Profile of Substance Misuse among Adolescent and Young Adult Gabapentinoid Users: A Register-Based Follow-up Study of Former Adolescent Psychiatric Inpatients

Gabapentinoid Dispensing to Children and Adolescents in the United States

INTRODUCTION

Gabapentin and pregabalin (gabapentinoids), are increasingly prescribed to children and adolescents off-label for various conditions, despite limited data and concerns for adverse outcomes including misuse and overdose. The extent of gabapentinoid use in children and adolescents is unknown.

METHODS

Nationally representative retail pharmacy dispensing data from IQVIA, was used to describe trends in gabapentinoid dispensing to children and adolescents aged ≤19 years from April 2017 through September 2023. The analysis was performed in 2024. Trends by patient age and sex, and by prescriber specialty are presented along with median quarterly rates (MQR) and quarterly percentage changes (QPC).

RESULTS

Over the study period, the gabapentinoid dispensing rate was 4534.9/100,000 individuals. The MQR was 168.9/100,000. Between Q2 2017 and Q2 2021, the QPC was not significant (QPC=0.08; 95%CI: -2.9, 0.8) but became significant between Q2 2021 and Q3 2023 (QPC: 2.8; 95% CI: 1.2, 8.4). Dispensing rates were highest for adolescents aged 10-19 years (MQR = 267.3/100,000) and females (MQR=187.6/100,000). Nurse practitioners prescribed the highest percent of gabapentinoids dispensed (17.8%). The total number of gabapentinoids dispensed increased from 2018 to 2022 across all specialties except psychiatry (-14.8%) and internal medicine (-9.2%), with nurse practitioners (48.2%), surgical specialists (48.0%), and addiction medicine specialists (51.2%) representing the largest increases.

CONCLUSIONS

Gabapentinoid receipt among US children and adolescents has increased. Future research can explore factors associated with prescribing including changing epidemiology of pain and psychiatric diagnoses in children and adolescents. Prescribing clinicians should carefully consider the potential risks and benefits of gabapentinoids in clinical practice.

Deprescribing interventions for gabapentinoids in adults: A scoping review

The emerging issue of rising gabapentinoid misuse is being recognized alongside the lack of current evidence supporting the safe and effective deprescribing of gabapentinoids. This scoping review aimed to assess the extent and nature of gabapentinoid deprescribing interventions in adults, either in reducing dosages, or prescribing of, gabapentinoids. Electronic databases were searched on 23 February 2022 without restrictions. Eligible studies included randomized, non-randomized and observational studies that assessed an intervention aimed at reducing/ceasing the prescription/use of a gabapentinoid in adults for any indication in a clinical setting. The research outcomes investigated the type of intervention, prescribing rates, cessations, patient outcomes and adverse events. Extracted outcome data were categorized as either short (≤3 months), intermediate (>3 but <12 months) or long (≥12 months) term. A narrative synthesis was conducted. The four included studies were conducted in primary and acute care settings. Interventions were of dose-reducing protocols, education and/or pharmacological-based approaches. In the randomized trials, gabapentinoid use could be ceased in at least one third of participants. In the two observational trials, gabapentinoid prescribing rates decreased by 9%. Serious adverse events and adverse events specifically related to gabapentinoids were reported in one trial. No study included patient-focused psychological interventions in the deprescribing process, nor provided any long-term follow-up. This review highlights the lack of existing evidence in this area. Due to limited available data, our review was unable to make any firm judgements on the most effective gabapentinoid deprescribing interventions in adults, highlighting the need for more research in this area.

Misuse of prescribed psychotropic medication and drug crime offending: A follow-up case-control study of former adolescent psychiatric inpatients

BACKGROUND

Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly.

AIMS

Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13-17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending.

METHODS

Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis.

RESULTS

75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders' purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending.

CONCLUSIONS

Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions.