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Alkhalaf AA, Bukhari RA, Alshehri EA, Alshehri SO, Badr AF. Abuse liability of gabapentin in the Saudi population after the pregabalin restriction: A cross-sectional study. J Taibah Univ Med Sci 2021; 16:700-705. [PMID: 34690650 PMCID: PMC8498723 DOI: 10.1016/j.jtumed.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Following the recently conducted local studies on the growing misuse of pregabalin, Pregabalin misuse has received national attention. These studies have led to the authorities restricting the availability of pregabalin to hospital pharmacies alone. While the recent epidemiological studies and case reports found gabapentin to be misused worldwide, it was previously presumed to be free of any abuse potential. This study assesses the likelihood of there being a diversion to Gabapentin abuse following the Pregabalin restriction in Jeddah, KSA. Methods A cross sectional observational study was conducted between November 2017 and December 2017 using a self-constructed online survey via Twitter and WhatsApp. The survey items included participants' demographics, additional history, Gabapentin for non-medical use (frequency, concurrent use with other drugs, and motivators), and how the participants knew about the Gabapentin misuse. The data was subjected to a descriptive analysis via the utilization of frequencies and percentages. The analysis was carried out by using SPSS V21. Results Data of the 370 respondents who took the surveys were collected. Most of the respondents were women (n = 289; 78.1%) and below the age of 30 years (n = 300; 81.1%). A total of 72 respondents (19.5%) had a history of psychoactive drug abuse. Ten of the respondents reported Gabapentin misuse (2.7%). Half of the participants reported prior Pregabalin misuse, and were un-employed. Most of the misusers (n = 8; 80%) came to know about the psychotropic effects of Gabapentin from friends. The most common motives for using it were to 'have fun' and 'peer pressure' (n = 6; 60%). Half of the misusers used Gabapentin on a weekly basis. Conclusion The findings of our study suggest a potential diversion from Pregabalin to Gabapentin misuse. Regulations and periodic reviews of the psychoactive prescription medications available in the community pharmacies are essential.
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Affiliation(s)
- Amina A Alkhalaf
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Raneem A Bukhari
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Elham A Alshehri
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Samah O Alshehri
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
| | - Aisha F Badr
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, KSA
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2
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Abstract
This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.
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Affiliation(s)
- Staffan Hägg
- Futurum, Jönköping, Region Jönköping County and Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Futurum, Hus B4, Ryhov Hospital, S-551 85, Jönköping, Sweden.
| | - Anna K Jönsson
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
| | - Johan Ahlner
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
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3
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Althobaiti YS, Alghorabi A, Alshehri FS, Baothman B, Almalki AH, Alsaab HO, Alsanie W, Gaber A, Almalki H, Alghamdi AS, Basfer A, Althobaiti S, Hardy AMG, Shah ZA. Gabapentin-induced drug-seeking-like behavior: a potential role for the dopaminergic system. Sci Rep 2020; 10:10445. [PMID: 32591630 PMCID: PMC7320158 DOI: 10.1038/s41598-020-67318-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/05/2020] [Indexed: 01/22/2023] Open
Abstract
Drugs of abuse represent a growing public health crisis. Accumulating evidence indicates that gabapentin (GBP), a prescription drug, is prone to misuse, abuse, withdrawal, and dependence. Commonly, drugs of abuse modulate the dopaminergic system to induce addiction. In this study, we used the conditioned place preference (CPP) model to investigate the involvement of the dopamine 1 (D1) receptor on the reward and reinforcement behavior of GBP. Under a CPP paradigm, male BALB/c mice were intraperitoneally injected either saline or 100, 200, or 300 mg/kg of GBP and confined to the injection-paired chamber for 30 min. In the pre-conditioning phase, mice were conditioned for 3 days, and baseline data were collected. In the conditioning phase, mice were given once-daily alternating injections of either GBP or saline for 8 days and subsequently assessed in a post-conditioning test. Injections of 300 mg/kg of GBP significantly increased the time spent in the drug-paired chamber compared to the saline-paired chamber. However, lower doses of GBP (100 and 200 mg/kg) showed no effect. Pre-treatment with SKF-83566, a D1 receptor antagonist, attenuated GBP-induced CPP. Thus, for the first time, we show that GBP can induce CPP through a dopaminergic-dependent mechanism.
