Gabapentin- The New Oxy

Over the last few years as the opioid epidemic ravages parts of the country there is growing concern over other medications that may be adding “fuel to the fire” for people with SUDsGabapentin is apparently being used more as an adjunct or replacement for substance users, especially those that use opiates.In December 2016 the Ohio Board of Pharmacy added gabapentin to its list of monitored controlled substances, even though it is not classified as such, after it became the most prescribed medication in the state. It was prescribed more than oxycodone by 9 million doses! In the entire US, gabapentin was the 5th most-prescribed drug in May 2017.

There are now concerns about misuse and diversion of gabapentin that were once reserved for opiates. A systematic review done last year included 33 studies and reports from 7 different studies and found gabapentin misuse in 1% of the general population but between 15-22% in people who also misuse opioids. Another study from a cohort of 500+ adults in Kentucky who reported nonmedical use of opioids, notes 15% also used gabapentin “to get high” in the previous 6 months. While this doesn’t seem like a lot it represented an almost 3000% (not a typo) increase in gabapentin use in this cohort since 2008.

From across the pond, a study from University of Bristol found an increase in gabapentoid (pregabalin and gabapentin) associated deaths increased from ~ 1/year in 2009 to a total of 137 in 2015. This corresponded with a 10 fold increase in gabapentoid prescribing from 2004 – 2015. People with SUD have reported that the gabepentoids apparently enhances the effects of heroin and other opiates. Experiments have also shown that low dose pregabalin will reduce heroin tolerance while at higher doses actually contributes to respiratory depression itself thus increasing the chance of overdosing.

A recent Cochrane review (June 2017) did find that:

There is moderate-quality evidence that oral gabapentin at doses of 1200 mg daily or more has an important effect on pain in some people with moderate or severe neuropathic pain after shingles or due to diabetes.

But in addition:

Over half of those treated with gabapentin will not have worthwhile pain relief but may experience adverse events.

 

Of course some people can/will turn anything into a drug….

 

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