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Muller S, Bailey J, Bajpai R, Helliwell T, Harrisson SA, Whittle R, Mallen CD, Ashworth J. Risk of adverse outcomes during gabapentinoid therapy and factors associated with increased risk in UK primary care using the clinical practice research datalink: a cohort study. Pain 2024; 165:2282-2290. [PMID: 38662459 PMCID: PMC11404328 DOI: 10.1097/j.pain.0000000000003239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/22/2024] [Indexed: 09/18/2024]
Abstract
ABSTRACT Growing evidence from pharmacovigilance data and postmortem toxicology reports highlights the misuse potential of gabapentinoids. This study aimed to investigate the risk of serious adverse outcomes (drug misuse, overdose, major trauma), and their risk factors, in primary care patients who are prescribed gabapentinoids. Using the UK Clinical Practice Research Datalink, a matched cohort study calculated adverse event rates separately for gabapentinoid-exposed and unexposed cohorts. In the exposed cohort, event rates for exposure to a range of potential risk factors were calculated. Event rates were compared using Cox proportional hazards models, adjusted for age, sex, deprivation, previous mental health diagnosis, and coprescribing with potentially interacting medicines. Substance misuse (gabapentin adjusted hazard ratio [95% CI]: 2.40 [2.25-2.55]), overdose (2.99 [2.56-3.49]), and major trauma (0-2.5 years: 1.35 [1.28-1.42]; 2.5 to 10 years: 1.73 [1.56-1.95]) were more common among patients prescribed gabapentinoids than matched individuals who were not. The association with overdose was stronger for pregabalin than gabapentin. All adverse outcomes were significantly associated with smoking, history of substance misuse, overdose, or a mental health condition and prescription of opioids, benzodiazepines, antidepressants, and Z-drug hypnotics (eg, gabapentin hazard ratios for association of concurrent opioid use: misuse 1.49 [1.47-1.51]; overdose 1.87 [1.78-1.96]; major trauma 1.28 [1.26-1.30]). Our findings highlight the importance of careful patient selection when prescribing gabapentinoids and the need to educate prescribers about the risks of these drugs, particularly in combination with other central nervous system depressants.
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Affiliation(s)
- Sara Muller
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - James Bailey
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Ram Bajpai
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Toby Helliwell
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
- Midlands Partnership University Foundation Trust, Stafford, Staffordshire, United Kingdom
| | - Sarah A Harrisson
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
- Midlands Partnership University Foundation Trust, Stafford, Staffordshire, United Kingdom
| | - Rebecca Whittle
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Julie Ashworth
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
- Midlands Partnership University Foundation Trust, Stafford, Staffordshire, United Kingdom
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Liu RX, Song DK, Zhang YY, Gong HX, Jin YC, Wang XS, Jiang YL, Yan YX, Lu BN, Wu YM, Wang M, Li XB, Zhang K, Liu SB. L-Cysteine: A promising nutritional supplement for alleviating anxiety disorders. Neuroscience 2024; 555:213-221. [PMID: 39089569 DOI: 10.1016/j.neuroscience.2024.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
Anxiety disorders are prevalent chronic psychological disease with complex pathogenic mechanisms. Current anxiolytics have limited efficacy and numerous side effects in many anxiety patients, highlighting the urgent need for new therapies. Recent research has been focusing on nutritional supplements, particularly amino acids, as potential therapies for anxiety disorders. Among these, L-Cysteine plays a crucial role in various biological processes. L-Cysteine exhibits antioxidant properties that can enhance the antioxidant functions of the central nervous system (CNS). Furthermore, metabolites of L-cysteine, such as glutathione and hydrogen sulfide have been shown to alleviate anxiety through distinct molecular mechanisms. Long-term administration of L-Cysteine has anxiolytic, antidepressant, and memory-improving effects. L-Cysteine depletion can lead to increased oxidative stress in the brain. This review delves into the potential mechanisms of L-Cysteine and its main products, glutathione (GSH) and hydrogen sulfide (H2S) in the management of anxiety and related diseases.
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Affiliation(s)
- Rui-Xia Liu
- College of Life Sciences, Northwest University, Xi'an 710069, China; Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Da-Ke Song
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Ying-Ying Zhang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Heng-Xin Gong
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Yu-Chen Jin
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Xin-Shang Wang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Pharmacy, Fourth Military Medical University, Xi'an, 710032, China
| | - Yong-Li Jiang
- Precision Pharmacy & Drug Development Center, Department of Pharmacy, Tangdu Hospital, Fourth Military Medical University, Xinsi Road 1, Shaanxi, Xi'an 710038, China
| | - Yu-Xuan Yan
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Bei-Ning Lu
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Yu-Mei Wu
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Min Wang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Xu-Bo Li
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China
| | - Kun Zhang
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China.
| | - Shui-Bing Liu
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, Xi'an 710032, China; State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Pharmacy, Fourth Military Medical University, Xi'an, 710032, China.
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Wagner C, Montecino A. [Emerging suicidal ideation in a bipolar patient after taking pregabalin: a case report]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 39208874 DOI: 10.1055/a-2374-2182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Bipolar disorder is a severe mental illness and often occurs with comorbidities like anxiety or alcohol abuse. Thus pregabalin could be a promising drug. We present a case report of a 37-year-old woman with bipolar II disorder suffering from a depressive episode with features of anxiety and increased alcohol consumption. The patient was started on quetiapine as monotherapy. After a few days of add-on pregabalin, we observed suicidal ideations and self-harming behaviour, although expression of anxiety as well as alcohol consumption showed a decrease. When we stopped pregabalin and increased the dosage of quetiapine, suicidal behaviour almost disappeared. In the relevant literature, there is disagreement on the use of pregabalin. On the one hand, pregabalin is described as a safe and well-tolerated drug, and on the other hand, there are also concerns about the suicidal effect of anticonvulsants. In conclusion, we recommend the cautious use of pregabalin and other anticonvulsant drugs in patients with affective disorder. There could be a promising effect on the comorbidities but the effect on mood remains still unclear.
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Yang S, Huang S, Hincapie-Castillo JM, Ke X, Ding H, Sher MR, Jones B, Wilson DL, Lo-Ciganic WH. Characteristics of US Medicare Beneficiaries with Chronic Cough vs. Non-Chronic Cough: 2011-2018. J Clin Med 2024; 13:4549. [PMID: 39124815 PMCID: PMC11312945 DOI: 10.3390/jcm13154549] [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: 06/14/2024] [Revised: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Chronic cough (CC), characterized as a cough lasting >8 weeks, is a common multi-factorial syndrome in the community, especially in older adults. Methods: Using a pre-existing algorithm to identify patients with CC within the 2011-2018 Medicare beneficiaries, we examined trends in gabapentinoid use through repeated cross-sectional analyses and identified distinct utilization trajectories using group-based trajectory modeling (GBTM) in a retrospective cohort study. Individuals without CC but with any respiratory conditions related to cough served as a comparator group. Results: Among patients with CC, gabapentinoid use increased from 18.6% in 2011 to 24.1% in 2018 (p = 0.002), with a similar upward trend observed in the non-CC cohort but with overall lower usage (14.7% to 18.4%; p < 0.001). Patients with CC had significantly higher burdens of respiratory and non-respiratory comorbidities, as well as greater healthcare service and medication use compared to the non-CC cohort. The GBTM analyses identified three distinct gabapentinoid utilization trajectories for CC and non-CC patients: no use (77.3% vs. 84.5%), low use (13.9% vs. 10.3%), and high use (8.8% vs. 5.2%). Conclusions: Future studies are needed to evaluate the safety and effectiveness of gabapentinoid use in patients with refractory or unexplained CC in real-world settings.
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Affiliation(s)
- Seonkyeong Yang
- Department of Pharmaceutical Outcomes and 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 and 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
- Merck & Co., Inc., Rahway, NJ 07065, USA (H.D.)
| | - Helen Ding
- Merck & Co., Inc., Rahway, NJ 07065, USA (H.D.)
| | | | - Bobby Jones
- Department of Pharmaceutical Outcomes and 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 and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32611, USA; (S.Y.); (S.H.); (B.J.); (D.L.W.)
| | - Wei-Hsuan Lo-Ciganic
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- North Florida/South Georgia Veterans Health System Geriatric Research Education and Clinical Center, Gainesville, FL 32608, USA
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Westra J, Raji M, Baillargeon J, Aparasu RR, Kuo YF. Patterns of gabapentinoid use among long-term opioid users. Prev Med 2024; 185:108046. [PMID: 38897356 DOI: 10.1016/j.ypmed.2024.108046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Understanding the clinical and demographic profile of patients on gabapentinoids can highlight areas of prescribing disparities, inform clinical practice, and guide future research to optimize effectiveness and safety of gabapentinoids for pain management. We used a national sample of Medicare beneficiaries to examine trends, patterns, and patient-level predictors of gabapentinoid use among long-term opioid users. METHODS Using a national Medicare sample between 2014 and 2020, we examined factors associated with gabapentinoid use among long-term opioid users. We included Medicare eligible long-term opioid users with no prior gabapentinoid use. The primary outcome was gabapentinoid use after the long-term opioid use episode. Logistic regression was used to test the association with gabapentinoid use for year, age, sex, race/ethnicity, region, Medicare entitlement, low-income status, frailty, pain locations, anxiety, depression, opioid use disorder, and opioid morphine milligrams equivalent. RESULTS Gabapentinoid use among long-term opioid users increased from 12.6% in 2014 to 16.8% in 2019 (p < .0001). Factors associated with increased gabapentinoid use were Hispanic ethnicity, back pain, nerve pain, and moderate or high opioid usage. Factors associated with decreased gabapentinoid use were older age and Medicare entitlement due to old age. CONCLUSIONS Variation of gabapentinoid use by socio-demographics and insurance status indicates opportunities to improve pain management and a need for shared therapeutic decision making informed by discussion between pain patients and providers regarding safety and effectiveness of pain therapies. Our findings underscore the need for future research into the comparative effectiveness and safety of gabapentinoids for non-cancer chronic pain in various subpopulations.
