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Durand L, O'Kane A, Tierney J, Cronly M, Bennett KE, Kavanagh Y, Keenan E, Cousins G. Gabapentinoids in Ireland 2010 to 2020: An observational study of trends in gabapentinoid prescribing, law enforcement drug seizures and postmortem toxicology. Br J Clin Pharmacol 2023. [PMID: 38072974 DOI: 10.1111/bcp.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
AIMS We explored trends in gabapentinoid prescribing, drug seizures and postmortem toxicology using a national pharmacy claims database, law enforcement drug seizures data and a population-based postmortem toxicology database. METHODS Gabapentinoid prescribing rates per 100 000 eligible population (2010-2020), annual number of drug seizures involving gabapentinoids (2012-2020) and gabapentinoid detection (positive) rates per 100 postmortem toxicology case (2013-2020) were calculated. Negative binomial regression models were used to evaluate longitudinal trends for gabapentin and pregabalin separately. RESULTS Gabapentin (adjusted rate ratio [RR] 1.06, 95% confidence interval [CI] 1.05-1.06, P < .001) and pregabalin (adjusted RR 1.08, 95% CI 1.08-1.09, P < .001) prescribing increased annually, with higher rates of pregabalin (vs. gabapentin) observed every year. Drug seizures involving pregabalin also increased over time (RR 1.54 95% CI 1.25-1.90, P < .0001). Of the 26 317 postmortem toxicology cases, 0.92% tested positive for gabapentin, and 6.37% for pregabalin. Detection rates increased for both gabapentin (RR 1.28, 95% CI 1.11-1.48, P < .001) and pregabalin (RR 1.13, 95% CI 1.11-1.48, P < .001) between 2013 and 2020. A total of 1901 cases (7.2%) tested positive for heroin/methadone; this sub-group had a higher detection rate for pregabalin (n = 528, 27.8%) and gabapentin (n = 41, 2.2%) over the study period, with a high burden of codetections for pregabalin with benzodiazepines (peaking at 37.3% in 2018), and pregabalin with prescription opioids (peaking at 28.9% in 2020). CONCLUSION This study raises concerns regarding the wide availability of pregabalin in Ireland, including a growing illicit supply, and the potential for serious harm arising from poly drug use involving pregabalin among people who use heroin or methadone.
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Affiliation(s)
- Louise Durand
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Aoife O'Kane
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Julie Tierney
- Human Toxicology, The State Laboratory, Kildare, Ireland
| | - Mark Cronly
- Human Toxicology, The State Laboratory, Kildare, Ireland
| | - Kathleen E Bennett
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Yvonne Kavanagh
- Chemical Analysis Discipline, Forensic Science Ireland, Dublin, Ireland
| | - Eamon Keenan
- National Social Inclusion Office, Health Service Executive, Dublin, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
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Ellis MS, Xu KY, Tardelli VS, Fidalgo TM, Buttram ME, Grucza RA. Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder. JAMA Psychiatry 2023; 80:1269-1276. [PMID: 37672238 PMCID: PMC10483381 DOI: 10.1001/jamapsychiatry.2023.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/05/2023] [Indexed: 09/07/2023]
Abstract
Importance Gabapentin prescriptions have drastically increased in the US due to off-label prescribing in settings such as opioid use disorder (OUD) treatment to manage a range of comorbid conditions and withdrawal symptoms, despite a lack of evidence. Objective To assess the purpose and associated risks of off-label gabapentin use in OUD treatment. Design, Setting, and Participants This retrospective recurrent-event case-control study with a crossover design used administrative claims data from MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Individuals aged 12 to 64 years with an OUD diagnosis and filling buprenorphine prescriptions were included in the primary analysis conducted from July 1, 2022, through June 1, 2023. Unit of observation was the person-day. Exposures Days covered by filled gabapentin prescriptions. Main Outcomes and Measures Primary outcomes were receipt of gabapentin in the 90 days after initiation of buprenorphine treatment and drug-related poisoning. Drug-related poisonings were defined using codes from International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Results A total of 109 407 patients were included in the analysis (mean [SD] age, 34.0 [11.2] years; 60 112 [54.9%] male). Among the 29 967 patients with Medicaid coverage, 299 (1.0%) were Hispanic, 1330 (4.4%) were non-Hispanic Black, 23 112 (77.1%) were non-Hispanic White, and 3399 (11.3%) were other. Gabapentin was significantly less likely to be prescribed to Black or Hispanic patients, and more likely to be prescribed to female patients, those with co-occurring substance use or mood disorders, and those with comorbid physical conditions such as neuropathic pain. Nearly one-third of persons who received gabapentin (4336 [31.1%]) had at least 1 drug-related poisoning after initiating buprenorphine treatment, compared with 13 856 (14.5%) among persons who did not receive gabapentin. Adjusted analyses showed that days of gabapentin use were not associated with hospitalization for drug-related poisoning (odds ratio, 0.98 [95% CI, 0.85-1.13]). Drug-related poisoning risks did not vary based on dosage. Conclusions and Relevance Gabapentin is prescribed in the context of a myriad of comorbid conditions. Even though persons receiving gabapentin are more likely to have admissions for drug-related poisoning, these data suggest that gabapentin is not associated with an increased risk of drug-related poisoning alongside buprenorphine in adjusted analyses. More data on the safety profile of gabapentin in OUD settings are needed.
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Affiliation(s)
- Matthew S. Ellis
- Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, Missouri
| | - Kevin Y. Xu
- Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, Missouri
| | - Vitor S. Tardelli
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Translational Addictions Research Laboratory, Centre for Addictions and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Thiago M. Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mance E. Buttram
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville
| | - Richard A. Grucza
- Department of Family and Community Medicine, St Louis University, St Louis, Missouri
- Department of Health and Outcomes Research, St Louis University, St Louis, Missouri
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Yang S, Huang S, Hincapie-Castillo JM, Ke X, Ding H, Schelfhout J, Sher MR, Jones B, Wilson DL, Lo-Ciganic WH. Patterns of Cough Medication Prescribing among Patients with Chronic Cough in Florida: 2012-2021. J Clin Med 2023; 12:6286. [PMID: 37834931 PMCID: PMC10573590 DOI: 10.3390/jcm12196286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Among patients with chronic cough (CC) in the 2012-2021 statewide OneFlorida Clinical Research Consortium database, we examined trends in cough medication (CM) prescribing prevalence over time in repeated cross-sectional analyses and identified distinct CM utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Among eligible adults (≥18 years) without cancer/benign respiratory tumor diagnoses, we identified CC patients and non-CC patients with any cough-related diagnosis. In the GBTM analysis, we calculated the number of monthly prescriptions for any CMs (excluding gabapentinoids) during the 12 months from the first qualifying cough event to identify distinct utilization trajectories. From 2012 to 2021, benzonatate (9.6% to 26.1%), dextromethorphan (5.2% to 8.6%), and gabapentinoid (5.3% to 14.4%) use increased among CC patients, while opioid antitussive use increased from 2012 to 2015 and decreased thereafter (8.4% in 2012, 14.7% in 2015, 6.7% in 2021; all p < 0.001). Of 15,566 CC patients and 655,250 non-CC patients identified in the GBTM analysis, CC patients had substantial burdens of respiratory/non-respiratory comorbidities and healthcare service and concomitant medication use compared to non-CC patients. Among CC patients, GBTM identified three distinct CM utilization trajectories: (1) no CM use (n = 11,222; 72.1%); (2) declining CM use (n = 4105; 26.4%); and (3) chronic CM use (n = 239; 1.5%). CC patients in Florida had limited CM use with increasing trends in use of benzonatate, dextromethorphan, and gabapentinoids and a decreasing trend in opioid antitussive use. CC patients, particularly with chronic prescription CM use, experienced substantial disease burden.
