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Pelerin JM, Fristot L, Gibaja V, Revol B, Gillet P, Lima-Tournebize J. Non-medical use of baclofen: A case series and review of the literature. Therapie 2023; 78:615-637. [PMID: 36922285 DOI: 10.1016/j.therap.2023.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/11/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Baclofen is widely used for spastic disorders and, most recently, for addictive disorders. The first signals of baclofen abuse occurred in the last decade. This study aims to assess the motives, diversion sources, and routes of administration associated with the non-medical use of baclofen and examine health problems related to the non-medical use of baclofen. METHODS Spontaneous reports of baclofen abuse reported to the addictovigilance centre of East France were analysed. A literature search was conducted using PubMed®, Web of Sciences®, and Google Scholar® databases. Both investigations were performed in February 2021 without a time limit. RESULTS Forty-six cases were analysed (33 from the literature review and 13 from the addictovigilance base). Baclofen's non-medical use mainly affected male subjects with addictive history, but issues of primary abuse in subjects without any substance abuse history were also observed. Euphoria search was the most common reason for misuse. The route of administration included oral, snorting, and sublingual use. Some cases involving illegal sources were also observed. Most patients misusing baclofen presented severe complications, mainly represented by neurological and respiratory disturbances. Physical and psychological dependence on baclofen was observed in three persons. CONCLUSIONS Although baclofen abuse remains relatively infrequent or (most likely) underestimated, this study helped confirm baclofen's intrinsic abuse potential and make visible the baclofen-abuse-related health visible harms. Careful consideration and benefit-risk analysis should be employed when prescribing baclofen, and emergency departments should be aware of baclofen dangers in abuse situations.
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Affiliation(s)
- Jean-Marc Pelerin
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France
| | - Lisa Fristot
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France
| | - Valérie Gibaja
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France; French Addictovigilance Network (FAN), 33000 Bordeaux, France
| | - Bruno Revol
- French Addictovigilance Network (FAN), 33000 Bordeaux, France; CEIP-Addictovigilance, university hospital of Grenoble, 38000 Grenoble, France
| | - Pierre Gillet
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France; Université de Lorraine, CNRS, IMoPA, 54000 Nancy, France
| | - Juliana Lima-Tournebize
- CEIP-addictovigilance, university hospital of Nancy, 54000 Vandœuvre-lès-Nancy, France; French Addictovigilance Network (FAN), 33000 Bordeaux, France.
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2
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Syed O, Jancic P, Fink AB, Knezevic NN. Drug Safety and Suicidality Risk of Chronic Pain Medications. Pharmaceuticals (Basel) 2023; 16:1497. [PMID: 37895968 PMCID: PMC10609967 DOI: 10.3390/ph16101497] [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] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic pain is one of the main leading causes of disability in the world at present. A variety in the symptomatology, intensity and duration of this phenomenon has led to an ever-increasing demand of pharmacological treatment and relief. This demand for medication, ranging from well-known groups, such as antidepressants and benzodiazepines, to more novel drugs, was followed by a rise in safety concerns of such treatment options. The validity, frequency, and diversity of such concerns are discussed in this paper, as well as their possible effect on future prescription practices. A specific caution is provided towards the psychological safety and toll of these medications, regarding suicidality and suicidal ideation. Most significantly, this paper highlights the importance of pharmacovigilance and underscores the necessity of surveillance programs when considering chronic pain medication.