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Affiliation(s)
- Jordan Westra
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Mukaila Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
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Zhang Z, Yang Q, Chen M, Yang W, Wang Y. Evaluating drug withdrawal syndrome risks through food and drug administration adverse event reporting system: a comprehensive disproportionality analysis. Front Pharmacol 2024; 15:1385651. [PMID: 39050751 PMCID: PMC11266151 DOI: 10.3389/fphar.2024.1385651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Objective The study aims to identify the drugs associated with drug withdrawal syndrome in the Food and Drug Administration Adverse Event Reporting System (FAERS) and estimate their risks of causing withdrawal syndrome. Methods All the data were collected from FAERS from the first quarter of 2004 to the third quarter of 2023. Disproportionality analyses of odds ratio (ROR) and proportional reported ratio were conducted to identify potential adverse effects signal of drug withdrawal syndrome. Results A total of 94,370 reports related to withdrawal syndrome from the data. The top 50 drugs with most frequency reported were analyzed, and 29 exhibited a positive signal based on the number of reports. The top three categories of drugs with positive signals included opioids, antidepressant drugs and antianxiety drugs. Other classifications included opioid antagonist, muscle relaxant, antiepileptic drugs, analgesics, hypnotic sedative drugs and antipsychotic drugs. Conclusion Our analysis of FAERS data yielded a comprehensive list of drugs associated with withdrawal syndrome. This information is vital for healthcare professionals, including doctors and pharmacists, as it aids in better recognition and management of withdrawal symptoms in patients undergoing treatment with these medications.
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Affiliation(s)
- Zheng Zhang
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Qianzhi Yang
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Minghao Chen
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yuping Wang
- Department of Pharmacy, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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Segebarth PB, Schallmo M, Odum S, Hietpas K, Michalek C, Chapman TM, Leas D, Milam RA, Hamid N. Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery: A Randomized Controlled Trial. Clin Spine Surg 2024; 37:138-148. [PMID: 38553433 DOI: 10.1097/bsd.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/28/2024] [Indexed: 05/07/2024]
Abstract
STUDY DESIGN Randomized controlled trial (RCT). OBJECTIVE Compare the efficacy of a multimodal, opioid-free (OF) pain management pathway with a traditional opioid-containing (OC) pathway in patients undergoing anterior cervical procedures. SUMMARY OF BACKGROUND DATA Previous studies have compared opioid-based pain regimens to opioid-sparing regimens following cervical spine surgery, but have been limited by high rates of crossover, retrospective designs, reliance on indwelling pain catheters, opioid utilization for early postoperative analgesia, and/or a lack of patient-reported outcome measures. METHODS This is a RCT in which patients were allocated to either an OF or OC perioperative pain management protocol. Eligible study participants included adult (age up to 18 y) patients who underwent primary, 1-level or 2-level anterior cervical surgery [anterior cervical discectomy and fusion (ACDF), anterior cervical disc arthroplasty (ACDA), or hybrid (ACDF and ACDA at different levels)] for degenerative pathology. The primary outcome variable was subjective pain level at 24 hours postoperative. The final study cohort consisted of 50 patients (22 OF, 28 OC). RESULTS Patients in the OF group reported lower median postoperative pain levels at 6 hours (4 for OF vs. 7 for OC; P =0.041) and 24 hours (3 for OF vs. 5 for OC; P =0.032). At 2-week and 6-week follow-up, pain levels were similar between groups. Patients in the OF group reported greater comfort at 12 hours (9 for OF vs. 5 for OC; P =0.003) and 24 hours (9 for OF vs. 5 for OC; P =0.011) postoperatively. Notably, there were no significant differences in patients' reported pain satisfaction, overall surgical satisfaction, or overall sense of physical and mental well-being. In addition, there were no significant differences in falls, delirium, or constipation postoperatively. CONCLUSIONS A multimodal OF pain management pathway following anterior cervical surgery for degenerative disease results in statistically noninferior pain control and equivalent patient-reported outcome measures compared with a traditional OC pathway.
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Benassayag Kaduri N, Dressler R, Abu Ahmad W, Rotshild V. Trends in Pregabalin Use and Prescribing Patterns in the Adult Population: A 10-Year Pharmacoepidemiologic Study. CNS Drugs 2024; 38:153-162. [PMID: 38273137 PMCID: PMC10881619 DOI: 10.1007/s40263-024-01064-5] [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] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Pregabalin is steadily gaining popularity worldwide, with epidemiological studies indicating an increase in labeled, off-labeled, and recreational uses. In Israel, pregabalin prescriptions are not regulated by the controlled substances legislations, prompting a need to examine its usage trends for potential policy adjustments. The objective of this study was to assess trends in pregabalin prescribing during a 10-year period, to characterize demographic and clinical characteristics of individuals prescribed pregabalin, and to identify risk factors associated with high-intensity pregabalin use. METHODS This retrospective, longitudinal study examined trends in pregabalin prescribing from 2010 to 2019 based on data extracted from the Clalit Health Services (CHS) electronic database. Annual pregabalin prescribing rate was calculated individually for each reporting year. A univariable analysis was conducted to compare the demographic and clinical characteristics of pregabalin users in 2019 with those in 2010. Multivariable regression analysis was performed to assess dose-related patterns by specific demographic and clinical characteristics. RESULTS Pregabalin prescription rate more than doubled over 10 years [odds ratio (OR) 2.3, p = 0.001], reaching 7.2 [95% confidence interval (CI) 7.18-7.28] prescriptions per 100 CHS members in 2019. The highest prescription rates were observed among the elderly population (13.2 and 24.1 prescriptions per 100 CHS members for those aged 55-74 and over 75 years old, respectively). Same-year administration of pregabalin with opioids, benzodiazepines, and Z-drugs was common; however, the percentage of patients using these drugs together declined in 2019 compared with 2010 (p < 0.001). Males, patients with low socioeconomic status, patients aged 35-54 years, and those who consumed opioids, benzodiazepines, and Z-drugs received higher pregabalin doses. CONCLUSION Pregabalin use has increased significantly in the Israeli adult-based CHS population, consistent with worldwide data. A growing use over time may indicate overprescription. More studies are needed on misuse patterns to identify populations most susceptible to high-dose and high-intensity pregabalin use.
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Affiliation(s)
- Nofar Benassayag Kaduri
- Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Reuven Dressler
- Jerusalem District, Clalit Health Services, Jerusalem, Israel
| | - Wiessam Abu Ahmad
- School of Public Health, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Victoria Rotshild
- Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
- Jerusalem District, Clalit Health Services, Jerusalem, Israel
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Nakajima-Ohyama KC, Shizusawa Y, Uchiyama S, Kishi Y, Tanimukai H. Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study. J NIPPON MED SCH 2024; 91:233-240. [PMID: 38777784 DOI: 10.1272/jnms.jnms.2024_91-214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. METHODS We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. RESULTS The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus. CONCLUSIONS GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.
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Affiliation(s)
- Kakusho Chigusa Nakajima-Ohyama
- Department of Neuropsychiatry, Nippon Medical School Musashi Kosugi Hospital
- Department of Neuropsychiatry, Ikeda Municipal Hospital
| | - Yoshie Shizusawa
- Department of Palliative Medicine, Ikeda Municipal Hospital
- Department of Palliative Medicine, Osaka Gyoumeikan Hospital
| | - Shotaro Uchiyama
- Department of Neuropsychiatry, Nippon Medical School Musashi Kosugi Hospital
| | - Yasuhiro Kishi
- Department of Neuropsychiatry, Nippon Medical School Musashi Kosugi Hospital
| | - Hitoshi Tanimukai
- School of Human Health Sciences, Graduate School of Medicine, Kyoto University
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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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Al-jedai A, Alkofide H, Almohimeed L, Alsalim L, Alruwaili A, Alissa DA, Almudaiheem H. The impact of a restricted pregabalin prescription policy on drug utilization: An observational multicenter study. Saudi Pharm J 2023; 31:101851. [PMID: 38028223 PMCID: PMC10665920 DOI: 10.1016/j.jsps.2023.101851] [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] [Received: 07/08/2022] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Saudi Food and Drug Authority (SFDA) classified pregabalin as a controlled substance in 2018; however, whether this policy change has affected pregabalin use is unclear. This study examined the trends in pregabalin prescriptions before and after the SFDA restriction. In addition, the co-prescription of controlled analgesics and the use of pregabalin for approved indications were also evaluated. Method A cross-sectional study was conducted on outpatient pregabalin prescriptions from three healthcare centers in Saudi Arabia. Interrupted time series analysis was used to assess changes over time in pregabalin prescriptions and the number of patients receiving pregabalin. June 2016 to June 2017 was identified as the pre-restriction period, and July 2018 to July 2019 as the post-restriction period. Results In this study, 77,760 pregabalin prescriptions were identified. There were 9,076 patients on pregabalin in the pre-restriction period with 16,875 prescriptions, compared with 7,123 patients and 19,484 prescriptions post-restriction. The total number of pregabalin users decreased by 21.5% post-restriction, and prescriptions increased by 15.5%. There was no significant change in the monthly trends in pregabalin prescriptions before and after the restriction. However, the of tramadol and acetaminophen/codeine prescriptions in patients who were using pregabalin increased in the post-restriction period by 21% and 16.1%, respectively. Conclusion Pregabalin use was reduced after the SFDA-enforced prescription restriction was implemented. This was accompanied by increased narcotics use in the post-implementation phase.
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Affiliation(s)
- Ahmed Al-jedai
- Ministry of Health Deputy of Therapeutic Affairs, Riyadh, Saudi Arabia
- Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Drug Regulation Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lujaine Almohimeed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lama Alsalim
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Dema A. Alissa
- Ministry of Health Deputy of Therapeutic Affairs, Riyadh, Saudi Arabia
- Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia
| | - Hajer Almudaiheem
- Ministry of Health Deputy of Therapeutic Affairs, Riyadh, Saudi Arabia
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12
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Awasthi H, Vohra A. Delirium following pregabalin discontinuation in an individual with no psychiatric or substance use history. BMJ Case Rep 2023; 16:e258104. [PMID: 37977830 PMCID: PMC10660150 DOI: 10.1136/bcr-2023-258104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
We report about a man in his mid-50s who was prescribed pregabalin (150 mg/day) for neuropathic pain due to a herniated intervertebral disc. Four weeks later, he presented to the emergency room with symptoms consistent with delirium. After ruling out acute intoxication with a substance and neurological causes, collateral information from the family and review of his medical chart indicated potential discontinuation syndrome owing to pregabalin. Following the successful treatment and resolution of delirium, the patient revealed he had been consistently consuming pregabalin doses upwards of 2 g/day over the past 2 weeks, leading to the premature exhaustion of his prescription and an abrupt cessation. The case findings underscore the necessity for physicians to recognise the potential for pregabalin misuse and the associated withdrawal risks, including delirium.
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Affiliation(s)
- Harshal Awasthi
- Addiction Psychiatry, Matra Chhaya Medical Centre, Kanpur, Uttar Pradesh, India
- Interior Health Authority - East Kootenay, Cranbrook, British Columbia, Canada
| | - Abhimanyu Vohra
- Addiction Medicine, Matra Chhaya Medical Centre, Kanpur, India
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13
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Rosenqvist TW, Osler M, Wium-Andersen MK, Wium-Andersen IK. Sedative drug-use in Denmark, 2000 to 2019: a nationwide drug utilization study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1493-1502. [PMID: 36562827 DOI: 10.1007/s00127-022-02409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
AIM To describe trends in and characteristics of sedative drug use from 2000 through 2019 in relation to the introduction of central regulations and new drugs. METHODS In this descriptive study, we used individual prescription data on the entire Danish population from the Danish National Prescription Registry to calculate yearly incidence and prevalence of use of benzodiazepines, benzodiazepine-related drugs (Z-drugs), melatonin, olanzapine, low-dose quetiapine, mianserin/mirtazapine, pregabalin, and promethazine from 2000 through 2019. From the Danish National Patient Registry, we obtained data on drug users' psychiatric and somatic comorbidity. RESULTS The use of benzodiazepines and Z-drugs declined gradually from 2000 through 2019, whereas the newer alternatives, melatonin, low-dose quetiapine, pregabalin and promethazine, increased in use, while the use of olanzapine and mianserin/mirtazapine was relatively stable. This development was seen in both men and women and across all age groups except for hypnotic benzodiazepines which showed a steep increase in the oldest age group from 2010. For all sedative drugs depression, anxiety, alcohol and misuse disorder, pain and cancer were the most prevalent comorbidities. During our study period, the number of individuals without any of the selected diagnoses increased. CONCLUSION In Denmark different central regulations have influenced prescription practice toward more restrictive use of Z-drugs and benzodiazepines, except for hypnotic benzodiazepine prescriptions increased after the introduction of special palliative care. An increase in use of newer sedative drugs, however, indicates that the regulations do not remove the need for sedative drugs in the population.
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Affiliation(s)
- Thomas Wolff Rosenqvist
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Ida Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
- Psychiatric Centre Copenhagen, Dept. O, Rigshospital, Edel Sauntes Allé 10, 2100, Copenhagen Ø, Denmark
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14
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Dold M, Bartova L, Volz HP, Seifritz E, Möller HJ, Schläfke S, Kasper S. Efficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2023; 273:1615-1628. [PMID: 36717399 PMCID: PMC10465640 DOI: 10.1007/s00406-022-01547-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION We report on a meta-analysis of Silexan, a proprietary active substance produced from Lavandula angustifolia, in subthreshold anxiety, mixed anxiety and depressive disorder (MADD), and generalized anxiety disorder (GAD). METHODS The present analyses are based on all currently completed 5 double-blind, randomized, placebo-controlled trials investigating Silexan in adult out-patients who received Silexan 1 × 80 mg/day or placebo for ten weeks according to random assignment (n = 1213). Efficacy was assessed based on the Hamilton Anxiety Rating Scale (HAMA), several anxiety self-rating scales, the Clinical Global Impression (CGI) scale, and the Short Form-36 (SF-36) health status questionnaire. RESULTS After ten weeks' treatment, Silexan was significantly superior to placebo in reducing the HAMA total score (including the psychic and somatic anxiety sub-scores) and self-rated anxiety. Based on a ≥ 50% HAMA total score reduction, the responder rate ratio was 1.34 favoring Silexan, and the rate ratio of subjects much or very much improved according to the CGI was 1.51. Silexan was also significantly superior in improving the physical and mental health summary scores of the SF-36. There were no significant between-group differences concerning the occurrence of adverse events (AEs), serious AEs, and premature withdrawal due to AEs. CONCLUSIONS This meta-analysis demonstrates that Silexan exerts significant anxiolytic effects in subthreshold anxiety, GAD and MADD that were consistently reflected in investigator ratings and patient-reported outcomes, including improvement of health-related life-quality, while showing favorable tolerability and safety.
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Affiliation(s)
- Markus Dold
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lucie Bartova
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Balthasar-Neumann-Platz 1, 97440, Werneck, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Sandra Schläfke
- Dr. Willmar Schwabe GmbH & Co. KG, Willmar-Schwabe-Straße 4, 76227, Karlsruhe, Germany
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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15
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McNeilage AG, Nielsen S, Murnion B, Ashton-James C. Experiences of misuse and symptoms of dependence among people who use gabapentinoids: a qualitative systematic review protocol. BMJ Open 2023; 13:e073770. [PMID: 37775298 PMCID: PMC10546131 DOI: 10.1136/bmjopen-2023-073770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Gabapentinoids are among the most widely prescribed pain medications. However, there is growing evidence to suggest that gabapentinoids may be associated with dependence and misuse. The aim of this systematic review is to synthesise the qualitative literature on gabapentinoid misuse and symptoms of dependence. The findings of this study will inform efforts to mitigate emerging harms. METHODS AND ANALYSIS A systematic review of qualitative research will explore lived experiences of misuse and symptoms of dependence among people who use gabapentinoids. Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE and PsycINFO) and grey literature sources will be searched from inception to May 2023. Qualitative studies that include people with lived experiences of gabapentinoid misuse and symptoms of gabapentinoid dependence will be included. Reference lists of included studies will also be screened for additional studies. The methodological quality of included studies will be appraised using the Critical Appraisal Skills Programme qualitative checklist, and higher quality studies will be prioritised in the thematic synthesis. The GRADE-CERQual approach will be used to assess confidence in the overall findings of the review. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The findings of this review will be disseminated in peer-reviewed journals, at conferences and on social media. PROSPERO REGISTRATION NUMBER CRD42023401832.
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Affiliation(s)
- Amy Gray McNeilage
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Bridin Murnion
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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16
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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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17
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Polat CS, Konak HE, Akıncı MG, Onat SS, Altas EU. Misuse of gabapentinoids (pregabalin and gabapentin) in patients with neuropathic pain related to spinal cord injury. J Spinal Cord Med 2023; 46:859-864. [PMID: 35108174 PMCID: PMC10446779 DOI: 10.1080/10790268.2021.2024709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate the misuse of gabapentinoids (pregabalin and gabapentin) in patients with neuropathic pain related to spinal cord injury. STUDY DESIGN Cross-sectional study. SETTING Outpatient clinic in a physical therapy and rehabilitation hospital. PARTICIPANTS 127 patients, aged 18-70 years, who had neuropathic pain related to spinal cord injury (SCI) and disease duration of at least 12 months. OUTCOME MEASURES Gabapentinoid use disorder of the patients was determined based on the DSM-5 diagnostic criteria for substance-related disorders. Patients were divided into 2 groups as those with drug misuse and those without drug misuse. Demographic and clinical information of the patients were compared between the groups. Factors associated with drug misuse were analyzed. RESULTS The misuse rate was 81.9% in patients using pregabalin and 69.69% in patients using gabapentin. Duration of disease and the Leeds assessment of neuropathic symptoms and signs (LANSS) score were statistically significantly higher in the drug misuse group. A statistically significant difference was found between the groups in terms of marital status, education and income level, and smoking and alcohol use. A statistically significant relationship was observed between drug misuse and duration of disease and LANSS score. CONCLUSION Misuse of gabapentinoids is prevalent in patients with neuropathic pain related to spinal cord injury. The duration of disease and the severity of NP are associated with misuse. Clinicians should exercise caution when prescribing gabapentinoids to patients with SCI.
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Affiliation(s)
- Cemile Sevgi Polat
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Hatice Ecem Konak
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Meltem Günes Akıncı
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sule Sahin Onat
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Elif Umay Altas
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
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18
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Chan AYL, Yuen ASC, Tsai DHT, Lau WCY, Jani YH, Hsia Y, Osborn DPJ, Hayes JF, Besag FMC, Lai ECC, Wei L, Taxis K, Wong ICK, Man KKC. Gabapentinoid consumption in 65 countries and regions from 2008 to 2018: a longitudinal trend study. Nat Commun 2023; 14:5005. [PMID: 37591833 PMCID: PMC10435503 DOI: 10.1038/s41467-023-40637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
Recent studies raised concerns about the increasing use of gabapentinoids in different countries. With their potential for misuse and addiction, understanding the global consumption of gabapentinoids will offer us a platform to examine the need for any interventional policies. This longitudinal trend study utilised pharmaceutical sales data from 65 countries and regions across the world to evaluate the global trends in gabapentinoid consumption between 2008-2018. The multinational average annual percentage change of gabapentinoid consumption was +17.20%, increased from 4.17 defined daily dose per ten thousand inhabitants per day (DDD/TID) in 2008 to 18.26 DDD/TID in 2018. High-income countries had the highest pooled gabapentinoid consumption rate (39.92 DDD/TID) in 2018, which was more than six times higher than the lower-middle income countries (6.11 DDD/TID). The study shows that despite differences in healthcare system and culture, a consistent increase in gabapentinoid consumption is observed worldwide, with high-income countries remaining the largest consumers.
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Affiliation(s)
- Adrienne Y L Chan
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, 72 9700, Groningen, The Netherlands
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Andrew S C Yuen
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Daniel H T Tsai
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, SW17 0RE, UK
- School of Pharamcy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wallis C Y Lau
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Yogini H Jani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Yingfen Hsia
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, SW17 0RE, UK
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - David P J Osborn
- Division of Psychiatry, University College London, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London, NW1 0PE, UK
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London, NW1 0PE, UK
| | - Frank M C Besag
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- East London Foundation NHS Trust, Bedfordshire, MK40 3JT, UK
| | - Edward C C Lai
- School of Pharamcy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, 72 9700, Groningen, The Netherlands
| | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK.
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK.
- Aston School of Pharmacy, Aston University, Birmingham, B4 7ET, UK.
| | - Kenneth K C Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK.
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK.
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Thompson I, Gadsby Z, Martin J, Thompson M, Tse R. Gabapentinoid detection in coronial casework in Gold Coast, Australia: a 5-year retrospective study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00694-3. [PMID: 37578626 DOI: 10.1007/s12024-023-00694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Gabapentinoids is a class of drug with analgesic, anxiolytic, and anticonvulsant properties and has a reported increase in prescription, use, and adverse outcomes. Regional studies are scant, and postmortem toxicological data may characterise patterns of regional use and inform local interventions. Characterising drug and non-drug-related deaths with gabapentinoid detection may also aid in toxicology interpretation. A 5-year retrospective study on all deaths admitted to the Gold Coast University Hospital under where toxicological analysis was performed. Of the gabapentinoids, only pregabalin was detected over the study period, and annual rates of detection did not differ significantly over the period (7.4-12.4%). In cases where pregabalin was detected, it was 15 times more likely to be a drug-related death. Drug-related deaths where pregabalin was detected have higher levels of pregabalin, are younger, and had a greater proportion of concurrent opioid detection. Postmortem detection of pregabalin was associated with drug-related deaths. Higher levels, younger decedents, and concurrent use of opioids were found in drug-related deaths. Public health interventions and regulated prescribing to target concurrent pregabalin and opioid use may address the burden of pregabalin drug-related deaths.
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Affiliation(s)
| | - Zeena Gadsby
- Griffith University School of Medicine, Southport, QLD, Australia
| | - Jeremy Martin
- Griffith University School of Medicine, Southport, QLD, Australia
| | - Melissa Thompson
- Forensic and Scientific Services, Health Support Queensland, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, Australia
| | - Rexson Tse
- Griffith University School of Medicine, Southport, QLD, Australia.
- Forensic and Scientific Services, Health Support Queensland, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, Australia.
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20
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Powell D, Shetty KD, Peet ED. Trends in overdose deaths involving gabapentinoids and Z-drugs in the United States. Drug Alcohol Depend 2023; 249:109952. [PMID: 37301069 PMCID: PMC10332434 DOI: 10.1016/j.drugalcdep.2023.109952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/10/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION As policies have been implemented to limit access to prescription opioids, other drugs have been prescribed off-label, sometimes concurrently with opioids, to manage pain. There are concerns about the use of gabapentinoids and "Z-drugs" with opioids. As the opioid crisis transitions to illicit opioids and polysubstance use, little work quantifies the concurrent involvement of non-opioid prescription drugs and illicit opioids in overdose deaths. METHODS Data from the census of deaths in the United States for 1999-2020 were used to understand trends in deaths involving gabapentinoids/Z-drugs and opioid co-involvement. These trends were studied overall and by sex, race, age, and education. RESULTS Per capita overdose deaths involving gabapentinoids/Z-drugs increased almost continuously since 1999, averaging 15.8% annual growth. This rate increased to 32% in 2020, primarily due to overdoses involving synthetic opioids. Women typically had higher rates of overdose deaths involving both opioids and gabapentinoids/Z-drugs, though this disparity disappeared in 2020. White Americans and American Indians/Alaskan Natives historically had higher rates than other racial groups; however, Black Americans experienced over 60% annual growth in recent years. Low education groups have been disproportionately impacted. The age incidence tends to be older than overdoses involving opioids more generally. CONCLUSION Overdose deaths involving opioids and gabapentinoids/Z-drugs have tended to disproportionately affect women and older age groups compared to all opioid-involved overdoses. As deaths involving synthetic opioids likely reflect use of illicitly-obtained opioids, there may be less of a role for policies targeting the concurrent prescribing of gabapentinoids/Z-drugs with opioids to reduce these deaths.
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Affiliation(s)
- David Powell
- RAND, 1200 S. Hayes St, Arlington, VA22202, United States.
| | | | - Evan D Peet
- RAND, 4570 Fifth Ave, Pittsburgh, PA15213, United States
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Vasudeva A, Tripathi R. Pregabalin Dependence and Management in a 55-Year-Old Female with Chronic Low Back Pain. Cureus 2023; 15:e44085. [PMID: 37750123 PMCID: PMC10518057 DOI: 10.7759/cureus.44085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
This case report explores the complexities of managing chronic pain and the subsequent development of pregabalin dependence in a 55-year-old female patient with a prior history of vertebral fracture. Over a period of 10 years, the patient relied on a combination of Aceclofenac and pregabalin to alleviate her pain. An alternative treatment approach was implemented, involving adjustments to medication dosages and gradual tapering. Throughout the treatment process, interdisciplinary collaboration played a pivotal role in addressing unexpected symptoms such as facial movements and neck swelling. This case report highlights the significance of recognizing and addressing pregabalin dependence in patients with chronic pain.
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Affiliation(s)
- Abhimanyu Vasudeva
- Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
| | - Richa Tripathi
- Psychiatry, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, IND
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Servais L, Huberland V, Richelle L. Misuse of Pregabalin: a qualitative study from a patient's perspective. BMC Public Health 2023; 23:1339. [PMID: 37438829 DOI: 10.1186/s12889-023-16051-6] [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: 12/21/2022] [Accepted: 06/05/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION The misuse of Pregabalin has been the subject of growing concern for several years. The effects sought are multiple and it is rarely taken as a single drug. It is most frequently used together with opioids, which may increase the risk of fatal overdose. In response to this emerging phenomenon, we seek to better understand the situation of misuse in Belgium and identify the people involved in it. METHODOLOGY A qualitative study using semi-structured interviews with 20 participants who misuse Pregabalin was conducted throughout the French-speaking region of Belgium between August 2021 and January 2022. Recruitment mostly took place in addictions centers, shelters for migrants and homeless persons and primary care centers. We then conducted a thematic analysis with the help of Nvivo software. RESULTS A profile emerged, of young male users, immigrants, mainly first generation immigrants coming from North Africa. They had in common a challenging or even traumatic migration pathway and precarious living conditions in Belgian territory. Most of them had no stable income. They saw Pregabalin as enabling them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they had apparently not recieved adequate medical care. This seemed to lead many of them to use Pregabalin as self-medication, for anxiety-depressive disorders and chronic pain, and it was sometimes initiated in their home country. Pregabalin was never used alone. CONCLUSION This study has highlighted a rare and insufficient documented profile of Pregabalin misuse: self-medication among a group of first generation immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.
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Affiliation(s)
- Louise Servais
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium.
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium.
| | - Vincent Huberland
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
| | - Lou Richelle
- Unité de Recherche en Soins Primaires ULB, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
- Département de Médecine Générale, Faculty of Medicine, Université Libre de Bruxelles, Route de Lennik 808, Brussels, CP 612 1070, Belgium
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Powell D, Peet ED, Pacula RL. Understanding the rise in overdose deaths involving opioids and non-opioid prescription drugs in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104104. [PMID: 37422359 PMCID: PMC10770297 DOI: 10.1016/j.drugpo.2023.104104] [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: 01/11/2023] [Revised: 04/11/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Previous studies demonstrate that the reformulation of OxyContin in the U.S. in 2010 induced substitution to illicit opioids, causing illicit opioid markets to grow disproportionately fast in states more exposed to the reformulation. In this paper, we examine if this shift to the illicit market also led to a rise in polysubstance overdose deaths involving non-opioid prescription drugs, including gabapentinoids and "Z-drugs" and, separately, benzodiazepines. METHODS Using a difference-in-differences framework, the relationship between exposure to reformulation and overdose death rates including specific substances was studied in each year from 1999 to 2020 while accounting for fixed differences across states, common nationwide shocks, and state-level differences in pain reliever misuse prior to reformulation. Exposure to reformulation was measured as the pre-reformulation rate of OxyContin misuse. RESULTS Exposure to reformulation predicted growth in overdose deaths involving gabapentinoids and Z-drugs. There is less evidence that it predicted growth in overdose deaths involving benzodiazepines. However, for all substances, there is strong evidence that pre-reformulation OxyContin misuse rates predicted post-reformulation growth in overdose deaths concurrently involving synthetic opioids. DISCUSSION The opioid crisis has changed in radical ways. This study links a major supply-side intervention to the increase in polysubstance overdose deaths involving non-opioid prescription drugs, specifically gabapentinoids and Z-drugs.
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Affiliation(s)
- David Powell
- RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202 USA.
| | - Evan D Peet
- RAND Corporation, 4570 Fifth Ave, Pittsburgh, PA 15213 USA
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Bas JL, Bas P, Bonilla F, Mariscal G, Pérez S, Bovea-Marco M, Rubio-Belmar PA, Bas T. Efficacy of perioperative gabapentin use in patients with idiopathic scoliosis undergoing fusion surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2521-2532. [PMID: 37209210 DOI: 10.1007/s00586-023-07764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/03/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE This study aimed to assess whether the perioperative use of gabapentin was associated with decreased opioid use. METHODS A meta-analysis was performed using PubMed, Embase, Scopus, and Cochrane Library. The randomized clinical trials included were focused on patients with adolescent idiopathic scoliosis who underwent posterior fusion surgery and were treated with gabapentin versus placebo medicine. The primary outcomes were opioid consumption at 24, 48, 72, and 96 h; time to introduction of oral medication, length of hospital stay, and period of urinary catheterization were also recorded. Data were combined using the Review Manager 5.4 software. RESULTS Four randomized clinical trials with a pool of 196 adolescent patients (mean age: 14.8 ± 2.0 years) were included. At 24 and 48 h after surgery, opioid consumption was significantly lower in the gabapentin group: (standardized mean difference [SMD]: -0.50; 95% confidence interval [CI] - 0.79 to - 0.22) and (SMD: - 0.59; 95% CI - 0.88 to - 0.30), respectively. At 72 and 96 h, there were no significant differences between studies: (SMD: - 0.19; 95% CI - 0.52 to 0.13) and (SMD: 0.12; 95% CI - 0.25 to 0.50), respectively. Regarding the administration type, there were significant differences in favor of the 15 mg/kg subgroup with 600 mg at 48 h (SMD: - 0.69; 95% CI - 1.08 to - 0.30). There were no significant differences concerning the time to introduction of oral medication (MD: - 0.08; 95% CI - 0.39 to 0.23), hospitalization time (MD: - 0.12; 95% CI - 0.40 to 0.16), or period of urinary catheterization (SMD: - 0.27; 95% CI - 0.58 to 0.05). CONCLUSIONS Gabapentin decreased opioid consumption during the first 48 h. Doses of 15 mg/kg showed superiority in reducing opioid consumption in the first 48 h. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Jose Luis Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Paloma Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Fernando Bonilla
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Gonzalo Mariscal
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Silvia Pérez
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miquel Bovea-Marco
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pedro Antonio Rubio-Belmar
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Teresa Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Lesnak JB, Nakhla DS, Plumb AN, McMillan A, Saha S, Gupta N, Xu Y, Phruttiwanichakun P, Rasmussen L, Meyerholz DK, Salem AK, Sluka KA. Selective androgen receptor modulator microparticle formulation reverses muscle hyperalgesia in a mouse model of widespread muscle pain. Pain 2023; 164:1512-1523. [PMID: 36508167 PMCID: PMC10250561 DOI: 10.1097/j.pain.0000000000002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
ABSTRACT Chronic pain is a significant health problem associated with disability and reduced quality of life. Current management of chronic pain is inadequate with only modest effects of pharmacological interventions. Thus, there is a need for the generation of analgesics for treating chronic pain. Although preclinical and clinical studies demonstrate the analgesic effects of testosterone, clinical use of testosterone is limited by adverse androgenic effects. Selective androgen receptor modulators (SARMs) activate androgen receptors and overcome treatment limitations by minimizing androgenic side effects. Thus, we tested whether daily soluble SARMs or a SARM-loaded microparticle formulation alleviated muscle hyperalgesia in a mouse-model of widespread pain (male and female C57BL/6J mice). We tested whether the analgesic effects of the SARM-loaded microparticle formulation was mediated through androgen receptors by blocking androgen receptors with flutamide pellets. In vitro and in vivo release kinetics were determined for SARM-loaded microparticles. Safety and toxicity of SARM treatment was determined using serum cardiac and liver toxicity panels, heart histology, and conditioned place preference testing. Subcutaneous daily SARM administration, and 2 injections, 1 week apart, of SARM-loaded microparticles alleviated muscle hyperalgesia in both sexes and was prevented with flutamide treatment. Sustained release of SARM, from the microparticle formulation, was observed both in vitro and in vivo for 4 weeks. Selective androgen receptor modulator treatment produced no cardiac or liver toxicity and did not produce rewarding behaviors. These studies demonstrate that SARM-loaded microparticles, which release drug for a sustained period, alleviate muscle pain, are safe, and may serve as a potential therapeutic for chronic muscle pain.