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Affiliation(s)
- Yusuf S Althobaiti
- Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, Health Science Campus, Airport Road, Al Haweiah, PO Box 888, Taif, 21974, Saudi Arabia. .,Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia. .,General Administration for Precursors and Laboratories, Ministry of Interior, General Directorate of Narcotics Control, Riyadh, Saudi Arabia.
| | - Amal Alghorabi
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia
| | - Fahad S Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Bandar Baothman
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia.,Deanship of Scientific Research, Taif University, Taif, Saudi Arabia
| | - Atiah H Almalki
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia.,Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Hashem O Alsaab
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia.,Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Walaa Alsanie
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia.,Department of Clinical Laboratories Science, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Ahmed Gaber
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia.,Department of Biology, Faculty of Science, Taif University, Taif, Saudi Arabia
| | - Hussam Almalki
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia
| | - Abdulrahman S Alghamdi
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia
| | - Ahmad Basfer
- Addiction and Neuroscience Research Unit, Biomedical Sciences Research Center, Taif University, Taif, Saudi Arabia
| | - Sultan Althobaiti
- Department of Pharmaceutical Care, Directorate of Health Affairs, Ministry of Health, Taif, Saudi Arabia
| | - Ana Maria Gregio Hardy
- Department of Physiology and Pharmacology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Zahoor A Shah
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA
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4
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Vickers-Smith R, Sun J, Charnigo RJ, Lofwall MR, Walsh SL, Havens JR. Gabapentin drug misuse signals: A pharmacovigilance assessment using the FDA adverse event reporting system. Drug Alcohol Depend 2020; 206:107709. [PMID: 31732295 PMCID: PMC7762328 DOI: 10.1016/j.drugalcdep.2019.107709] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although there have been increasing reports of intentional gabapentin misuse, epidemiological evidence for the phenomenon is limited. The purpose of this study was to determine whether there are pharmacovigilance abuse signals for gabapentin. METHODS Using FDA Adverse Events Reporting System reports from January 1, 2005 to December 31, 2015, we calculated pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayes geometric mean) for abuse-related adverse event (AR-AE)-gabapentin pairs. Loglinear modeling assessed the frequency of concurrent reporting of abuse-related and abuse-specific AEs (AS-AEs) associated with gabapentin. Findings were compared to a positive (pregabalin) and negative (duloxetine) control. RESULTS From 2005-2015 there were 5,951,229 unique AE reports submitted to the FDA including 99,977 for gabapentin, 73,977 for duloxetine, and 97,813 for pregabalin. Significant drug-AR-AE pair signals involving gabapentin included: drug abuser, multiple drug overdose, and substance-induced psychotic disorder. Significant drug AR-AE signals involving gabapentin and pregabalin, but not duloxetine, were: ataxia, dependence, drug abuse, increased drug tolerance, and overdose. Compared to duloxetine, gabapentin had significantly greater odds of a co-report for an AS-AE with drug withdrawal syndrome (OR: 6.55), auditory hallucinations (OR: 4.57), delusions (OR: 2.36), euphoric mood (OR: 5.45), ataxia (OR: 2.85), drug abuser (OR: 3.01), aggression (OR: 1.98), psychotic disorder (OR: 1.96), and feeling abnormal (OR: 1.31). CONCLUSIONS We identified abuse-related signals for gabapentin and highlighted several CNS effects that may be associated with its abuse. Gabapentin prescribers should be aware of the drug's abuse liability and effects that may accompany its use.