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Affiliation(s)
- Osman Syed
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA
| | - Predrag Jancic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
| | - Adam B. Fink
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Harborview Medical Center, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98104, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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3
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McLaughlin MJ, Fisher MT. A critical evaluation of oral baclofen in pediatric patients with cerebral palsy. J Pediatr Rehabil Med 2023; 16:3-9. [PMID: 36872802 PMCID: PMC10116143 DOI: 10.3233/prm-230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Affiliation(s)
- Matthew J McLaughlin
- Children's Mercy -Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Mark T Fisher
- Children's Mercy -Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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4
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Gibson CJ, Li Y, Jasuja GK, Keyhani S, Byers AL. Long-term Psychoactive Medications, Polypharmacy, and Risk of Suicide and Unintended Overdose Death Among Midlife and Older Women Veterans. J Gen Intern Med 2022; 37:770-777. [PMID: 36042093 PMCID: PMC9481785 DOI: 10.1007/s11606-022-07592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rates of suicide and unintended overdose death are high among midlife and older women, yet there is paucity of data identifying women at greatest risk. Psychoactive medications, commonly prescribed and co-prescribed in this population, may serve as salient indicators of risk for these outcomes. OBJECTIVE To determine whether long-term psychoactive medications and psychoactive polypharmacy predict risk of suicide and unintended overdose death among midlife and older women Veterans above and beyond other recognized factors. DESIGN Longitudinal cohort study PARTICIPANTS: Women Veterans aged ≥ 50 with at least one Veterans Health Administration (VHA) clinical encounter in FY2012-2013. MAIN MEASURES Long-term psychoactive medications (opioids, benzodiazepines, sedative-hypnotics, antidepressants, antipsychotics, and antiepileptics, prescribed for ≥ 90/180 days) and psychoactive polypharmacy (overlapping for ≥ 1 day) from VHA pharmacy records; suicide and unintended overdose death through December 31, 2018. KEY RESULTS In this national sample of 154,558 midlife and older women Veterans (mean age 63.4, SD 9.3 years), 130 died by suicide and 175 died from unintentional overdose over an average of 5.6 years. In fully adjusted models, long-term opioids (hazard ratio (HR) 2.01, 95% CI 1.21-3.35) and benzodiazepines (HR 2.99, 95% CI 1.82-4.91) were associated with death by suicide; opioids (HR 3.62, 95% CI 2.46-5.34), benzodiazepines (HR 2.77, 95% CI 1.73-4.42), sedative-hypnotics (HR 1.87, 95% CI 1.06-3.29), antidepressants (HR 1.47, 95% CI 1.03-2.12), antipsychotics (HR 1.81, 95% CI 1.02-3.22), and antiepileptics (HR 2.17, 95% CI 1.48-3.19) were associated with unintended overdose death. Women who were co-prescribed ≥ 3 psychoactive medications had over 2-fold increased risk of suicide (HR 2.83, 95% CI 1.65-4.84) and unintended overdose death (HR 2.60, 95% CI 1.72-3.94). CONCLUSIONS Long-term psychoactive medications and psychoactive medication polypharmacy were important indicators of risk for death by suicide and death by unintended overdose among midlife and older women Veterans, even after accounting for psychiatric and substance use disorders.
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Affiliation(s)
- Carolyn J Gibson
- San Francisco VA Health Care System, 4150 Clement Street, 116P, San Francisco, CA, 94121, USA.
- University of California, San Francisco, San Francisco, USA.
| | - Yixia Li
- NCIRE-The Veterans Health Research Institute, San Francisco, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, USA
- Boston University School of Medicine, Boston, USA
| | - Salomeh Keyhani
- San Francisco VA Health Care System, 4150 Clement Street, 116P, San Francisco, CA, 94121, USA
- University of California, San Francisco, San Francisco, USA
| | - Amy L Byers
- San Francisco VA Health Care System, 4150 Clement Street, 116P, San Francisco, CA, 94121, USA
- University of California, San Francisco, San Francisco, USA
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5
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Mattson CL, Chowdhury F, Gilson TP. Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths - 23 States and the District of Columbia, 2019-2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:664-666. [PMID: 35552367 PMCID: PMC9098248 DOI: 10.15585/mmwr.mm7119a3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Epstein SE, Hopper K, Farrell KS. Manual plasma exchange to treat an accidental overdose of intravenous lipid emulsion in a dog with baclofen toxicosis. J Am Vet Med Assoc 2022; 260:650-656. [DOI: 10.2460/javma.21.03.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
CASE DESCRIPTION
An approximately 2-year-old sexually intact male German Shorthair Pointer was presented for treatment of baclofen toxicosis.