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Affiliation(s)
- Joseph B. Lesnak
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
| | - David S. Nakhla
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Ashley N. Plumb
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
| | - Alexandra McMillan
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
- Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sanjib Saha
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Nikesh Gupta
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Yan Xu
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Pornpoj Phruttiwanichakun
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Lynn Rasmussen
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
| | | | - Aliasger K. Salem
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa; Iowa City, IA
| | - Kathleen A. Sluka
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa; Iowa City, IA
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Kwaśny A, Włodarczyk A, Dywel A, Szarmach J, Strandberg O, Cubała WJ. Residual insomnia in major depressive disorder: a systematic review. Front Psychiatry 2023; 14:1190415. [PMID: 37398584 PMCID: PMC10312086 DOI: 10.3389/fpsyt.2023.1190415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The ultimate goal in major depressive disorder (MDD) treatment is recovery. A proportion of MDD patients with formal remission experience persistent difficulties, which impair their daily functioning. Residual insomnia is one of the most common residual symptoms. Patients with residual insomnia experience relapse significantly earlier and have a poor prognosis. Little is known about possible ways of treatment and what subtype of insomnia is mostly reported. Methods A systematic literature review was carried out in PubMed and Web of Science to synthesize the current status of knowledge about effective treatment methods and insomnia subtypes in residual insomnia in MDD. Results A few non-pharmacological treatment methods e.g., Cognitive Behavioral Therapy for Insomnia (CBT-I), Mindfulness-Based Cognitive Therapy (MBCT), behavioral activation (BA) and pharmacological methods (gabapentin, clonazepam) have proven to mitigate residual insomnia. Cognitive Behavioral Therapy for Depression (CBT-D) ameliorates insomnia complaints to a limited extent. Mid-nocturnal insomnia is the most common residual insomnia subtype in MDD patients. Conclusion Residual insomnia is a very common complaint and most often appears as mid-nocturnal insomnia. Scarce data points out the benefits from pharmacotherapy, psychotherapy, and BA. More research is needed.
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Kulig CE, Hooda Z, Lebow E, Cerda L, Zaku B. Acute withdrawal in the postoperative setting in a patient taking standard therapeutic doses of pregabalin. J Surg Case Rep 2023; 2023:rjad375. [PMID: 37388509 PMCID: PMC10299905 DOI: 10.1093/jscr/rjad375] [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: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
Pregabalin is a gamma-aminobutyric acid analog that binds to voltage-gated calcium channels within the central nervous tissues, inhibiting the release of many excitatory neurotransmitters. It is used to treat various conditions including postherpetic neuralgia and diabetic peripheral neuropathy. Recently, its use has increased as part of non-opioid pain management algorithms. Prolonged use in high doses of pregabalin is associated with physical dependency and abuse, which can be seen when the medication is abruptly stopped. This phenomenon has been seen in studies focused on patients having abused or grown dependent on pregabalin. However, this has not been documented in patients taking therapeutic levels in the perioperative setting. This case report highlights a patient who experienced acute withdrawal symptoms of pregabalin after coronary artery bypass and aortic root enlargement.
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Affiliation(s)
- Caitlin E Kulig
- St. Joseph’s University Medical Center, Paterson, NJ, USA
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Zamaan Hooda
- Correspondence address. Tel: 847-525-2312; Fax: 973-754-3599; E-mail:
| | - Elissa Lebow
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Luis Cerda
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Bledi Zaku
- St. Joseph’s University Medical Center, Paterson, NJ, USA
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Huang YH, Pan MH, Yang HI. The association between Gabapentin or Pregabalin use and the risk of dementia: an analysis of the National Health Insurance Research Database in Taiwan. Front Pharmacol 2023; 14:1128601. [PMID: 37324474 PMCID: PMC10266423 DOI: 10.3389/fphar.2023.1128601] [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: 12/20/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
Objective: Previous studies have shown that gabapentin or pregabalin use is associated with cognitive decline. Herein, we aimed to evaluate the association between gabapentin or pregabalin use and the risk of dementia. Methods: In this retrospective, population-based matched cohort study, all research data were collected from the 2005 Longitudinal Health Insurance Database, which contains data of 2 million people randomly selected from the National Health Insurance Research Database of Taiwan in 2005. The study extracted data from 1 January 2000, to 31 December 2017. Adult patients taking gabapentin or pregabalin were included in the exposure group, and patients not using gabapentin or pregabalin matched to exposure subjects in a 1:5 ratio by propensity scores composed of age, sex and index date were included in the non-exposure group. Results: A total of 206,802 patients were enrolled in the study. Of them, 34,467 gabapentin- or pregabalin-exposure and 172,335 non-exposure patients were used for analysis. The mean follow-up day (±standard deviation) after the index date was 1724.76 (±1282.32) and 1881.45 (±1303.69) in the exposure and non-exposure groups, respectively; the incidence rates of dementia were 980.60 and 605.48 per 100,000 person-years, respectively. The multivariate-adjusted hazard ratio of risk of dementia for gabapentin or pregabalin exposure versus the matched non-exposed group was 1.45 (95% confidence interval [CI], 1.36-1.55). The risk of dementia increased with higher cumulative defined daily doses during the follow-up period. Moreover, the stratification analysis revealed that the risk of dementia associated with gabapentin or pregabalin exposure was significant in all age subgroups; however, it was higher in younger patients (age <50) than in the older patients (hazard ratio, 3.16; 95% CI, 2.23-4.47). Conclusion: Patients treated with gabapentin or pregabalin had an increased risk of dementia. Therefore, these drugs should be used with caution, particularly in susceptible individuals.
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Affiliation(s)
- Yu-Hua Huang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- College of Medicine, Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Mei-Hung Pan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Hwai-I Yang
- College of Medicine, Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Graduate Institue of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Biomedical Translation Research Center, Academia Sinica, Taipei, Taiwan
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Fagan HA, Baldwin DS. Pharmacological Treatment of Generalised Anxiety Disorder: Current Practice and Future Directions. Expert Rev Neurother 2023:1-14. [PMID: 37183813 DOI: 10.1080/14737175.2023.2211767] [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: 05/16/2023]
Abstract
INTRODUCTION Generalized Anxiety Disorder (GAD) is a common psychiatric condition, characterized by the presence of general apprehensiveness and excessive worry. Current management consists of a range of pharmacological and psychological treatments. However, many patients do not respond to first-line pharmacological treatments and novel anxiolytic drugs are being developed. AREAS COVERED In this review, the authors first discuss the diagnostic criteria and epidemiology of GAD. The effective pharmacological treatments for GAD and their tolerability are addressed. Current consensus guidelines for treatment of GAD are discussed, and maintenance treatment, the management of treatment resistance, and specific management of older adults and children/adolescents are considered. Finally, novel anxiolytics under development are discussed, with a focus on those which have entered clinical trials. EXPERT OPINION A range of effective treatments for GAD are available, particularly duloxetine, escitalopram, pregabalin, quetiapine, and venlafaxine. There is a limited evidence base to support the further pharmacological management of patients with GAD who have not responded to initial treatment. Although many novel anxiolytics have progressed to clinical trials, translation from animal models has been mostly unsuccessful. However, the potential of several compounds including certain psychedelics, ketamine, oxytocin, and agents modulating the orexin, endocannabinoid, and immune systems merits further study.
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Affiliation(s)
- Harry A Fagan
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- College Keep, Southern Health NHS Foundation Trust, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- College Keep, Southern Health NHS Foundation Trust, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Bonnet U, McAnally H. Gabapentinoids: condemned without sufficient evidence? THE LANCET REGIONAL HEALTH. EUROPE 2023; 28:100629. [PMID: 37025421 PMCID: PMC10070123 DOI: 10.1016/j.lanepe.2023.100629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, D-44577 Castrop-Rauxel, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, D-45147 Essen, Germany
| | - Heath McAnally
- Northern Anesthesia & Pain Medicine, LLC, Eagle River, AK, USA
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Baskaran P, Mohandass A, Gustafson N, Bennis J, Louis S, Alexander B, Nemenov MI, Thyagarajan B, Premkumar LS. Evaluation of a polymer-coated nanoparticle cream formulation of resiniferatoxin for the treatment of painful diabetic peripheral neuropathy. Pain 2023; 164:782-790. [PMID: 36001079 PMCID: PMC9950295 DOI: 10.1097/j.pain.0000000000002765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/10/2022] [Indexed: 02/02/2023]
Abstract
ABSTRACT Painful diabetic peripheral neuropathy (PDPN) is one of the major complications of diabetes. Currently, centrally acting drugs and topical analgesics are used for treating PDPN. These drugs have adverse effects; some are ineffective, and treatment with opioids is associated with use dependence and addiction. Recent research indicates that transient receptor potential vanilloid 1 (TRPV1) expressed in the peripheral sensory nerve terminals is an emerging target to treat pain associated with PDPN. Block of TRPV1 ion channel with specific antagonists, although effective as an analgesic, induced hyperthermia in clinical trials. However, TRPV1 agonists are useful to treat pain by virtue of their ability to cause Ca 2+ influx and subsequently leading to nerve terminal desensitization. Here, we report the effectiveness of an ultrapotent TRPV1 agonist, resiniferatoxin (RTX) nanoparticle, in a topical formulation (RTX-cream; RESINIZIN) that alleviates pain associated with DPN in animal models of diabetes. Resiniferatoxin causes nerve terminal depolarization block in the short term, which prevents pain during application and leading to nerve terminal desensitization/depletion in the long term resulting in long-lasting pain relief. Application of RTX cream to the hind limbs suppresses thermal hyperalgesia in streptozotocin-induced diabetic rats and mini pigs without any adverse effects as compared with capsaicin at therapeutic doses, which induces intense pain during application. Resiniferatoxin cream also decreases the expression of TRPV1 in the peripheral nerve endings and suppresses TRPV1-mediated calcitonin gene-related peptide release in the skin samples of diabetic rats and mini pigs. Our preclinical data confirm that RTX topical formulation is an effective treatment option for PDPN.