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Affiliation(s)
- Rachel Vickers-Smith
- University of Louisville School of Nursing, Louisville, KY 40202, USA; Department of Biostatistics, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA; Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Jiangwen Sun
- Department of Computer Science, Old Dominion University, Norfolk, VA 23529, USA
| | - Richard J Charnigo
- Department of Biostatistics, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
| | - Michelle R Lofwall
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Sharon L Walsh
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA; Department of Pharmaceutical Sciences, University of Kentucky College of Pharmacy, 789 South Limestone, Lexington, KY 40508, USA
| | - Jennifer R Havens
- Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA
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5
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Vento AE, Kotzalidis GD, Cacciotti M, Papanti GD, Orsolini L, Rapinesi C, Savoja V, Calabrò G, Del Casale A, Piacentino D, Caloro M, Girardi P, Schifano F. Quetiapine Abuse Fourteen Years Later: Where Are We Now? A Systematic Review. Subst Use Misuse 2020; 55:304-313. [PMID: 31573374 DOI: 10.1080/10826084.2019.1668013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Quetiapine, an atypical antipsychotic endowed with weak dopamine antagonist, potent 5-HT2A-blocking, partial 5-HT1A-agonist, anti-H1 histamine, adrenolytic, and sigma1 receptor agonist activities, since an original 2004 report is increasingly misused. Although some of its pharmacodynamics might explain some motives for voluptuary use, most of its actions are directed at setting-off those motives. Hence, it is possible that its popularity in special populations is due to the fact that the unpleasant or unwanted effects of addiction substances are somehow soothed by quetiapine. Currently, quetiapine is tested in substance use disorders, showing some promise, but it is likely to be misused in certain contexts. Objectives: To review the evidence for the use of quetiapine as addiction substance and investigate the characteristics of populations involved in such addiction. Methods: A systematic review of literature on various databases retrieved on September 7, 2018 87 records to comment. Results. We reviewed the evidence for quetiapine's addictive potential in the light of its pharmacodynamics properties and presented two cases of recreational quetiapine use, by a 35-year old male patient with past addictive behavior and by a 50-year-old woman with major depressive disorder and conversion disorder. We found quetiapine to be abused mainly by addict populations and people with law involvement. Conclusions/Importance: There is no reason to include quetiapine among regulated substances, but monitoring of its use in selected populations is warranted. Psychiatrists and physicians working in the penitentiary system should be aware of the addictive potential of quetiapine and adopt measures restricting its use.
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Affiliation(s)
- Alessandro E Vento
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,School of psychology - G. Marconi, Telematic University, Rome, Italy.,Addictions Observatory (ODDPSS), Rome, Italy.,Mental Health Department - ASL Roma 2, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Marta Cacciotti
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,School of psychology - G. Marconi, Telematic University, Rome, Italy.,Addictions Observatory (ODDPSS), Rome, Italy.,Mental Health Department - ASL Roma 2, Rome, Italy
| | - G Duccio Papanti
- Udine Mental Health Department - SOPDC, Udine, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Herts, England
| | - Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Herts, England.,Neomesia Mental Health, Villa Jolanda Hospital, Jesi, Italy.,Polyedra Research, Teramo, Italy
| | - Chiara Rapinesi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Valeria Savoja
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,Mental Health Department, ASL Roma 4, Rome, Italy
| | - Giuseppa Calabrò
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Daria Piacentino
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology (Cpn), Niaaa Dicbr and Nida Irp; National Institutes of Health, Bethesda, MD, USA
| | - Matteo Caloro
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Paolo Girardi
- NESMOS Department (Neurosciences, Mental Health and Sensory Organs), Sapienza University - Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Herts, England
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6
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Ghaly RF, Plesca A, Rana S, Candido KD, Knezevic NN. Gabapentin-related suicide: Myth or fact? Surg Neurol Int 2018; 9:210. [PMID: 30488008 PMCID: PMC6213802 DOI: 10.4103/sni.sni_420_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/01/2017] [Indexed: 01/07/2023] Open
Abstract
Background: The opioid epidemic in America is real and is estimated to be the number one cause of death in adults under 50 years of age. Finding alternative analgesic medications is part of the effort to decrease the prescription of narcotics, with gabapentin being at the top of the list. Case Description: In the present case, we discuss the side-effects of gabapentin, used as part of the multimodal treatment approach of painful spinal degenerative disease. The patient stated that he had noticed personality changes after gabapentin was initiated, and that he had become more depressed, frustrated, and aggressive. His uncontrolled pain and acute mood changes led him to attempt suicide by hanging himself. Gabapentin was discontinued and the patient's suicidal ideation completely subsided. Conclusion: It is imperative to screen, identify, and appropriately manage patients with underlying psychiatric disorders prior to initiating pain management with gabapentin. Therefore, it is crucial to raise awareness of gabapentin as a potential cause of depression, aggressive behavior, and suicidal ideation.