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Affiliation(s)
- Seonkyeong Yang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Shu Huang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Juan M. Hincapie-Castillo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Xuehua Ke
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (H.D.); (J.S.)
| | - Helen Ding
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (H.D.); (J.S.)
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (H.D.); (J.S.)
| | | | - Bobby Jones
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Meaadi J, Obara I, Eldabe S, Nazar H. The safety and efficacy of gabapentinoids in the management of neuropathic pain: a systematic review with meta-analysis of randomised controlled trials. Int J Clin Pharm 2023:10.1007/s11096-022-01528-y. [PMID: 36848024 DOI: 10.1007/s11096-022-01528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/01/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive. AIM This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting. METHOD Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality. RESULTS 50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo. CONCLUSION Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.
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Affiliation(s)
- Jawza Meaadi
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.,King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ilona Obara
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Sam Eldabe
- Department of Pain and Anaesthesia, James Cook Hospital, Middlesbrough, UK
| | - Hamde Nazar
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.,Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, UK
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Yang S, Hincapie-Castillo JM, Ke X, Schelfhout J, Ding H, Sher MR, Zhou L, Chang CY, Wilson DL, Lo-Ciganic WH. Evaluation of Cough Medication Use Patterns in Ambulatory Care Settings in the United States: 2003-2018. J Clin Med 2022; 11:jcm11133671. [PMID: 35806956 PMCID: PMC9267927 DOI: 10.3390/jcm11133671] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Using 2003−2018 National Ambulatory Medical Care Survey data for office-based visits and 2003−2018 National Hospital Ambulatory Medical Care Survey data for emergency department (ED) visits, we conducted cross-sectional analyses to examine cough medication (CM) use trends in the United States (US) ambulatory care settings. We included adult (≥18 years) patient visits with respiratory-infection-related or non-infection-related cough as reason-for-visit or diagnosis without malignant cancer or benign respiratory tumor diagnoses. Using multivariable logistic regressions, we examined opioid antitussive, benzonatate, dextromethorphan-containing antitussive, and gabapentinoid use trends. From 2003−2005 to 2015−2018, opioid antitussive use decreased in office-based visits (8.8% to 6.4%, Ptrend = 0.03) but remained stable in ED visits (6.3% to 5.9%, Ptrend = 0.99). In both settings, hydrocodone-containing antitussive use declined over 50%. Benzonatate use more than tripled (office-based:1.6% to 4.8%; ED:1.5% to 8.0%; both Ptrend < 0.001). Dextromethorphan-containing antitussive use increased in ED visits (1.8% to 2.6%, Ptrend = 0.003) but stayed unchanged in office-based visits (3.8% to 2.7%; Ptrend = 0.60). Gabapentinoid use doubled in office-based visits (1.1% in 2006−2008 to 2.4% in 2015−2018, Ptrend < 0.001) but was negligible in ED visits. In US office-based and ED ambulatory care settings, hydrocodone-containing antitussive use substantially declined from 2003 to 2018, while benzonatate use more than tripled, and dextromethorphan-containing antitussive and gabapentinoid use remained low (<3%).
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Affiliation(s)
- Seonkyeong Yang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
| | - Juan M. Hincapie-Castillo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Xuehua Ke
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (J.S.); (H.D.)
| | - Jonathan Schelfhout
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (J.S.); (H.D.)
| | - Helen Ding
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA; (X.K.); (J.S.); (H.D.)
| | | | - Lili Zhou
- Global Patient Safety, BeiGene USA, Inc., San Mateo, CA 94403, USA;
| | - Ching-Yuan Chang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (C.-Y.C.); (D.L.W.)
- Center for Drug Evaluation and Safety (CoDES), College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-6255
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Slane A, Robert S, Rarrick C, Weeda E. Survey of noncontrolled medication misuse patterns. Ment Health Clin 2022; 12:199-204. [PMID: 35801164 PMCID: PMC9190268 DOI: 10.9740/mhc.2022.06.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The abuse potential of opioids and other controlled substances is well-known; however, reports of noncontrolled prescription medication (NCPM) misuse deserves further attention. Whereas several studies investigate patterns, motivations, and biochemical mechanisms underlying the misuse potential of NCPM, the clinical significance of NCPM misuse is not well-understood. The primary objectives of this project were to identify prescriber perceptions of NCPM misuse and evaluate patient reported patterns of misuse through survey responses. Methods Adult patients admitted to psychiatry services and prescribers working in psychiatry or on a general medicine service during the study time frame were invited to participate. Surveys were collected anonymously for both patients and prescribers. Results NCPM misuse was reported by 38.4% of patients. Trazodone (35%) and quetiapine (30%) were most commonly reported as being misused. Opioid (24.1% vs 4.3%; P = .023) and cannabis use disorders (13.8% vs 0%; P = .019) were reported more frequently in patients who misuse NCPM, whereas no difference was seen for other SUDs (P > .05). There was no difference between psychiatric and general medicine prescribers regarding familiarity with NCPM misuse (n = 21 [87.5%] vs n = 13 [81.3%]; P = .668). Discussion High rates of NCPM misuse were seen in this patient population. Our findings confirm previous reports of quetiapine misuse and also reveal that trazodone is frequently misused. Based on the observations in this study, the misuse of NCPM is identified as prevalent and noteworthy at our institution, warranting provider education and future studies.
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Affiliation(s)
| | - Sophie Robert
- 2 Psychiatric Clinical Pharmacy Specialist, The Medical University of South Carolina, Charleston, South Carolina
| | - Christine Rarrick
- 3 Psychiatric Clinical Pharmacy Specialist, The Medical University of South Carolina, Charleston, South Carolina
| | - Erin Weeda
- 4 Assistant Professor, The Medical University of South Carolina College of Pharmacy, Charleston, South Carolina
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Hadlandsmyth K, Bernardy NC, Lund BC. Central nervous system polytherapy among veterans with posttraumatic stress disorder: changes across a decade. Gen Hosp Psychiatry 2022; 74:46-50. [PMID: 34906798 DOI: 10.1016/j.genhosppsych.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objectives were to investigate rates and patterns of polytherapy among veterans with PTSD across time (in 2009 and 2019), describe features of polytherapy prescribing, and identify demographic and clinical factors associated with polytherapy. METHODS Veterans Affairs (VA) administrative data were used to build cohorts of all VA-served veterans with PTSD in 2009 (N = 458,620) and 2019 (N = 877,785). Frequency of CNS active drug classes, rates of polytherapy (≥5 concurrent CNS drugs), clinical features associated with polytherapy, number of prescribers, and patterns of co-prescribed medications were examined. RESULTS The 12-month period prevalence of CNS polytherapy declined from 12.1% in 2009 to 6.9% in 2019. However, polytherapy rates increased from 3.3% in 2009 to 4.1% in 2019, when opioids and benzodiazepines were excluded. In multivariable regression analysis, CNS polytherapy was more common among women, White people, middle-age veterans (45-64 years), rural residents, veterans receiving care at a medical center, and those with psychiatric comorbidities. CNS polytherapy regimens involved a mean of 2.3 prescribers and the majority (86.6%) included at least one medication commonly prescribed for pain management. CONCLUSIONS CNS polytherapy declined among veterans with PTSD from 2009 to 2019 and was wholly attributable to decreases in opioid and benzodiazepine prescribing.
