriptions of Gabapentin Misuse and Associated Behaviors among a Sample of Opioid (Mis)users in South Florida

ABSTRACT Gabapentin has received increased attention due to a growing number of reports of misuse and diversion. However, significant details about gabapentin misuse are scant. Data are drawn from a mixed-methods study examining gabapentin misuse in South Florida. The sample includes 49 respondents who were age 18 or over and reported past year use of illicit opioids and/or the misuse of prescription opioid medications, as well as, recent (past 90 days) gabapentin misuse. Respondents were female (40.8%), Hispanic (30.6%), Black (16.3%), white (49.0%), and other race/ethnicity (4.1%). Mean age was 37.6. Many respondents (43%) misused gabapentin without ever receiving a prescription and 14% misused prior to being prescribed. Mean frequency of recent misuse was 25.4 days and included a mean of 51.65 pills/doses. Prevalent routes of administration included swallowing (85.7%) and snorting (10.2%). Gabapentin misuse occurred concomitantly with any opioid (44.9%), benzodiazepines (38.8%), alcohol (24.5%), and powder cocaine (24.5), among others. Respondents’ descriptions indicate that gabapentin produces feelings reminiscent of alcohol intoxication or opioid-induced euphoria, but for some it produces no noticeable effect or only alleviates pain. Greater understanding of gabapentin misuse, especially associated behaviors and concomitant use is needed to inform prevention and intervention efforts, and to guide policy approaches.

Gabapentin misuse, need for pharmacist diligence on the rise

Gabapentin misuse, need for pharmacist diligence on the rise

Off-Label Use of Gabapentinoids: A New Paradigm

Off-Label Use of Gabapentinoids: A New Paradigm