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Affiliation(s)
- Ramsis F Ghaly
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Ghaly Neurosurgical Associates, Aurora, Chicago, Illinois, USA.,Department of Anesthesiology, University of Illinois, Chicago, Illinois, USA
| | - Ana Plesca
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Shalini Rana
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Department of Anesthesiology, University of Illinois, Chicago, Illinois, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Department of Anesthesiology, University of Illinois, Chicago, Illinois, USA
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7
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Peckham AM, Fairman KA, Sclar DA. Prevalence of Gabapentin Abuse: Comparison with Agents with Known Abuse Potential in a Commercially Insured US Population. Clin Drug Investig 2017; 37:763-773. [DOI: 10.1007/s40261-017-0530-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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8
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9
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Abstract
The objective of this study was to evaluate the extent of gabapentin misuse in a dually diagnosed correctional population, and to evaluate if this abuse is specific to the presence of an opioid use disorder (OUD). Two-hundred and fifty former inmates, living in a correctional community center, who were referred for a psychiatric evaluation, were asked, through a brief written questionnaire, whether or not they used the following drugs for non-medical use in the past: opiates, gabapentin, buproprion, quetiapine, and fluoxetine. The average age of this population was 37.2 ± 12.1 years (n = 250). Sixty-four percent were male, 72 % were white, 27 % were black, and 1 % was Hispanic. All patients had substance use disorders, the large majority (72 %) to more than one substance. Fifty-eight percent had an opioid use disorder, again mostly in combination with other drugs and/or alcohol. Depressive disorders and attention deficit hyperactivity disorder were the most common psychiatric conditions. Sixty-two percent of patients reported prescription drug misuse of any kind. As expected, a high percent (55 %) reported opiate misuse. No patient reported fluoxetine misuse. Sixteen percent reported having misused gabapentin in the past. Of patients with an opioid use disorder (OUD: n = 145), 26 % endorsed gabapentin abuse while only 4 % of patients without an OUD (n = 105) endorsed the non-medical use of gabapentin. This difference was highly statistically significant (Chi square χ2 = 21.6, p < 0.0001). A growing concern about gabapentin misuse was supported in this study: 26 percent of opiate addicted patients reported illegally obtaining, overusing, or malingering problems to obtain gabapentin. This study highlights the fact that gabapentin abuse appears specific to an opioid addicted population.
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Affiliation(s)
- Leo Bastiaens
- Renewal Treatment Inc., 700 Fifth Ave, Pittsburgh, PA, 15219, USA.
| | - James Galus
- Renewal Treatment Inc., 700 Fifth Ave, Pittsburgh, PA, 15219, USA
| | - Cherise Mazur
- Renewal Treatment Inc., 700 Fifth Ave, Pittsburgh, PA, 15219, USA
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10
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Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction 2016; 111:1160-74. [PMID: 27265421 PMCID: PMC5573873 DOI: 10.1111/add.13324] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/24/2015] [Accepted: 01/20/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Since its market release, gabapentin has been presumed to have no abuse potential and subsequently has been prescribed widely off-label, despite increasing reports of gabapentin misuse. This review estimates and describes the prevalence and effects of, motivations behind and risk factors for gabapentin misuse, abuse and diversion. METHODS Databases were searched for peer-reviewed papers demonstrating gabapentin misuse, characterized by taking a larger dosage than prescribed or taking gabapentin without a prescription, and diversion. All types of studies were considered; grey literature was excluded. Thirty-three papers met inclusion criteria, consisting of 23 case studies and 11 epidemiological reports. Published reports came from the United States, the United Kingdom, Germany, Finland, India, South Africa and France, and two analyzed websites not specific to a particular country. RESULTS Prevalence of gabapentin misuse in the general population was reported to be 1%, 40-65% among individuals with prescriptions and between 15 and 22% within populations of people who abuse opioids. An array of subjective experiences reminiscent of opioids, benzodiazepines and psychedelics were reported over a range of doses, including those within clinical recommendations. Gabapentin was misused primarily for recreational purposes, self-medication or intentional self-harm and was misused alone or in combination with other substances, especially opioids, benzodiazepines and/or alcohol. Individuals with histories of drug abuse were most often involved in its misuse. CONCLUSIONS Epidemiological and case report evidence suggests that the anti-epileptic and analgesic medication gabapentin is being misused internationally, with substance abuse populations at special risk for misuse/abuse.