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Affiliation(s)
- Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; University of Iowa, Carver College of Medicine, Department of Anesthesia, 200 Hawkins Dr, Iowa City, IA 52242-1089, USA.
| | - Nancy C Bernardy
- White River Junction VA Medical Center Research Department, White River Junction, VT, USA; National Center for PTSD, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, NH, USA
| | - Brian C Lund
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; University of Iowa College of Public Health, Department of Epidemiology, Iowa City, IA, USA
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Riley SB, Garbutt K, Crow C, Isbell TS, Scalzo AJ. Gabapentin prevalence: clinical and forensic experience in St. Louis, Missouri, USA. Forensic Sci Res 2021; 6:218-223. [PMID: 34868714 PMCID: PMC8635626 DOI: 10.1080/20961790.2021.1991075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah B Riley
- School of Medicine Department of Pathology, Saint Louis University, St. Louis, Missouri, USA.,School of Medicine Department of Pediatrics, Saint Louis University, St. Louis, Missouri, USA
| | - Kelsie Garbutt
- Department of Sociology and Anthropology, Forensic Sciences Program, Saint Louis University, St. Louis, Missouri, USA
| | - Chelsea Crow
- School of Medicine Department of Pathology, Saint Louis University, St. Louis, Missouri, USA
| | - T Scott Isbell
- School of Medicine Department of Pathology, Saint Louis University, St. Louis, Missouri, USA.,School of Medicine Department of Pediatrics, Saint Louis University, St. Louis, Missouri, USA
| | - Anthony J Scalzo
- Department of Sociology and Anthropology, Forensic Sciences Program, Saint Louis University, St. Louis, Missouri, USA
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Knezevic NN, Aijaz T, Camacho-Ortega A, Candido KD. A Retrospective Analysis of Gabapentinoid and Opioids to Opioid Monotherapy for Pain Relief in Patients with Chronic Neck and Low Back Pain. PAIN MEDICINE 2021; 22:1760-1766. [PMID: 33502505 DOI: 10.1093/pm/pnab006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We compared the reduction in pain and opioid consumption in patients with chronic spinal pain on concomitant gabapentinoids and opioids with patients using opioids only. DESIGN This was a retrospective chart review of patients with chronic neck or low back pain who were on opioids with at least a 24-month follow-up. SETTING Single-center pain clinic in an urban setting. SUBJECTS 167 patients with chronic spinal pain lasting at least six months. METHODS Patients on gabapentin or pregabalin were included in the gabapentinoid group, while the other patients were included in the non-gabapentinoid group. Primary outcome was assessment of pain scores measured via a numeric rating scale (NRS), and secondary outcomes were response to the treatment (>2 point reduction on NRS) and daily opioid use measured in morphine milliequivalents. RESULTS Pain scores were reduced in the first six months and plateaued after that in both groups. At the end of 24 months, the average pain score was 6.71 in the gabapentinoid group, while the average pain score was 7.18 in the non-gabapentinoid group. There was no statistical significance between the groups (p = 0.28). There was no difference in response to treatment in gabapentinoid group (33.3%) when compared with non-gabapentinoid group (32.7%). We also failed to find any significant difference in daily opioid usage between the two groups. CONCLUSION Gabapentinoids may not lead to reduction in pain or opioid consumption in patients with chronic spinal pain. A careful approach must be adopted while prescribing gabapentinoids in the chronic spinal pain patient population.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.,Department of Anesthesiology, University of Illinois, Chicago, Illinois.,Department of Surgery, University of Illinois, Chicago, Illinois, USA
| | - Tabish Aijaz
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Alvaro Camacho-Ortega
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.,Department of Anesthesiology, University of Illinois, Chicago, Illinois.,Department of Surgery, University of Illinois, Chicago, Illinois, USA
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Abstract
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.
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Affiliation(s)
- Staffan Hägg
- Futurum, Jönköping, Region Jönköping County and Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Futurum, Hus B4, Ryhov Hospital, S-551 85, Jönköping, Sweden.
| | - Anna K Jönsson
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
| | - Johan Ahlner
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
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11
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Evoy KE, Peckham AM, Covvey JR, Tidgewell KJ. Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability. J Clin Pharmacol 2021; 61 Suppl 2:S89-S99. [PMID: 34396549 DOI: 10.1002/jcph.1833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Kirk E Evoy
- The University of Texas at Austin College of Pharmacy, Austin, Texas, USA.,University Health System, San Antonio, Texas, USA
| | - Alyssa M Peckham
- School of Pharmacy, Northeastern University, Boston, Massachusetts, USA.,Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Kevin J Tidgewell
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
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12
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Buttram ME, Kurtz SP, Margolin ZR, Severtson SG. Increasing rates of buprenorphine diversion in the United States, 2002 to 2019. Pharmacoepidemiol Drug Saf 2021; 30:1514-1519. [PMID: 34302707 DOI: 10.1002/pds.5334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Recent reports suggest that buprenorphine is being diverted and used non-medically. However, no apparent studies have reported national-level data on buprenorphine diversion. METHODS Case report data were drawn from a quarterly survey of prescription drug diversion completed by a national sample of law enforcement and regulatory agencies who engage in drug diversion investigations. Quarterly rates of buprenorphine diversion per 100 000 population and 100 000 prescriptions dispensed were calculated for the period 2002 through 2019. Population-based diversion rates were also calculated by U.S. region. RESULTS In total, 9670 cases of diverted buprenorphine were reported across all 50 states and the District of Columbia during the study period. Buprenorphine diversion rates, per 100 000 population, were characterized by an accelerating increase over time; increases in diversion rates from 1st quarter 2002 through 4th quarter 2006 were not statistically significant, yet from 1st quarter 2007 through 4th quarter 2019, the rate of diversion cases increased by 0.0067 cases per 100 000 per quarter (p < 0.001). Buprenorphine diversion rates per 100 000 prescriptions dispensed indicated a gradual increase over time; from 3rd quarter 2010 through 4th quarter 2019, diversion rates showed a statistically significant increase of 0.28 cases (p = 0.037) per quarter on average. The Northeast was the only region that did not observe an increase in the average quarterly change in buprenorphine diversion rates after 2006. CONCLUSIONS Findings from this study illustrate longitudinal national trends of increasing buprenorphine diversion. Continued systematic surveillance of this phenomenon is needed.
