How prevalent and severe is addiction on GABAmimetic drugs in an elderly German general hospital population? Focus on gabapentinoids, benzodiazepines, and z-hypnotic drugs

Abuse of gabapentinoids in individuals with substance use disorders

The abuse of gabapentinoids has increased rapidly, and death cases have been reported with increasing rates. This study examines the toxicological analysis data of substance abuse cases conducted after legal regulations were implemented in Türkiye. The focus will be on the medicolegal implications of gabapentinoid positivity in these cases. Urine samples collected between July 2021 and July 2022 from individuals (ages 18-45) presenting at Manisa Mental Health and Diseases Hospital with diagnosed or suspected substance use disorders were analyzed for the presence of pregabalin, gabapentin, and other accompanying substances. High-resolution liquid chromatography-mass spectrometry (Orbitrap) was employed for analysis. The analysis reports and sociodemographic data of 10,300 cases were retrieved from the patient record system and subjected to statistical analysis using SPSS 25.0. Gabapentinoid positivity was detected in 21.6% (n = 2224) of these cases (pregabalin (PGB) 18.9% (n = 1943) and gabapentin (GBP) 5.3% (n = 546)). Of the positive cases, 93.9% (n = 2089) were male, with an average age of 28 ± 6.7. Forensic cases (probation and judicial) represented the majority of admitted and positive cases 2.6% (n = 265) of cases tested positive for both pregabalin and gabapentin. While an overall increase in pregabalin and gabapentin positivity rates was observed over time, a statistically significant difference (p < 0.05) was noted between years. Seven substances were detected with gabapentinoids. Methamphetamine was the most common accompanying substance, representing nearly half of the detected substances (46.8%, n = 1040), followed by THC-COOH (26.8%, n = 595). Despite legal regulations, the use of gabapentinoids is increasing rapidly. The study highlights the urgent need to include gabapentinoids in routine screening tests, enforce stricter prescribing guidelines, and actively prevent their illegal use.

Geographic Atrophy in Age-Related Macular Degeneration

BACKGROUND

Age-related macular degeneration (AMD), a condition of multifactorial origin, is a major cause of irreversible vision loss in industrialized countries. The dry late stage of the disease, known as geographic atrophy (GA), is characterized by progressive loss of photoreceptor cells and retinal pigment epithelial cells in the central retina. An estimated 300 000 to 550 000 people in Germany suffer from GA.

METHODS

This review is based on pertinent literature retrieved by a selective search in the PubMed and Web of Science databases.

RESULTS

In 2023, the complement inhibitors pegcetacoplan and avacincaptad pegol were approved in the USA for repeated intravitreal injections and thereby became the first drugs ever approved for the treatment of GA. In Europe, the marketing authorization application for both drugs was withdrawn by the manufacturers after a negative judgment was expressed by the European Medicines Agency (EMA) Committee for Medicinal Products for Human Use. The EMA stated that the significant slowing of atrophy progression that had been achieved in the approval trials did not lead to any clinically relevant functional benefit for the patients. Further treatment approaches, including gene therapy, are now being studied in clinical trials. There is evidence that micronutrients may slow the progression of atrophy.

CONCLUSION

In Europe at present, there is no approved treatment for GA due to AMD. There is thus a continuing need for preventive and rehabilitative measures such as smoking cessation, a balanced diet, and magnifying visual aids for patients in the advanced stages of the disease.

Trends in Benzodiazepine and Z-Drug Prescriptions in Eastern China (2015-2021)

Objective

This study analyses trends in the prescription and usage of benzodiazepines (BZDs) and Z-drugs within specialised medical institutions and emergency outpatient services in China from 2015 to 2021, focusing on demographics and prescribing patterns to promote better management practices.

Methods

A retrospective study was conducted from 2015 to 2021, reviewing prescription information and population characteristics from 10 hospitals, including specialised psychiatric institutions and general hospitals in Zhejiang, Jiangsu, and Shanghai. The study analysed a total of 33,569 valid prescriptions.

Results

There was a noticeable increase in the total defined daily doses of both benzodiazepines and Z-drugs, with significant variations among different drugs. Lorazepam and zopiclone showed the most substantial increases in usage. Drugs like clonazepam and lorazepam were predominantly prescribed, indicating specific patterns in disease management, particularly for insomnia and anxiety.

Conclusions

This study reveals a significant increase in benzodiazepine and Z-drug prescriptions, particularly among elderly and female patients. The findings highlight the need for targeted interventions and policy reforms to ensure safe prescribing practices and mitigate the risks associated with long-term use in these vulnerable populations.