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Affiliation(s)
- Padmamalini Baskaran
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
- Ion Channel, Pharmacology LLC, Springfield, IL, USA
| | | | - Noah Gustafson
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Jane Bennis
- School of Pharmacy, University of Wyoming, Laramie, WY, USA
| | - Somaja Louis
- Department of Pharmacology, Southern Illinois University, Springfield, IL
| | | | - Mikhail I. Nemenov
- Department of Anesthesia, Stanford University, Palo Alto, CA, USA
- LasMed LLC, Mountain View, CA, USA
| | | | - Louis S. Premkumar
- Department of Pharmacology, Southern Illinois University, Springfield, IL
- Ion Channel, Pharmacology LLC, Springfield, IL, USA
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Marcot D, Castelan Camargo HC. [Pregabalin under the prison lens. Reflections on an emerging issue]. L'ENCEPHALE 2023; 49:199-201. [PMID: 35725510 DOI: 10.1016/j.encep.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
The practice of medicine in prison confronts the prescriber with emerging trends in psychotropic drug misuse. We examine the increasing demand for pregabaliun, as we observe it in patients in detention, and offer a reflection on the health issues. We explain our approach to abstaining from prescribing.
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Affiliation(s)
- D Marcot
- Filière légale du Centre Neuchâtelois de Psychiatrie, site de Préfargier, 2074 Marin Epagnier, Suisse.
| | - H C Castelan Camargo
- Filière légale du Centre Neuchâtelois de Psychiatrie, site de Préfargier, 2074 Marin Epagnier, Suisse
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Strayer RJ, Friedman BW, Haroz R, Ketcham E, Klein L, LaPietra AM, Motov S, Repanshek Z, Taylor S, Weiner SG, Nelson LS. Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine. J Emerg Med 2023; 64:517-540. [PMID: 36997435 DOI: 10.1016/j.jemermed.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Haroz
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, New Jersey
| | - Eric Ketcham
- Department of Emergency Medicine, Department of Behavioral Health, Addiction Medicine, Presbyterian Healthcare System, Santa Fe & Española, New Mexico
| | - Lauren Klein
- Department of Emergency Medicine, Good Samaritan Hospital, West Islip, New York
| | - Alexis M LaPietra
- Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Zachary Repanshek
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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Hammad AM, Naser A, Amawi H, Hall FS, Tiwari AK, Al-Trad B. Effect of amoxicillin/clavulanic acid in attenuating pregabalin-induced condition place preference. Behav Brain Res 2023; 439:114244. [PMID: 36470419 DOI: 10.1016/j.bbr.2022.114244] [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: 06/10/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Substance abuse is a worldwide problem with serious repercussions for patients and the communities where they live. Pregabalin (Lyrica), is a medication commonly used to treat neuropathic pain. Like other analgesic medications there has been concern about pregabalin abuse and misuse. Although it was initially suggested that pregabalin, like other gabapentinoids, has limited abuse liability, questions still remain concerning this inquiry. Changes in glutamate system homeostasis are a hallmark of adaptations underlying drug dependence, including down-regulation of the glutamate transporter 1 (GLT-1; SLC1A2) and the cystine/glutamate antiporter (xCT; SLC7A11). In this study, it was found that pregabalin (90 mg/kg) produces a conditioned place preference (CPP), indicative of reinforcing effects that suggest a potential for abuse liability. Moreover, like other drugs of abuse, pregabalin also produced alterations in glutamate homeostasis, reducing the mRNA expression of Slc1a2 and Slc7a11 in the nucleus accumbens (NAc) and medial prefrontal cortex (mPFC). Amoxicillin clavulanic acid, a β-lactam antibiotic, blocked the reinforcing effects of pregabalin and normalized glutamate homeostasis. These results suggest that pregabalin has abuse potential that should be examined more critically, and that, moreover, the mechanisms underlying these effects are similar to those of other drugs of abuse, such as heroin and cocaine. Additionally, these results support previous findings showing normalization of glutamate homeostasis by β-lactam drugs that provides a novel potential therapeutic approach for the treatment of drug abuse and dependence.
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Affiliation(s)
- Alaa M Hammad
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan.
| | - Asma'a Naser
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid 21163, Jordan
| | - Haneen Amawi
- Department of Clinical Pharmacy and Pharmacy Practice, College of Pharmacy, Yarmouk University, Irbid 21163, Jordan
| | - F Scott Hall
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Amit K Tiwari
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Bahaa Al-Trad
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid 21163, Jordan
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Jalilian Khave L, Noori M, Rahimi-Movaghar A, Noroozi A. Management of gabapentin misuse in a patient with previous history of opioid use disorder: Case report. Asian J Psychiatr 2023; 80:103322. [PMID: 36423434 DOI: 10.1016/j.ajp.2022.103322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022]
Abstract
We present a 37-year-old male who misuses 12 g of gabapentin per day associated with dependence and withdrawal. He had a previous history of opioid use disorder (OUD) which has been in remission. An outpatient gradual dose reduction regimen was tried and failed and the patient decided to discontinue gabapentin abruptly. Symptomatic medication to relieve gabapentin withdrawal was also unsuccessful and resulted in the reinstatement of OUD. Finally, the patient was stabilized using buprenorphine maintenance treatment and discontinued opioids and gabapentin misuse. The clinical implications and significance of taking regulatory actions to control gabapentin misuse have been discussed.
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Affiliation(s)
- Laya Jalilian Khave
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.; Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Noori
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.
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Bonnet U, Kanti AK, Scherbaum N, Specka M. The Role of Gabapentinoids in the Substance Use Pattern of Adult Germans Seeking Inpatient Detoxification Treatment - A Pilot Study. J Psychoactive Drugs 2023; 55:102-111. [PMID: 35290159 DOI: 10.1080/02791072.2022.2050858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To shed more light on the addictive power of the gabapentinoids (GPTs) gabapentin and pregabalin, we performed a structured face-to-face interview with GPT-users about DSM-IV-dependence-criteria (sedatives), consume-motives and cessation-needs. Among 100 patients consecutively admitted to a detoxification-ward, fifteen (15%) reported lifetime GPT-use (18-50 years old, 2 females): seven (7%) used gabapentin, twelve (12%) pregabalin and four had lifetime experiences with both GPTs. Of the seven gabapentin-users, three patients were dependent including one person with a spontaneous remission. Of the 12 pregabalin-users, five were dependent, including two persons with a spontaneous remission. Fourteen of fifteen cases reported GPT-use side-by-side with an opioid-use, mostly for sparing opioids. Twelve GPT-users additionally co-used benzodiazepines. In no case, a GPT was the reason for detoxification treatment or reported to be involved in an emergency event. Altogether, every 7th patient (n = 15) of our inpatient detoxification-seeking sample reported GPT-use including 50% (n = 8) who were dependent. Among them, 35% (3/8) had been already spontaneously remitted. As GPT-users reported no cession-need and the vast majority were primarily affected by co-occurring opioid- and benzodiazepine-addiction, we assume that GPTs more likely played a bystander-role than mediating the addictive behavior of this population with multiple recreational drug use experience.
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Affiliation(s)
- Udo Bonnet
- Head of the Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen and Professor, University of Duisburg/Essen, Essen, Germany
| | - Ann-Kristin Kanti
- Resident Physician at the Department of Internal Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg/Essen, Castrop-Rauxel, Germany
| | - Norbert Scherbaum
- Head of the Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg/Essen and Professor, University of Duisburg/Essen, Essen, Germany
| | - Michael Specka
- Senior psychologist and researcher in the Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR Hospital Essen, University of Duisburg-Essen and Doctor rerum medicarum of the University of Duisburg/Essen, Essen, Germany
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Billig JI, Gunaseelan V, Yazdanfar M, Sears ED, Iwashyna TJ, Chang T, Waljee JF. Gabapentinoid Prescribing for Carpal Tunnel Syndrome. Hand (N Y) 2023; 18:106S-113S. [PMID: 35225033 PMCID: PMC9896291 DOI: 10.1177/15589447211063544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gabapentinoids, including gabapentin and pregabalin, are commonly prescribed for neuropathic pain, but robust evidence recommends against using gabapentinoids for the treatment of carpal tunnel syndrome (CTS). We aimed to quantify national prescribing patterns of gabapentinoids for CTS. METHODS We performed a retrospective population-based cohort study using claims data of gabapentinoid-naïve patients with a new diagnosis of CTS (2009-2016). Our primary outcome was a new gabapentinoid fill for CTS. We assessed temporal trends and characteristics associated with a gabapentinoid fill. Multivariable logistic regression was used to evaluate the association between patient-level factors and a new gabapentinoid fill for CTS. RESULTS Of the 248 324 previously gabapentinoid-naïve patients with CTS, 9589 patients (4%) filled a gabapentinoid prescription. Sixty-one percent were prescribed by primary care providers or medical subspecialists. Patients with a history of neck pain (odds ratio [OR]: 1.31, 95% confidence interval [CI], 1.25-1.38), back pain (OR: 1.25, 95% CI, 1.20-1.31), arthritis (OR: 1.25, 95% CI, 1.18-1.31), and other pain conditions (OR: 1.26, 95% CI, 1.20-1.31) were associated with an increased odds of a new gabapentinoid fill. In addition, patients with a history of alcohol or substance use disorder were significantly associated with a new gabapentinoid prescription fill (OR: 1.33, 95% CI, 1.20-1.47). CONCLUSIONS Despite evidence recommending against the use of gabapentinoids for CTS, gabapentinoids were frequently initiated among those with higher risk for misuse, including substance use disorders. Given the effectiveness of bracing or surgery for CTS and the risks associated with gabapentinoids, efforts aimed at disseminating evidence-based treatment for CTS are critical to minimize the harms of gabapentinoid misuse.