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Affiliation(s)
- Mance E Buttram
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida, USA
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13
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Zhou L, Bhattacharjee S, Kwoh K, Tighe PJ, Reisfield GM, Malone DC, Slack M, Wilson DL, Chang CY, Lo-Ciganic WH. Dual-trajectories of opioid and gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study. Addiction 2021; 116:819-830. [PMID: 32648951 PMCID: PMC7796992 DOI: 10.1111/add.15189] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/04/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Little is known about opioid and gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose. DESIGN Retrospective cohort study. SETTING US Medicare. PARTICIPANTS Using a 5% sample (2011-16), we identified 71 005 fee-for-service Medicare beneficiaries with fibromyalgia, low back pain, neuropathy and/or osteoarthritis initiating OPIs and/or GABAs [mean age ± standard deviation (SD) = 65.5 ± 14.5 years, female = 68.1%, white = 76.8%]. MEASUREMENTS Group-based multi-trajectory models identified distinct OPI-GABA use patterns during the year of OPI and/or GABA initiation, based on weekly average standardized daily dose (i.e. OPIs = morphine milligram equivalent, GABAs = minimum effective daily dose). We estimated models with three to 12 trajectories and selected the best model based on Bayesian information criterion (BIC) and Nagin's criteria. We estimated risk of time to first drug overdose diagnosis within 12 months following the index year, adjusting for socio-demographic and health factors using inverse probability of treatment weighted multivariable Cox proportional hazards models. FINDINGS We identified 10 distinct trajectories (BIC = -1 176 954; OPI-only = 3, GABA-only = 3, OPI-GABA = 4). Compared with OPI-only early discontinuers (40.6% of the cohort), 1-year drug overdose risk varied by trajectory group: consistent low-dose OPI-only users [16.6%; hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.19-1.82], consistent high-dose OPI-only users (1.8%; HR = 4.57, 95% CI = 2.99-6.98), GABA-only early discontinuers (12.5%; HR = 1.39, 95% CI = 1.09-1.77), consistent low-dose GABA-only users (11.0%; HR = 1.44, 95% CI = 1.12-1.85), consistent high-dose GABA-only users (3.1%; HR = 1.43, 95% CI = 0.94-2.17), early discontinuation of OPIs and consistent low-dose GABA users (6.9%; HR = 1.24, 95% CI = 0.90-1.69), consistent low-dose OPI-GABA users (3.4%; HR = 2.49, 95% CI = 1.76-3.52), consistent low-dose OPI and high-dose GABA users (3.2%; HR = 2.46, 95% CI = 1.71-3.53) and consistent high-dose OPI and moderate-dose GABA users (0.9%; HR = 7.22, 95% CI = 4.46-11.69). CONCLUSIONS Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and gabapentinoids. High-dose opioid-only users and all consistent opioid and gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid-only early discontinuers.
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Affiliation(s)
- Lili Zhou
- Department of Pharmacy Practice and Science, College of
Pharmacy, University of Arizona, Tucson, Arizona USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of
Pharmacy, University of Arizona, Tucson, Arizona USA
| | - Kent Kwoh
- Department of Medicine, Division of Rheumatology, College
of Medicine, University of Arizona, Tucson, Arizona USA,University of Arizona Arthritis Center, College of
Medicine, University of Arizona, Tucson, Arizona USA
| | - Patrick J Tighe
- Department of Anesthesiology, College of Medicine,
University of Florida, Gainesville, Florida USA
| | - Gary M. Reisfield
- Divisions of Addiction Medicine & Forensic Psychiatry,
Departments of Psychiatry & Anesthesiology, College of Medicine, University of
Florida, Gainesville, Florida USA
| | - Daniel C. Malone
- Department of Pharmacotherapy, College of Pharmacy,
University of Utah, Salt Lake City, Utah USA
| | - Marion Slack
- Department of Pharmacy Practice and Science, College of
Pharmacy, University of Arizona, Tucson, Arizona USA
| | - Debbie L. Wilson
- Department of Pharmaceutical Outcomes and Policy, College
of Pharmacy, University of Florida, Gainesville, Florida USA
| | - Ching-Yuan Chang
- Department of Pharmaceutical Outcomes and Policy, College
of Pharmacy, University of Florida, Gainesville, Florida USA,Center for Drug Evaluation and Safety, College of Pharmacy,
University of Florida, Gainesville, Florida USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College
of Pharmacy, University of Florida, Gainesville, Florida USA,Center for Drug Evaluation and Safety, College of Pharmacy,
University of Florida, Gainesville, Florida USA
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14
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Zhang Y, Castracane AR, Winstanley EL. Assessment of gabapentin misuse using prescription drug monitoring program data. Subst Abus 2021; 42:454-459. [PMID: 33689673 DOI: 10.1080/08897077.2021.1891602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gabapentin is an anticonvulsant medication with potential misuse reported in case reports and population studies, highlighting the need to reexamine its abuse liability. The purpose of this study was to describe gabapentin dispensing patterns and assess potential misuse. Methods: We used data from Ohio's Prescription Drug Monitoring Program (PDMP) from December 1, 2016 to March 31, 2017 and restricted the population to adults who filled at least one gabapentin prescription (N = 379,372). Gabapentin dispensing patterns are described and multiple strategies were used to assess potential misuse, including Lorenz-1 curve analysis. Supratherapeutic dosing, number of prescribers and number of pharmacies used were compared for individuals who were co-dispensed medications for opioid use disorder (MOUD) and those who were not. Results: More than one million gabapentin prescriptions were dispensed during the 4-month period, with a mean dose of 1103.8 mg. While few individuals received supratherapeutic dosing, exceptionally high doses were observed. Half of the individuals (50.9%) were co-dispensed gabapentin and opioids. The Lorenz-1 value for gabapentin (5.5%) did not exceed the threshold for misuse potential. Individuals co-dispensed MOUD were more likely to have supratherapeutic dosing; however, they had a lower Lorenz-1 value compared to individuals not co-dispensed MOUD. Conclusions: Among Ohio residents dispensed gabapentin, there was no evidence of misuse using PDMP data based on the Lorenz-1 value, yet supratherapeutic dosing of gabapentin was observed and was associated with OUD. New strategies may be needed to identify the non-medical use of gabapentin.
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Affiliation(s)
- Yifan Zhang
- School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | | | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.,Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
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15
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Evoy KE, Covvey JR, Peckham AM, Reveles KR. Gabapentinoid misuse, abuse and non-prescribed obtainment in a United States general population sample. Int J Clin Pharm 2021; 43:1055-1064. [PMID: 33387188 DOI: 10.1007/s11096-020-01217-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Abstract
Background Reports of gabapentinoid (gabapentin and pregabalin) misuse are on the rise, but few studies have assessed this within the general US population. Objective Describe lifetime misuse/abuse/non-prescribed obtainment of gabapentinoids and descriptive characteristics associated with such actions in a US general population sample. Setting This cross-sectional questionnaire was administered online by Qualtrics® research panel aggregator via quota-based sampling. Methods Data were collected from a sample of respondents that mirrored the general US population aged 18-59 years with regards to age, geographic region, ethnicity, income, and education level, based on most recent census data. Misuse/abuse/non-prescribed obtainment was collectively defined as use of a gabapentinoid for reasons other than a diagnosed medical condition, using with the intention of altering one's state of consciousness, or obtaining without a prescription. A multivariable logistic regression model was created to predict misuse/abuse/non-prescribed obtainment of gabapentinoids, incorporating relevant covariates. Main outcome measure Proportion of sample indicating lifetime misuse/abuse/non-prescribed obtainment of gabapentinoids. Results Among 1,843 respondents, 121 (6.6%) reported gabapentinoid misuse/abuse/non-prescribed obtainment. Specifically, 2.1% (n = 39) and 1.5% (n = 27) of respondents for gabapentin and pregabalin, respectively, met study criteria for abuse. Opioids were the most common medication co-administered with gabapentinoids (among 50-70% of respondents) for misuse/abuse. Previous treatment for addiction (OR: 2.61, 95% CI: 1.32-5.14, p = 0.005) and the total attitudinal risk score (OR: 1.14, 95% CI: 1.09-1.19, p < 0.001) were associated with gabapentinoid misuse/abuse/non-prescribed obtainment. Conclusion Among those surveyed, 6.6% reported previous gabapentinoid misuse/abuse/non-prescribed obtainment, providing one of the first estimates within a nationally distributed, US general population sample.
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Affiliation(s)
- Kirk E Evoy
- The University of Texas At Austin College of Pharmacy, 7703 Floyd Curl Dr. - MC 6220, San Antonio, TX, 78229, USA. .,University Health System, San Antonio, TX, USA. .,The University of Texas Health San Antonio School of Medicine, 7703 Floyd Curl Dr. MC - 6220, San Antonio, TX, 78229, USA.