A Hidden Pandemic? Abuse of Gabapentinoids: A Brief Review of Recent Studies

BACKGROUND

Gabapentin and pregabalin were developed for epilepsy and neuropathic pain. They work via voltage-gated calcium channels and are used for broad-spectrum diagnoses, e.g., epilepsy, neuropathic pain, other chronic pain syndromes, anxiety disorders, alcohol-drug withdrawal syndromes, agitation, insomnia, etc. Especially in a world dealing with the opioid crisis, gabapentinoids were considered safer alternatives to opioid analgesics.

METHODS

This review aims to comprehensively search and summarize recent studies concerning the abuse of gabapentinoids published between 2021 and 2022 from various regions around the world.

RESULTS

Studies have highlighted that a history of substance use disorder is a significant risk factor for gabapentinoid abuse. Concurrent abuse of gabapentinoids with illicit drugs can exacerbate drug-related damages. Drug screening and postmortem toxicology tests have revealed an increase in gabapentinoid consumption. In response to the abuse potential, several countries have classified gabapentinoids as controlled substances.

CONCLUSION

Gabapentinoids are highly abused molecules worldwide. Physicians should be aware of their abuse potential.

Folic acid supplementation improved nicotine withdrawal-induced of memory loss via affecting oxidative status, inflammatory response, cholinergic activity, BDNF and amyloid-B in adolescent male rat

BACKGROUND

The present study aimed to assess whether folic acid (FA) have potential to prevent memory impairment caused by nicotine (Nico) withdrawal in adolescent male rats.

METHODS AND MATERIALS

The experiments were divided into 7 groups: 1) vehicle, 2) Nico (Nico 2 mg/kg injection from 21 to 42 days of ages), 3-5) Nico FA5/10/15 mg/kg (received Nico from 21 to 42 days of ages and received FA at three doses 5, 10 and 15 mg/kg 43-63 days of ages), and 6) received normal saline from 21 to 42 days of age after that received FA 15 mg/kg by oral gavage from 43 to 63 days of age. At 64-69 days of ages, behavioral tests related to memory including Morris Water Maze (MWM) and Object Recognition Test (ORT) were performed and related biochemical analysis including the hippocampal levels of oxidative stress markers, inflammatory indices, brain-derived neurotrophic factor (BDNF), nitrite, amyloid-B and acetylcholinesterase [1] were measured.

RESULTS

Results showed that nicotine exposure in adolescence followed by withdrawal dramatically impaired learning and memory performance along with affecting a variety of biochemical markers in the hippocampal tissues. In addition, it was observed that administration of FA significantly ameliorated Nico withdrawal-induced adverse effects through restoration of the mentioned biochemical disturbances.

CONCLUSION

The present study and other relevant researches demonstrated that FA as a well-known, inexpensive, and safe supplement has strong potential to either prevent or ameliorate the detrimental effect of Nico withdrawal. However, further investigation is required to be more elucidated the precise mechanisms underlying memory impairment-induced by Nico withdrawal.

The Role of Gabapentinoids in the Substance Use Pattern of Adult Germans Seeking Inpatient Detoxification Treatment - A Pilot Study

To shed more light on the addictive power of the gabapentinoids (GPTs) gabapentin and pregabalin, we performed a structured face-to-face interview with GPT-users about DSM-IV-dependence-criteria (sedatives), consume-motives and cessation-needs. Among 100 patients consecutively admitted to a detoxification-ward, fifteen (15%) reported lifetime GPT-use (18-50 years old, 2 females): seven (7%) used gabapentin, twelve (12%) pregabalin and four had lifetime experiences with both GPTs. Of the seven gabapentin-users, three patients were dependent including one person with a spontaneous remission. Of the 12 pregabalin-users, five were dependent, including two persons with a spontaneous remission. Fourteen of fifteen cases reported GPT-use side-by-side with an opioid-use, mostly for sparing opioids. Twelve GPT-users additionally co-used benzodiazepines. In no case, a GPT was the reason for detoxification treatment or reported to be involved in an emergency event. Altogether, every 7^th patient (n = 15) of our inpatient detoxification-seeking sample reported GPT-use including 50% (n = 8) who were dependent. Among them, 35% (3/8) had been already spontaneously remitted. As GPT-users reported no cession-need and the vast majority were primarily affected by co-occurring opioid- and benzodiazepine-addiction, we assume that GPTs more likely played a bystander-role than mediating the addictive behavior of this population with multiple recreational drug use experience.