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Affiliation(s)
- Rachel V. Smith
- Center on Drug and Alcohol Research, Department of Behavioral
Science, University of Kentucky College of Medicine, Lexington, KY
- Department of Epidemiology, University of Kentucky College of Public
Health, Lexington, KY
- Department of Biostatistics, University of Kentucky College of
Public Health, Lexington, KY
| | - Jennifer R. Havens
- Center on Drug and Alcohol Research, Department of Behavioral
Science, University of Kentucky College of Medicine, Lexington, KY
- Department of Epidemiology, University of Kentucky College of Public
Health, Lexington, KY
| | - Sharon L. Walsh
- Center on Drug and Alcohol Research, Department of Behavioral
Science, University of Kentucky College of Medicine, Lexington, KY
- Department of Pharmacology, University of Kentucky College of
Medicine, Lexington, KY
- Department of Pharmaceutical Sciences, University of Kentucky
College of Pharmacy, Lexington, KY
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11
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Berlin RK, Butler PM, Perloff MD. Gabapentin Therapy in Psychiatric Disorders: A Systematic Review. Prim Care Companion CNS Disord 2015; 17:15r01821. [PMID: 26835178 DOI: 10.4088/pcc.15r01821] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/12/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Gabapentin is commonly used off-label in the treatment of psychiatric disorders with success, failure, and controversy. A systematic review of the literature was performed to elucidate the evidence for clinical benefit of gabapentin in psychiatric disorders. DATA SOURCES Bibliographic reference searches for gabapentin use in psychiatric disorders were performed in PubMed and Ovid MEDLINE search engines with no language restrictions from January 1, 1983, to October 1, 2014, excluding nonhuman studies. For psychiatric references, the keywords bipolar, depression, anxiety, mood, posttraumatic stress disorder (posttraumatic stress disorder and PTSD), obsessive-compulsive disorder (obsessive-compulsive disorder and OCD), alcohol (abuse, dependence, withdraw), drug (abuse, dependence, withdraw), opioid (abuse, dependence, withdraw), cocaine (abuse, dependence, withdraw), and amphetamine (abuse, dependence, withdraw) were crossed with gabapentin OR neurontin. STUDY SELECTION AND DATA EXTRACTION The resulting 988 abstracts were read by 2 reviewers; references were excluded if gabapentin was not a study compound or psychiatric symptoms were not studied. The resulting references were subsequently read, reviewed, and analyzed; 219 pertinent to gabapentin use in psychiatric disorders were retained. Only 34 clinical trials investigating psychiatric disorders contained quality of evidence level II-2 or higher. RESULTS Gabapentin may have benefit for some anxiety disorders, although there are no studies for generalized anxiety disorder. Gabapentin has less likely benefit adjunctively for bipolar disorder. Gabapentin has clearer efficacy for alcohol craving and withdrawal symptoms and may have a role in adjunctive treatment of opioid dependence. There is no clear evidence for gabapentin therapy in depression, PTSD prevention, OCD, or other types of substance abuse. Limitations of available data include variation in dosing between studies, gabapentin as monotherapy or adjunctive treatment, and differing primary outcomes between trials. CONCLUSIONS Further research is required to better clarify the benefit of gabapentin in psychiatric disorders.
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Affiliation(s)
- Rachel K Berlin
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Paul M Butler
- Department of Neurology, Tufts University School of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Michael D Perloff
- Department of Neurology, Boston University School of Medicine, Boston University Medical Center, Boston, Massachusetts
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