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, 600 Forbes Avenue, 418 Mellon Hall, Pittsburgh, PA, 15282, USA
| | - Alyssa M Peckham
- School of Pharmacy, Northeastern University, Bouvé College of Health Sciences, 360 Huntington Ave, Boston, MA, R218 TF02115, USA.,Department of Pharmacy, Massachusetts General Hospital, 360 Huntington Ave, Boston, MA, R218 TF02115, USA
| | - Kelly R Reveles
- The University of Texas At Austin College of Pharmacy, 7703 Floyd Curl Dr. - MC 6220, San Antonio, TX, 78229, USA.,The University of Texas Health San Antonio School of Medicine, 7703 Floyd Curl Dr. MC - 6220, San Antonio, TX, 78229, USA
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16
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Tambon M, Ponté C, Jouanjus E, Fouilhé N, Micallef J, Lapeyre-Mestre M. Gabapentinoid Abuse in France: Evidence on Health Consequences and New Points of Vigilance. Front Psychiatry 2021; 12:639780. [PMID: 33613345 PMCID: PMC7886797 DOI: 10.3389/fpsyt.2021.639780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Gabapentinoid drugs (gabapentin and pregabalin) are widely used worldwide for epileptic and pain disorders. First signals of gabapentinoid abuse occurred in the last decade. This study aims to describe clinical characteristics of gabapentinoid use related disorders and health consequences in France. Materials and Methods: We designed a multisource investigation reviewing data reported to the French Addictovigilance Network (FAN) with pregabalin and gabapentin from 2010 to 2019. Information was obtained through the analysis of Spontaneous Reports (SRs) notified by health professionals and the pharmacoepidemiological surveys OSIAP (suspicious prescriptions forms indicators of potential abuse), OPPIDUM (observation of illicit drugs and misuse of psychotropic medications), DRAMES (death related to prescription drugs and other substances), and DTA (toxic deaths due to analgesics). Results: Over 2010-2019 period, were collected: (i) 265 SRs (258 pregabalin; 7 gabapentin); (ii) 816 forged prescription forms (805 pregabalin, 10 gabapentin, 1 involving both drugs); (iii) 145 cases of gabapentinoid use in people who use drugs (121 pregabalin; 24 gabapentin) and (iv) 31 cases of gabapentinoid-related deaths (25 pregabalin; 6 gabapentin). Risk factors of gabapentinoid abuse were opioid use disorders or psychiatric history, but cases of primary abuse in subjects without any substance abuse history were observed. Adverse outcomes concern almost exclusively pregabalin, with coma, dyspnea, convulsion, and conduction disorders. Treatment demands increased from 10.6% in 2018 to 23.1% in 2019, with pregabalin cited as the first substance leading to addictological care in the 2019 OPPIDUM survey. Gabapentinoid-related deaths increased over time. Pregabalin has become the first drug mentioned in forged prescriptions in 2019 (23.8% of OSIAP), while it ranked at the 15th position in 2017 (2.6%). Discussion: This study shows the importance of addictovigilance monitoring for gabapentinoids. Addictovigilance data helped to make visible the gabapentinoid-abuse related health harms (hospitalization for serious neurologic, psychiatric or cardiac effects, requests for addictological support and deaths) and to confirm the intrinsic abuse potential of pregabalin. These data highlight new points of vigilance considering observed primary abuse. At this point in France, the risk of abuse and related complications is very apparent with pregabalin. Still, it is identical to that observed elsewhere with gabapentin.
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Affiliation(s)
- Marine Tambon
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Camille Ponté
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Emilie Jouanjus
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France
| | - Nathalie Fouilhé
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie-Pharmacosurveillance, CHU Grenoble-Alpes, Grenoble, France
| | - Joelle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France.,CEIP-Addictovigilance PACA Corse, Marseille, France
| | - Maryse Lapeyre-Mestre
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France.,Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France
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Abstract
BACKGROUND A 2017 systematic review (SR) identified 59 studies examining gabapentinoid (pregabalin and gabapentin) misuse/abuse. Evidence of gabapentinoid misuse/abuse has since grown substantially. OBJECTIVE Update previous SR and describe new insights regarding gabapentinoid abuse. METHODS A SR of PubMed was conducted to identify studies published from 7/29/2016-8/31/2020. Four searches were performed using the following terms: "gabapentin [MeSH] OR pregabalin [MeSH] OR gabapentinoid" AND one of the following substance misuse/abuse-related terms: "substance-related disorders [MeSH]", "overdose", "abuse", or "misuse". Clinicaltrials.gov and the Cochrane Library database were searched to identify ongoing studies or similar SRs. Reference lists of included studies were reviewed to identify additional literature. All studies with novel data related to pregabalin and/or gabapentin abuse, misuse, or overdose conducted during the study period were included. Articles not written in English, review articles, and animal studies were excluded. RESULTS Fifty-five studies were included (29 [52.7%] from North America, 17 [30.9%] Europe, 6 [10.9%] Asia, and 3 [5.5%] Australia). Forty-six observational studies and 10 case reports/series were included (one manuscript included both). Twenty (36.4%) studied gabapentin only, 18 (32.7%) pregabalin only, and 17 (30.9%) both pregabalin/gabapentin. These studies corroborate findings from the previous SR that gabapentinoids are increasingly abused or misused to self-medicate, that gabapentinoids can produce desirable effects alone but are often used concomitantly with other drugs, and that opioid use disorder is the greatest risk factor for gabapentinoid abuse. While the original SR identified the largest studies having been published in Europe, this review identified several more generalisable US studies that have subsequently been conducted. The most concerning finding was increased evidence of associated patient harm, including increased hospital utilisation and opioid-related overdose mortality risk. CONCLUSION Evidence suggests that gabapentinoid misuse/abuse represents a growing trend that is causing significant patient harm. Prescribers should exercise appropriate caution with use in high-risk populations and monitor for signs of misuse or abuse.
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18
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Buttram ME, Kurtz SP. Descriptions of Gabapentin Misuse and Associated Behaviors among a Sample of Opioid (Mis)users in South Florida. J Psychoactive Drugs 2020; 53:47-54. [PMID: 32748701 DOI: 10.1080/02791072.2020.1802087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, USA
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, USA
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19
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Jones NS, Comparin JH. Interpol review of controlled substances 2016-2019. Forensic Sci Int Synerg 2020; 2:608-669. [PMID: 33385148 PMCID: PMC7770462 DOI: 10.1016/j.fsisyn.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.