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Affiliation(s)
| | | | | | - Erika D. Sears
- University of Michigan, Ann Arbor,
USA
- VA Ann Arbor Healthcare System, MI,
USA
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Abstract
Importance Anxiety disorders have a lifetime prevalence of approximately 34% in the US, are often chronic, and significantly impair quality of life and functioning. Observations Anxiety disorders are characterized by symptoms that include worry, social and performance fears, unexpected and/or triggered panic attacks, anticipatory anxiety, and avoidance behaviors. Generalized anxiety disorder (6.2% lifetime prevalence), social anxiety disorder (13% lifetime prevalence), and panic disorder (5.2% lifetime prevalence) with or without agoraphobia are common anxiety disorders seen in primary care. Anxiety disorders are associated with physical symptoms, such as palpitations, shortness of breath, and dizziness. Brief screening measures applied in primary care, such as the Generalized Anxiety Disorder-7, can aid in diagnosis of anxiety disorders (sensitivity, 57.6% to 93.9%; specificity, 61% to 97%). Providing information about symptoms, diagnosis, and evidence-based treatments is a first step in helping patients with anxiety. First-line treatments include pharmacotherapy and psychotherapy. Selective serotonin reuptake inhibitors (SSRIs, eg, sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs, eg, venlafaxine extended release) remain first-line pharmacotherapy for generalized anxiety disorder, social anxiety disorder, and panic disorder. Meta-analyses suggest that SSRIs and SNRIs are associated with small to medium effect sizes compared with placebo (eg, generalized anxiety disorder: standardized mean difference [SMD], -0.55 [95% CI, -0.64 to -0.46]; social anxiety disorder: SMD, -0.67 [95% CI, -0.76 to -0.58]; panic disorder: SMD, -0.30 [95% CI, -0.37 to -0.23]). Cognitive behavioral therapy is the psychotherapy with the most evidence of efficacy for anxiety disorders compared with psychological or pill placebo (eg, generalized anxiety disorder: Hedges g = 1.01 [large effect size] [95% CI, 0.44 to 1.57]; social anxiety disorder: Hedges g = 0.41 [small to medium effect] [95% CI, 0.25 to 0.57]; panic disorder: Hedges g = 0.39 [small to medium effect[ [95% CI, 0.12 to 0.65]), including in primary care. When selecting treatment, clinicians should consider patient preference, current and prior treatments, medical and psychiatric comorbid illnesses, age, sex, and reproductive planning, as well as cost and access to care. Conclusions and Relevance Anxiety disorders affect approximately 34% of adults during their lifetime in the US and are associated with significant distress and impairment. First-line treatments for anxiety disorders include cognitive behavioral therapy, SSRIs such as sertraline, and SNRIs such as venlafaxine extended release.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York
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Kanti AK, Specka M, Scherbaum N, Bonnet U. [Comparative Harm/Benefit Analysis of Various Psychotropic Substances from the Perspective of German Drug Users and Addiction Medicine Experts - A Contribution to Psychoeducation of Substance-Addicted Individuals and Restriction/Legalization Debates]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022. [PMID: 36522164 DOI: 10.1055/a-1971-9558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND To date, we cannot find any current international comparative study on the assessment of a benefit/harm profile of various licit and illicit psychoactive substances conducted by adult drug users and addiction experts as well. Particularly, there is no study from the German-speaking area of Western Europe. METHODS In addition to the data already published by 101 German addiction medicine experts (published in this journal, [1]), we carried out interviews using a structured questionnaire with 100 German substance dependent users, residing in acute and rehabilitation clinical setting, to evaluate 34 psychoactive substances regarding their health and social harm potential for users and others as well as their potential benefit. RESULTS Both, users and experts estimated traditional illicit drugs, such as heroin, crack/cocaine and methamphetamine, to be particularly harmful. Synthetic cannabinoids, alcohol and benzodiazepines were in the upper midfield, cannabis and psychotropic mushrooms in the lower midfield, and gabapentinoids at the bottom of the harm rankings of both, users and experts. In comparison with the experts, the users estimated methadone and benzodiazepines to be significantly more harmful. In the benefit analysis, users rated traditional illicit drugs including cannabis and psychotropic mushrooms as well as nicotine as significantly more useful than the experts. In contrast to the experts (traditional illicit drugs), the users did not assess any substance as very harmful and very useless at the same time. Only a few users reported to have experiences with opioid analgesics which, however, did not differ between the users´ and experts´ harm/benefit-assessments. Neither users nor experts predicted cannabis-legalization to change the overall risk potential of cannabis. Specific cognitive valuation biases seemed to be prominent in both groups. CONCLUSION This study presents first harm/benefit assessments of psychotropic substances from the perspective of German addiction medicine experts and drug users. The results can be valuable to the psychoeducation of substance-addicted individuals and to current restriction or legalization debates.
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Affiliation(s)
- Ann-Kristin Kanti
- Klinik für Innere Medizin, Evangelisches Krankenhaus Castrop-Rauxel, (Akademisches Lehrkrankenhaus der Universität Duisburg-Essen), Castrop-Rauxel, Deutschland
| | - Michael Specka
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Norbert Scherbaum
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Udo Bonnet
- LVR-Klinikum Essen, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Castrop-Rauxel, (Akademisches Lehrkrankenhaus der Universität Duisburg-Essen), Castrop-Rauxel, Deutschland
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Swenson JD, Conrad KM, Pace NL, Phillips K, Saltzman CL. Scheduled, Simultaneous Dosing of Pregabalin, Celecoxib, and Acetaminophen Markedly Reduces or Eliminates Opioid Use After ACL Reconstruction Using Allograft or Hamstring Tendon Autograft: A Randomized Clinical Trial. Orthop J Sports Med 2022; 10:23259671221140837. [PMID: 36518729 PMCID: PMC9743025 DOI: 10.1177/23259671221140837] [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: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Opioid analgesics continue to be prescribed after ambulatory surgery despite untoward adverse effects, risk of overdose, and association with substance use disorder. PURPOSE/HYPOTHESIS The purpose was to investigate the use of a novel system to provide scheduled and simultaneous dosing of acetaminophen, celecoxib, and pregabalin after anterior cruciate ligament reconstruction (ACLR). It was hypothesized that this system would markedly reduce pain and opioid use compared with existing best practice. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Included were 100 patients scheduled for elective, primary ACLR using allograft or hamstring tendon autograft. Selection criteria included age between 18 and 65 years and weight between 65 and 120 kg. Exclusion criteria were a known allergy to any drug used in the study or the use of opioid analgesics before surgery. Patients in the intervention group received a blister pack with scheduled, simultaneous doses of acetaminophen, celecoxib, and pregabalin; patients were also given oxycodone 5 mg as needed for breakthrough pain. Patients in the control group were prescribed ibuprofen and oxycodone 5 mg/acetaminophen 325 mg as needed for pain. The primary outcome measure was pain. Secondary outcomes were nausea, itching, and daily oxycodone use. Patients were asked to quantify their average pain at rest, nausea, and itching on an 11-point verbal scale (from 0 to 10). These data were recorded for 6 days during daily telephone contacts with patients after hospital discharge. RESULTS Cumulative results for 6 days showed significantly lower values in the intervention group compared with the control group for pain (median [interquartile range], 28 [14-35] vs 35 [28-41], respectively; P = .009) and oxycodone use (median [interquartile range] number of tablets, 0 [0-2] vs 8 [1.25-16], respectively; P < .001). Based on these data, the upper tolerance limits for the number of oxycodone tablets required by 90% of patients in the intervention and control groups were 8 tablets and 30 tablets, respectively. Cumulative results for nausea and itching were also significantly lower for the intervention group. Most patients in the intervention group used no opioids during recovery. CONCLUSION Simultaneous dosing of 3 nonopioid analgesics resulted in reduced postoperative pain and markedly lower opioid use. REGISTRATION NCT04015908 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jeffrey D. Swenson
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - Kevin M. Conrad
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - Nathan L. Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - Kathleen Phillips
- Department of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Charles L. Saltzman
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
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Bonnet U, Specka M, Kanti AK, Scherbaum N. Differences between users' and addiction medicine experts' harm and benefit assessments of licit and illicit psychoactive drugs: Input for psychoeducation and legalization/restriction debates. Front Psychiatry 2022; 13:1041762. [PMID: 36465301 PMCID: PMC9709475 DOI: 10.3389/fpsyt.2022.1041762] [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: 09/11/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is a lack of benefit/harm assessments of illicit and licit psychoactive substances performed by substance-dependent users in comparison to addiction medicine experts. Methods We extended the analyses of substance harm/benefit assessments of German addiction medicine experts (N = 101), in parts reported recently in this journal [doi.org/10.3389/fpsyt.2020.59219], by the perspectives of substance-addicted persons. The same questionnaire as used for the abovementioned "experts-study" was handed out to inpatient detoxification or rehab treatment seeking German substance-dependent adults (N = 117) for a subsequent structured interview about harms and benefits of 33 new and traditional psychoactive substances comprising also prescription drugs. Results and discussion Both, users and experts, ranked the traditional illicit psychoactive substances heroin, cocaine and amphetamines within the top overall harm level group. Synthetic cannabinoids, alcohol and benzodiazepine were in a subordinate top-harm level position. Both cohorts also ranked methadone, nicotine and cannabis within the midrange and buprenorphine as well as psychotropic mushrooms within the lowest harm level positions. Experiences with prescription drugs (including opioidergic analgesics and gabapentinoids), cathinones, GHB, methamphetamine and methylphenidate was not prevalent in our user population. The same applied to barbiturates, propofol, kratom, ayahuasca with nearly zero assessments for each substance. The most user-experiences (>50% per assessed substance) were reported with nicotine, cannabis, alcohol, cocaine, heroin, amphetamine and methadone (core group). The user's overall harm ratings in terms of these psychoactive substances were similar to those of the experts with the exception of the methadone assessment which was rated by the experts to be significantly less harmful if compared with the users' estimation (supposed "treatment bias" of experts). The users' benefit ratings for the traditional illicit psychoactive substances, cannabis as well as for nicotine were significantly more positive in comparison to those of the experts (supposed "attraction bias" of users). Both, experts and users, ranked the harms arising from the use of alcohol or benzodiazepines (usually unregulated substances) higher than the harms caused by the use of methadone, cannabis or psychotropic mushrooms (regulated by most Western narcotic acts). Users attributed the most benefits to buprenorphine, methadone and cannabis. This might reflect a main limitation of the study as the data are from an user population comprising over 50% patients who sought detoxification-treatment of opiates where methadone and buprenorphine are usual transient medications (supposed "selection bias"). Conclusion This study addressed current trends of psychoactive substance abuse (e.g., synthetic cannabinoids, prescription drugs) and provides from both perspectives (that of the user and that of the addiction medicine experts) robust harm/benefit evaluations at least of a core group of psychoactive substances (traditional illicit psychoactive substances, cannabis, methadone, alcohol and nicotine). The results of this study can be valuable to the psychoeducation of substance-addicted individuals and to current restriction/legalization debates, especially in the Western-EU.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Germany - Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Michael Specka
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Ann-Kristin Kanti
- Department of Internal Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Castrop-Rauxel, Germany - Academic Teaching Hospital of the University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Grauer JS, Cramer JD. Association of State-Imposed Restrictions on Gabapentin with Changes in Prescribing in Medicare. J Gen Intern Med 2022; 37:3630-3637. [PMID: 35018568 PMCID: PMC9585149 DOI: 10.1007/s11606-021-07314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Between August 2016 and July 2018, three states classified gabapentin as a Schedule V drug and nine states implemented prescription drug monitoring program (PDMP) regulation for gabapentin. It is highly unusual for states to take drug regulation into their own hands. The impact of these changes on gabapentin prescribing is unclear. OBJECTIVE To determine the effect of state-imposed regulation on gabapentin prescribing for Medicare Part D enrollees from 2013 to 2018. DESIGN Population-based difference-in-difference(DID) analysis study utilizing the Medicare Part D Prescriber Public Use File. PARTICIPANTS All eligible Medicare Part D prescribers excluding those outside of the fifty states and the District of Columbia were included in our analysis. Prescriber data and key sociodemographic variables were organized by state and year. States with a gabapentin schedule change or PDMP regulation enacted before 2019 were included in the intervention group. For the Schedule V DID analysis, a control group of the ten highest opioid-prescribing states was used. INTERVENTIONS States with gabapentin schedule changes or PDMP regulation before January 1, 2019, were included and compared to control states that did not implement these policies. MAIN MEASURES Total days' supply of gabapentin per enrollee per year was the primary outcome variable. KEY RESULTS The mean total days' supply of gabapentin per enrollee increased 41% from 19.71 to 27.81 total days' supply per enrollee per year between 2013 and 2018. After adjustment, Schedule V gabapentin regulation resulted in a reduction of 8.37 total days of gabapentin prescribed per enrollee (95% confidence interval of - 10.34 to - 6.39). In contrast, PDMP regulation resulted in a reduction of 1.01 total days of gabapentin prescribed per enrollee (95% confidence interval of - 1.74 to - 0.29). CONCLUSIONS Classifying gabapentin as a Schedule V drug results in substantial reduction in total days prescribed whereas PDMP regulation results in modest reduction.