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Affiliation(s)
- Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA
| | - Jeffrey H. Comparin
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
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20
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Buttram ME, Kurtz SP. Preliminary Evidence of Pregabalin Misuse among Prescription and/or Illicit Opioid (Mis)users. J Psychoactive Drugs 2020; 52:172-175. [PMID: 32106790 DOI: 10.1080/02791072.2020.1734695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pregabalin is approved for the management of neuropathic pain, partial-onset seizures, and fibromyalgia. Although it is considered to have low potential for abuse, reports of misuse of pregabalin are emerging. The present study contributes to this literature by presenting preliminary evidence of pregabalin misuse. Mixed method interviews were conducted with prescription and/or illicit opioid (mis)users who reported a history of pregabalin misuse (N = 5). During semi-structured interviews, respondents provided descriptions of this practice, including motivation, route of administration, source, and drugs used/misused in combination with pregabalin. Motivations for pregabalin misuse included the self-treatment of physical pain (N = 1) and to achieve a desired psychoactive effect and/or combat opioid withdrawal symptoms (N = 4). Respondents described the misuse of pregabalin to potentiate the effects of heroin and cocaine, to feel "tipsy," and to experiment. We believe this report represents the first detailed contextual data about the misuse of pregabalin in the U.S. These misuse practices may represent an early indication of a growing problem. The recent permissibility of lower price generic versions has the potential to increase availability, decrease prices, and exacerbate pregabalin misuse.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University , Miami, FL, USA
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University , Miami, FL, USA
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Buttram ME, Surratt HL. Factors Associated with Gabapentin Misuse among People Who Inject Drugs in Appalachian Kentucky. Subst Use Misuse 2020; 55:2364-2370. [PMID: 32917119 PMCID: PMC7643539 DOI: 10.1080/10826084.2020.1817082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida, USA
| | - Hilary L Surratt
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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22
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Stein MD, Kenney SR, Anderson BJ, Conti MT, Bailey GL. Prescribed and non-prescribed gabapentin use among persons seeking inpatient opioid detoxification. J Subst Abuse Treat 2019; 110:37-41. [PMID: 31952626 DOI: 10.1016/j.jsat.2019.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/11/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Persons with opioid use disorder (OUD) are at increased risk for gabapentin misuse. Rising rates of concomitant gabapentin-opioid use in the U.S. are concerning given heightened risk of fatal overdose. OBJECTIVE To examine predictors of ever using gabapentin among persons seeking treatment for opioid use and to assess if reasons for gabapentin use differed by gender and how gabapentin was procured (prescribed, non-prescribed, or both). METHOD Persons with OUD were recruited from a managed withdrawal program. t-Tests and Pearson χ2 tests of independence were used to compare reasons for gabapentin use by gender and source of acquisition. RESULTS Among participants (n = 401; 69.1% male, 84.5% White, 86.8% sought treatment for heroin use, 90.0% insured), female gender, higher educational attainment, injection drug use (IDU), history of overdose, and chronic pain were associated with gabapentin use. Overall, reasons for use were similar across genders among those reporting a history of gabapentin use (65.8%), although males were more likely to use to get high than females. About half (47.0%) reported only using gabapentin that was not prescribed, 20.5% had only used prescribed gabapentin, and 32.5% reported prescribed and non-prescribed use. Persons prescribed gabapentin were most likely to use it to control pain (81.5%); for those using diverted gabapentin only and those reporting both prescribed and non-prescribed gabapentin use, the most common reasons for intake were to: get high, increase effects of heroin, substitute for opioids, and help with opioid withdrawal. CONCLUSIONS In this sample of people with OUD entering inpatient detoxification program, a majority reported a history of gabapentin use, with most using diverted gabapentin. The range of reasons for gabapentin use point to the need to better understand why co-use is common.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Boston University School of Public Health, Boston, MA 02118, United States of America
| | - Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Warren Alpert Medical School of Brown University, Providence, RI 02912, United States of America.
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America
| | - Micah T Conti
- Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States of America
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI 02912, United States of America; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States of America
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23
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Buttram ME, Kurtz SP, Cicero TJ, Havens JR. An ethnographic decision model of the initiation of gabapentin misuse among prescription and/or illicit opioid (mis)user. Drug Alcohol Depend 2019; 204:107554. [PMID: 31542629 PMCID: PMC6905052 DOI: 10.1016/j.drugalcdep.2019.107554] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 01/21/2023]
Abstract
AIMS Gabapentin is used in the treatment of seizures and neuralgia, and it is prescribed off-label to treat substance use disorders and withdrawal symptoms. Recent research documents misuse of gabapentin, especially among prescription opioid misusers. The present study contributes to this literature by examining the initiation of gabapentin misuse. METHODS Qualitative interviews were conducted with prescription and/or illicit opioid (mis)users who reported a history of gabapentin misuse (N = 62) and who did not (N = 29). During semi-structured interviews, respondents provided descriptions of the first time they misused gabapentin. An ethnographic decision model was constructed to illustrate the factors that influence the initiation decision. RESULTS Multiple individual, social, and environmental factors influence the decision to initiate gabapentin misuse. Respondents described the initiation decision related to: a) wanting to feel a psychoactive high during times of limited access to one's preferred drug because of institutional barriers (e.g., substance abuse treatment; jail; transitional living facility; N = 18); b) the desire to use multiple drugs, including for experimentation or to potentiate another substance (N = 18); and c) the need to self-treat withdrawal symptoms during periods of opioid nonuse or when opioids were unavailable (N = 16). Respondents also initiated gabapentin misuse to self-treat physical pain (N = 10). CONCLUSIONS Multiple approaches are needed to mitigate gabapentin misuse, including limiting availability in institutional settings and informal channels as well as addressing the needs of drug users who experience physical pain and withdrawal symptoms. Continued research is needed to examine therapeutic uses of gabapentin and behaviors related to misuse.
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Affiliation(s)
- Mance E. Buttram
- ARSH: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Ave., Suite 112, Miami, FL 33138 USA
| | - Steven P. Kurtz
- ARSH: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Ave., Suite 112, Miami, FL 33138 USA
| | - Theodore J. Cicero
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave., Box 8134, St. Louis, MO 63110 USA
| | - Jennifer R. Havens
- Department of Behavioral Science, University of Kentucky, 333 Waller Ave., Suite 480, Lexington, KY 40504 USA
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24
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Balon R, Silberman EK, Starcevic V, Cosci F, Freire RC, Nardi AE, Rickels K, Shader R. Benzodiazepines, antidepressants and addiction: A plea for conceptual rigor and consistency. J Psychopharmacol 2019; 33:1467-1470. [PMID: 31556796 DOI: 10.1177/0269881119878171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Balon
- Department of Psychiatry, Wayne State University, Detroit, MI, USA.,Department of Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.,Department of Anesthesiology, Wayne State University, Detroit, MI, USA
| | | | - Vladan Starcevic
- Sydney Medical School, University of Sydney, Sydney, nsw, Australia
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Firenze, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Rafael C Freire
- Department of Psychiatry, Queens University, Kingston, on, Canada.,Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karl Rickels
- University of Pennsylvania, Philadelphia, PA, USA
| | - Richard Shader
- Department of Immunology, Tufts University, Boston, MA, USA
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25
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Buttram ME, Kurtz SP, Ellis MS, Cicero TJ. Gabapentin prescribed during substance abuse treatment: The perspective of treatment providers. J Subst Abuse Treat 2019; 105:1-4. [PMID: 31443885 DOI: 10.1016/j.jsat.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gabapentin, a prescription medication approved for the treatment of seizures and neuralgia, is often prescribed off-label for substance use treatment, mental health problems, and pain. Emerging reports also suggest it is misused for the purpose of getting high. The present study examines substance abuse treatment provider key informants' experiences with gabapentin prescribed to clients in treatment. The focus of this exploratory study is to ascertain how gabapentin is used in these settings and the benefits and risks for clients. METHODS Key informants from South Florida participated in confidential, in-depth interviews (N = 12). Data analyses included descriptive and in vivo coding schemes and employed a descriptive qualitative approach. RESULTS All key informants recognized the benefits of prescribing gabapentin to clients in treatment for problems related to withdrawal symptoms, mental distress and pain. At the same time, half of participants described gabapentin misuse among clients and four key informants described such misuse as a first marker of relapse. Key informants also stated that more research must be done about how to use gabapentin effectively in treatment settings. CONCLUSIONS These findings illustrate the lack of clarity about the efficacy of administration of gabapentin in treatment settings. Additional research about how to best use gabapentin, for whom it may be beneficial, and the effect of prescribed gabapentin on addiction recovery is needed.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA.
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 7255 NE 4th Avenue, Suite 112, Miami, FL 33138, USA
| | - Matthew S Ellis
- Washington University, Department of Psychiatry, Campus Box 8134, 600 S. Euclid Avenue, St. Louis, MO 63110, USA
| | - Theodore J Cicero
- Washington University, Department of Psychiatry, Campus Box 8134, 600 S. Euclid Avenue, St. Louis, MO 63110, USA
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26
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Leonard JB, Klein-Schwartz W. Characterization of intentional-abuse venlafaxine exposures reported to poison control centers in the United States. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:421-426. [PMID: 30973750 DOI: 10.1080/00952990.2019.1599382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 06/09/2023]
Abstract
Background: Venlafaxine use to achieve an amphetamine-like high has been described but data regarding the epidemiology and clinical effects are sparse. Objectives: Describe the prevalence and toxicity of venlafaxine abuse reported to US poison control centers. Methods: This was a retrospective review of venlafaxine exposures reported to the National Poison Data System (NPDS) from 2000 to 2016. Inclusion criteria were: age 12 years and older, reason for exposure intentional-abuse, and either single-substance exposure or venlafaxine was the first substance. The primary outcome was prevalence of intentional-abuse of venlafaxine. Secondary outcomes characterized demographics, geographic distribution, toxicity, and outcomes. Results: Intentional-abuse accounted for 752 of 85,621 venlafaxine exposures. Overall prevalence was 87.8 intentional-abuse exposures/10,000 venlafaxine exposures reported to NPDS (range, 59.3-117.6/10,000). Prevalence decreased from 107/10,000 in 2000 to 59.3/10,000 in 2016. Median age was 23 years and 50% were female. Primary route was ingestion (90.8%) with 4.7% using venlafaxine via inhalation/intranasal insufflation, and 3.7% both routes. There were 227 venlafaxine-only exposures; 54.0% were treated/released from the emergency department, 20% were admitted for medical management, 9.0% to a psychiatric facility, and 17.0% managed at home. Known medical outcomes for single-substance exposures were: no effect (24.0%), minor (39.0%), moderate (33.0%), and major (4.0%); no deaths occurred. Most frequent clinical effects were tachycardia (33.9%), drowsiness (20.7%), and agitation (11.5%). Conclusion: The prevalence of venlafaxine abuse reported to poison control centers has decreased. Medical outcomes are usually not serious. Clinicians should be aware that non-medical use is possible but infrequently reported to poison control centers.
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Affiliation(s)
- James B Leonard
- a Maryland Poison Center, Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Wendy Klein-Schwartz
- a Maryland Poison Center, Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy , Baltimore , MD , USA
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27
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Driot D, Jouanjus E, Oustric S, Dupouy J, Lapeyre-Mestre M. Patterns of gabapentin and pregabalin use and misuse: Results of a population-based cohort study in France. Br J Clin Pharmacol 2019; 85:1260-1269. [PMID: 30737829 DOI: 10.1111/bcp.13892] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of this study was to assess the use and factors associated with the misuse of gabapentin and pregabalin in the general French population, through a cohort study in the EGB (General Sample of Beneficiaries), a national representative sample of the French general population. METHODS New users of gabapentin and pregabalin were identified from June 2006 to December 2014, and new users of duloxetine served as control group. Misuse was defined as a use of higher daily doses than recommended. Cox proportional hazard regression models were performed to identify associated factors of misuse. RESULTS Misuse was more frequent in the 8692 new users of pregabalin (12.8%) than in the 1963 gabapentin (6.6%) or the 3214 duloxetine new users (9.7%) (P < 0.001). Factors associated with misuse were pregabalin (hazard ratio [HR] 1.48; 95% confidence interval [CI] [1.29-1.69]), age (HR[18-45] versus > 70 years 1.98 [1.70-2.31] and HR[58-70] versus > 70 years 1.25 [1.06-1.47]), multiple prescribers (HR2 or 3 versus 1 prescriber 1.29 [1.15-1.45]; HR4 or more versus 1 prescriber 1.54 [1.30-1.83]), cancer (1.28 [1.11-1.47]), multiple sclerosis (1.53 [1.07-2.18]), neuropathy (1.85 [1.19-2.89]), depression (1.26 [1.07-1.49]) and methadone (2.61 [1.16-5.84]). After this first episode of drug misuse, 11.6% of gabapentin and 10.7% of pregabalin misusers developed a primary addiction. CONCLUSION In a cohort of new users, misuse is more likely to occur in new users of pregabalin, with different associated factors of misuse compared to gabapentin and duloxetine. Health professionals and prescribers must be aware of this misuse potential, which could lead to abuse and dependence.
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Affiliation(s)
- Damien Driot
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Emilie Jouanjus
- Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France.,Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP), Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, France
| | - Stéphane Oustric
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Julie Dupouy
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Maryse Lapeyre-Mestre
- Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France.,Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP), Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, France.,Centre d'Investigation Clinique, 1436 Inserm CHU, CHU de Toulouse, France
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28
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Kurtz SP, Buttram ME, Margolin ZR, Wogenstahl K. The diversion of nonscheduled psychoactive prescription medications in the United States, 2002 to 2017. Pharmacoepidemiol Drug Saf 2019; 28:700-706. [DOI: 10.1002/pds.4771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 01/07/2019] [Accepted: 02/17/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Steven P. Kurtz
- Center for Applied Research on Substance Use and Health DisparitiesNova Southeastern University Miami Florida USA
| | - Mance E. Buttram
- Center for Applied Research on Substance Use and Health DisparitiesNova Southeastern University Miami Florida USA
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30
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Nichols TA, Robert S, Taber DJ, Cluver J. Alcohol withdrawal-related outcomes associated with gabapentin use in an inpatient psychiatric facility. Ment Health Clin 2019; 9:1-5. [PMID: 30627496 PMCID: PMC6322820 DOI: 10.9740/mhc.2019.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Limited evidence exists evaluating the impact of gabapentin in conjunction with benzodiazepines for the management of alcohol withdrawal. A review of outcomes associated with combination gabapentin and benzodiazepine therapy may illuminate new therapeutic uses in clinical practice. Methods This retrospective study evaluated the impact of gabapentin on as-needed use of benzodiazepines in inpatients being treated for acute alcohol withdrawal. The treatment cohort consisted of patients prescribed gabapentin while on a symptom-triggered alcohol withdrawal protocol. The control cohort consisted of patients on symptom-triggered alcohol withdrawal protocol without concurrent gabapentin use. Secondary objectives included length of hospital stay, duration on alcohol withdrawal protocol, frequency of complicated withdrawal, and use of additionally prescribed as-needed or scheduled benzodiazepines. Results The gabapentin cohort was on the alcohol withdrawal protocol for a similar duration, compared with the control cohort (median of 4 [interquartile range: 2,6] days vs 3 [2,4] days, P = .09, respectively). Similarly, the gabapentin cohort required a median of 1 [1,2] benzodiazepine dose for alcohol withdrawal symptoms compared with a median of 1 [1,2] dose in the control cohort, P = .89. No significant difference was found between cohorts for as-needed and scheduled benzodiazepine use. Length of stay in hospital was similar between groups. Discussion These results suggest that gabapentin use, in conjunction with benzodiazepines, impacts neither the time on alcohol withdrawal protocol or the number of benzodiazepine doses required for withdrawal. Larger, prospective studies are needed to detect if gabapentin alters benzodiazepine usage and to better elucidate gabapentin's role in acute alcohol withdrawal.