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Affiliation(s)
- Jordan S Grauer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, 4201 St Antoine St, UHC 5E, Detroit, MI, 48201, USA
| | - John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, 4201 St Antoine St, UHC 5E, Detroit, MI, 48201, USA.
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Baldwin DS, Masdrakis V. Non-prescribed use of gabapentinoids: Mechanisms, predisposing factors, associated hazards and clinical management. Eur Neuropsychopharmacol 2022; 63:6-8. [PMID: 35905525 DOI: 10.1016/j.euroneuro.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/08/2023]
Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Southern Health NHS Foundation Trust, Southampton, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Vasilios Masdrakis
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; First Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens Medical School, Greece
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Coles S, Dabbs W, Wild S. Pharmacologic Management of Chronic Pain. Prim Care 2022; 49:387-401. [DOI: 10.1016/j.pop.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krysa K, Kowalczyk E, Borysowski J, Lachota M, Pasierski T. Exclusion of older adults from clinical trials in cancer-related pain. Front Med (Lausanne) 2022; 9:945481. [PMID: 35991635 PMCID: PMC9385985 DOI: 10.3389/fmed.2022.945481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is one of the most common symptoms in cancer patients including older adults. The objective of this study was to evaluate the enrollment criteria that can limit the inclusion of older adults in clinical trials concerning cancer-related pain (CRP). The study included 356 trials registered with ClinicalTrials.gov. Our primary outcome measures were the proportion of trials that excluded patients based on upper age limits (80 years of age or less), strict organ-specific exclusion criteria, broad and imprecise criteria, and inadequate performance score. One hundred and twenty-six trials (35.4%) had upper age limits. Strict exclusion criteria were used in 95 (26.7%) trials. Broad and imprecise exclusion criteria were listed in 57 (16.2%) trials. Low performance score was used as an exclusion criterion in 4 trials (1.1%). Overall, in 241 trials (67.7%) there was either an upper age limit or at least one strict or broad and imprecise exclusion criterion, or a criterion involving the performance status. The odds of excluding older adults were significantly higher in certain neoplasm types, study objectives, intervention types, and center locations. In conclusion, considerable proportion of recent clinical trials concerning CRP either explicitly exclude older adults or create high risk of such exclusion which substantially limits the evidence base for the treatment of such patients in clinical practice. Sponsors and investigators should consider careful modification of the enrollment criteria to improve the inclusion of older individuals who make up the major proportion of cancer patients population.
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Affiliation(s)
| | - Ewa Kowalczyk
- Clinical Research Development Centre, Medical Research Agency, Warsaw, Poland
| | - Jan Borysowski
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
- Centre for Studies on Research Integrity, Institute of Law Studies, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Jan Borysowski
| | - Mieszko Lachota
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Pasierski
- Department of Medical Ethics and Palliative Medicine, Medical University of Warsaw, Warsaw, Poland
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Alghamdi K, Lysecki D. Role of gabapentin in reducing the need for high-risk medications in patients with stable severe neurological impairment. J Taibah Univ Med Sci 2022; 18:170-174. [DOI: 10.1016/j.jtumed.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022] Open
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Woods A, Drovandi A, Konstantatos A, Bui T. Appropriateness of gabapentinoid prescription for surgical and trauma pain in gabapentinoid‐naïve patients: a retrospective review. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aaron Woods
- Pharmacy Department Alfred Health Melbourne Australia
- College of Medicine and Dentistry James Cook University Townsville Australia
| | - Aaron Drovandi
- College of Medicine and Dentistry James Cook University Townsville Australia
| | - Alex Konstantatos
- Anaesthesia and Perioperative Medicine Department Alfred Health Melbourne Australia
- Medicine Nursing and Health Sciences Monash University Melbourne Australia
| | - Thuy Bui
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
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Kuo YF, Liaw V, Yu X, Raji MA. Opioid and Benzodiazepine Substitutes: Impact on Drug Overdose Mortality in Medicare Population. Am J Med 2022; 135:e194-e206. [PMID: 35341773 PMCID: PMC9232943 DOI: 10.1016/j.amjmed.2022.02.039] [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: 01/24/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Gabapentinoids (GABAs) and serotonergic drugs (selective serotonin reuptake inhibitors [SSRIs]/serotonin and norepinephrine reuptake inhibitors [SNRIs]) are increasingly being prescribed as potential substitutes to opioids and benzodiazepines (benzos), respectively, to treat co-occurring pain and anxiety disorders. The toxicities of these drug classes and their combinations are not well understood. METHODS We conducted a matched case-control study using 2013-2016 Medicare files linked to the National Death Index. Cases were enrollees who died from drug overdose. Controls were enrollees who died from other causes. Cases and controls were matched on patient characteristics and prior chronic conditions. Possession of any opioids, GABAs, benzos, and SSRIs/SNRIs in the month prior to death was defined as drug use. Combination drug use was defined as possessing at least 2 types of these prescriptions for an overlapping period of at least 7 days in the month prior to death. RESULTS Among 4323 matches, benzo possession was associated with twice the risk for drug overdose death in cases vs controls. Compared with opioid-benzo co-prescribing, combinations involving SSRIs/SNRIs and opioids (or GABAs) were associated with decreased risk (adjusted odds ratio 0.55; 95% confidence interval, 0.44-0.69 for opioids and SSRIs/SNRIs; adjusted odds ratio 0.59; 95% confidence interval, 0.44-0.79 for GABAs and SSRIs/SNRIs). Fatal drug overdose risk was similar in users of GABA-opioid, GABA-benzo, and opioid-benzo combinations. CONCLUSIONS Benzodiazepines, prescribed alone or in combination, were associated with an increased risk of drug overdose death. SSRIs/SNRIs were associated with lower risk of overdose death vs benzodiazepines. GABAs were not associated with decreased risk compared with opioids, raising concerns for GABAs' perceived relative safety.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging; Department of Preventive Medicine and Population Health; Institute for Translational Science; Office of Biostatistics, University of Texas Medical Branch, Galveston.
| | - Victor Liaw
- School of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Xiaoying Yu
- Department of Preventive Medicine and Population Health; Office of Biostatistics, University of Texas Medical Branch, Galveston
| | - Mukaila A Raji
- Department of Internal Medicine and Sealy Center on Aging; Department of Preventive Medicine and Population Health
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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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Olopoenia A, Camelo-Castillo W, Qato DM, Adekoya A, Palumbo F, Sera L, Simoni-Wastila L. Adverse outcomes associated with concurrent gabapentin, opioid, and benzodiazepine utilization: A nested case-control study. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100302. [PMID: 36777316 PMCID: PMC9904085 DOI: 10.1016/j.lana.2022.100302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Gabapentin, opioids, and/or benzodiazepines are commonly prescribed for a variety of pain and psychiatric conditions. Despite the high likelihood of co-prescription of these medications, little is known about co-utilization of gabapentin (GABA), opioids (OP), and benzodiazepines (BZD) and associated public health outcomes. Methods Using Medicare CCW Data, 2013-2016, we conducted a nested case-control study to examine the association between concurrent utilization of GABA, OP, and BZD and respiratory depression, opioid, and substance-related overdose among Medicare disabled beneficiaries. Cases and controls were Fee-for-service disabled beneficiaries who had a diagnosis of acute pain (AP), chronic pain (CP) or mental health conditions (MH) and received GABA, OP or BZD. Cases with respiratory depression, opioid or substance-related overdose were matched with up to 4 controls on socio-demographics, year of cohort entry and disease risk score. Primary exposure was concurrent medication utilization defined as an overlap of at least one day in prescriptions for GABA, OP and BZD. Findings Across all cohorts, the majority of cases and controls were under 65, female, dually eligible and had prior histories of pain and mental health conditions. GABA+OP+BZD use was associated with increased odds of respiratory depression [AOR(95%CI)-AP: 1.35 (1.19-1.52), CP:1.24 (1.11-1.38) and MH: 1.16 (1.02-1.32) vs. OP only], opioid-related overdose [AP: 1.43 (1.04-1.98), CP: 1.47 (1.07-2.00) and MH: 1.44 (1.04-2.00) vs. OP only], and substance-related overdose [AP: 1.77 (1.26-2.50), CP: 1.70 (1.24-2.34) and MH: 1.92 (1.31-2.82) vs. GABA only]. While there were cohort differences in the association between GABA+OP and both respiratory depression and opioid-related overdose, GABA+OP and GABA+BZD use were associated with significantly higher odds of substance-related overdose across all clinical cohorts. Interpretation Among Medicare disabled beneficiaries, concurrent utilization of gabapentin, opioids, and benzodiazepines is associated with multiple adverse outcomes. Given this, it is imperative that the benefits and risks of co-prescribing these medications be comprehensively examined. Funding None.
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Affiliation(s)
- Abisola Olopoenia
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA,Corresponding author at: 2671 Avenir Pl, Vienna, VA, 22180.
| | - Wendy Camelo-Castillo
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Danya M. Qato
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA,School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA
| | - Adepeju Adekoya
- Johns Hopkins Medicine, Department of Anesthesiology & Critical Care Medicine, Division of Chronic Pain Medicine, Baltimore, MD, USA
| | - Frank Palumbo
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA
| | - Leah Sera
- Department of Pharmacy Practice and Science, University of Maryland Baltimore, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA,Peter Lamy Center on Drug Therapy and Aging, University of Maryland Baltimore, Baltimore, MD, USA
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