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Affiliation(s)
- Taylor A Nichols
- Clinical Pharmacy Specialist - Mental Health, Phoenix Veteran's Affairs Health Care System, Phoenix, Arizona,
| | - Sophie Robert
- Clinical Pharmacy Specialist - Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Research Assistant Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina; Adjunct Assistant Professor, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina
| | - David J Taber
- Associate Professor, Medical University of South Carolina Division of Transplant Surgery, Charleston, South Carolina; Clinical Pharmacy Specialist - Transplant and Research, Ralph H. Johnson Veteran's Affairs Medical Center, Medical University of South Carolina, Charleston, South Carolina
| | - Jeffrey Cluver
- Deputy Chair, Vice Chair for Education and Training, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Farrugia LA, Rhyee SH, Campleman SL, Judge B, Kao L, Pizon A, Porter L, Riederer AM, Wiegand T, Calello D, Wax PM, Brent J. The Toxicology Investigators Consortium Case Registry-the 2017 Annual Report. J Med Toxicol 2018; 14:182-211. [PMID: 30094774 DOI: 10.1007/s13181-018-0679-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
The Toxicology Investigators Consortium (ToxIC) Case Registry was established by the American College of Medical Toxicology in 2010. The Registry collects data from participating sites with the agreement that all bedside medical toxicology consultations will be entered. The objective of this eighth annual report is to summarize the Registry's 2017 data and activity with its additional 7577 cases. Cases were identified for inclusion in this report by a query of the ToxIC database for any case entered from 1 January to 31 December 2017. Detailed data was collected from these cases and aggregated to provide information which includes demographics (e.g., age, gender, race, ethnicity), reason for medical toxicology evaluation (e.g., intentional pharmaceutical exposure, envenomation, withdrawal from a substance), agent and agent class, clinical signs and symptoms (e.g., vital sign abnormalities, organ system dysfunction), treatments and antidotes administered, fatality, and life support withdrawal data. Females were involved in 50.4% of cases. Transgender demographic information collection was initiated in 2017 to better represent the population and there were 36 cases involving transgender patients. Adults aged 19-65 were the most commonly reported age group. Non-opioid analgesics were the most commonly reported agent class, with acetaminophen again the most common agent reported. There were 93 fatalities reported in 2017. Treatment interventions were frequently reported with 30.6% receiving specific antidotal therapy. Major trends in demographics and exposure characteristics remained similar to past years' reports. While treatment interventions were commonly required, fatalities were rare.
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Affiliation(s)
- Lynn A Farrugia
- Hartford Hospital and University of Connecticut School of Medicine, 80 Seymour Street, Hartford, CT, 06102, USA.
| | - Sean H Rhyee
- University of Massachusetts Medical School, 55 Lake Avenue North, LA-202, Worcester, MA, 01655, USA
| | - Sharan L Campleman
- American College of Medical Toxicolog, 10645 N. Tatum Blvd., Suite 200-111, Phoenix, AZ, 85028, USA
| | - Bryan Judge
- Spectrum Health Blodgett Hospital, 1840 Wealthy Street SE, Grand Rapids, MI, 49506, USA
| | - Louise Kao
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, 46202, USA
| | - Anthony Pizon
- University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Lauren Porter
- Banner-University Medical Center Phoenix, 925 E. McDowell Rd, Phoenix, AZ, 85006, USA
| | - Anne M Riederer
- American College of Medical Toxicolog, 10645 N. Tatum Blvd., Suite 200-111, Phoenix, AZ, 85028, USA
| | - Timothy Wiegand
- University of Rochester Medical Center and Strong Memorial Hospital, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Diane Calello
- New Jersey Medical School, Rutgers, The State University of New Jersey, 140 Bergen Street, Suite G1600, Newark, NJ, 07101-1709, USA
| | - Paul M Wax
- University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Jeffrey Brent
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
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Slavova S, Miller A, Bunn TL, White JR, Kirschke D, Light T, Christy D, Thompson G, Winecker R. Prevalence of gabapentin in drug overdose postmortem toxicology testing results. Drug Alcohol Depend 2018; 186:80-85. [PMID: 29554591 DOI: 10.1016/j.drugalcdep.2018.01.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/30/2017] [Accepted: 01/22/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The goal of this study was to establish and compare baseline data on the prevalence of gabapentin identified through postmortem toxicology testing among drug overdose decedents in several geographically diverse states/jurisdictions with differing levels of drug overdose fatality burdens in 2015. METHODS Death certificates and postmortem toxicology result reports from five U.S. jurisdictions were used to identify residents who died from drug overdoses in year 2015 and to calculate prevalence rates of gabapentin in postmortem toxicology by jurisdiction. RESULTS On average, 22% of all drug overdose decedents in our study tested positive for gabapentin. The percentage of gabapentin-positive overdose deaths varied significantly among jurisdictions: 4% in Northeast Tennessee, 7% in Maricopa County, 15% in West Virginia, 20% in North Carolina, and 41% in Kentucky (p < 0.0001). Among the drug overdose decedents who tested positive for opioids (including heroin), 26% also tested positive for gabapentin, with significant variation among states/jurisdictions (p < 0.0001). There was a significant difference in the gender distribution among drug overdose decedents who tested positive for gabapentin (46% male) vs. those who tested negative for gabapentin (65% male) (p < 0.0001). In Kentucky, gabapentin was listed as a contributing drug on the death certificate in 40% of the overdose deaths with gabapentin-positive toxicology; in North Carolina this percentage was 57%. CONCLUSIONS Routine gabapentin postmortem testing and linking of death certificate, medical examiner, coroner, toxicology, and prescription history data will provide more reliable information on the extent of gabapentin misuse, diversion, and implications for clinical care.
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Affiliation(s)
- Svetla Slavova
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA.
| | - Alison Miller
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; North Carolina Office of the Chief Medical Examiner, Raleigh, NC, USA
| | - Terry L Bunn
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; Kentucky Injury Prevention and Research Center, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Jessica R White
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; Office of Epidemiology, Maricopa County Department of Public Health, Phoenix, AZ, USA
| | - David Kirschke
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; Tennessee Department of Health, Northeast Regional Health Office, Johnson City, TN, USA
| | - Tom Light
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; West Virginia Health Statistics Center, A Unit of The West Virginia Bureau for Public Health, Department of Health and Human Resources, Charleston, WV, USA
| | - Daniel Christy
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; West Virginia Health Statistics Center, A Unit of The West Virginia Bureau for Public Health, Department of Health and Human Resources, Charleston, WV, USA
| | - Gary Thompson
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; West Virginia Health Statistics Center, A Unit of The West Virginia Bureau for Public Health, Department of Health and Human Resources, Charleston, WV, USA
| | - Ruth Winecker
- Council of State and Territorial Epidemiologists Overdose Subcommittee, USA; University of North Carolina, School of Medicine, Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA
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Treatment of Generalized Anxiety Disorder with Gabapentin. Case Rep Psychiatry 2017; 2017:6045017. [PMID: 29387502 PMCID: PMC5745655 DOI: 10.1155/2017/6045017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/14/2017] [Accepted: 11/28/2017] [Indexed: 01/03/2023] Open
Abstract
Gabapentin is frequently used in the treatment of anxiety disorders. However, there are no randomized controlled trials on the effectiveness of this medication in generalized anxiety disorder (GAD), and there are only a few case reports. We present a case of a 59-year-old female with a psychiatric history of GAD. The patient discontinued benzodiazepines after more than 7 years of daily treatment which led to rebound anxiety, benzodiazepine withdrawal symptoms, and suicidal ideation. She was psychiatrically hospitalized and started on gabapentin. Over the next 10 months of outpatient follow-up, she attempted to taper off gabapentin due to personal preference to limit medications. During this time, we observed a clear dose-response pattern of gabapentin on GAD symptoms. In the absence of controlled studies, these findings may offer important information about the effectiveness of gabapentin in GAD.
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