CLINICAL FINDINGS
The dog had signs of severe baclofen toxicosis (no gag reflex, intermittent vocalization, and stupor) and received intravenous lipid emulsion (142 mL/kg) as a constant rate infusion over 11 hours. Severe hypertriglyceridemia (29,221 mg/dL; reference interval, 19 to 133 mg/dL) developed, followed by cardiovascular depression (poor peripheral perfusion, hyperlactatemia, and hypertension), severe hypoglycemia (26 mg/dL), acute kidney injury (serum creatinine, 3.6 mg/dL), intravascular hemolysis, and coagulopathy (hypocoagulable thromboelastogram and marked bilateral epistaxis).
TREATMENT AND OUTCOME
Therapeutic plasma exchange was performed in 4 stages to treat the hypertriglyceridemia. For each stage, an approximately 500-mL aliquot of blood (22 mL/kg) was removed and centrifuged, and the patient’s RBCs and allogenic fresh-frozen plasma were returned to the dog. Approximately 1.2 times the dog’s plasma volume was exchanged, reducing the serum triglyceride concentration to 1,349 mg/dL and improving the dog’s cardiovascular function and coagulation. Hours after the procedure was completed, the dog regurgitated and developed acute respiratory distress as a result of presumptive aspiration pneumonia, and the owner elected to have the dog euthanized.
CLINICAL RELEVANCE
Veterinarians should be aware of possible complications associated with administration of intravenous lipid emulsion, and veterinary-specific guidelines for the maximum dose of intravenous lipid emulsion should be developed to help prevent adverse effects. TPE appears to be an effective method for treating iatrogenic hypertriglyceridemia in dogs.
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Affiliation(s)
- Steven E. Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Kate S. Farrell
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
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7
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Hadlandsmyth K, Bernardy NC, Lund BC. Central nervous system polytherapy among veterans with posttraumatic stress disorder: changes across a decade. Gen Hosp Psychiatry 2022; 74:46-50. [PMID: 34906798 DOI: 10.1016/j.genhosppsych.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objectives were to investigate rates and patterns of polytherapy among veterans with PTSD across time (in 2009 and 2019), describe features of polytherapy prescribing, and identify demographic and clinical factors associated with polytherapy. METHODS Veterans Affairs (VA) administrative data were used to build cohorts of all VA-served veterans with PTSD in 2009 (N = 458,620) and 2019 (N = 877,785). Frequency of CNS active drug classes, rates of polytherapy (≥5 concurrent CNS drugs), clinical features associated with polytherapy, number of prescribers, and patterns of co-prescribed medications were examined. RESULTS The 12-month period prevalence of CNS polytherapy declined from 12.1% in 2009 to 6.9% in 2019. However, polytherapy rates increased from 3.3% in 2009 to 4.1% in 2019, when opioids and benzodiazepines were excluded. In multivariable regression analysis, CNS polytherapy was more common among women, White people, middle-age veterans (45-64 years), rural residents, veterans receiving care at a medical center, and those with psychiatric comorbidities. CNS polytherapy regimens involved a mean of 2.3 prescribers and the majority (86.6%) included at least one medication commonly prescribed for pain management. CONCLUSIONS CNS polytherapy declined among veterans with PTSD from 2009 to 2019 and was wholly attributable to decreases in opioid and benzodiazepine prescribing.
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Affiliation(s)
- Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; University of Iowa, Carver College of Medicine, Department of Anesthesia, 200 Hawkins Dr, Iowa City, IA 52242-1089, USA.
| | - Nancy C Bernardy
- White River Junction VA Medical Center Research Department, White River Junction, VT, USA; National Center for PTSD, White River Junction, VT, USA; Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, NH, USA
| | - Brian C Lund
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246-2208, USA; University of Iowa College of Public Health, Department of Epidemiology, Iowa City, IA, USA
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8
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Karavolis ZA, Su AB, Peckham AM. State-level response to gabapentin misuse in the United States: Implications and future direction. Am J Health Syst Pharm 2021; 79:e143-e148. [PMID: 34951456 DOI: 10.1093/ajhp/zxab486] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Gabapentin misuse is on the rise and has forced many US states to mobilize policies to address this public health concern. The purpose of this manuscript is to update state-level gabapentin misuse-related policies in the US through September 1, 2021, discuss the benefits and risks of current measures, and highlight gaps in national response. METHODS Identification of state and federal district policy changes and deliberations related to gabapentin were searched via internet for all 50 states and 1 federal district (n = 51). Only results from state regulatory bodies, such as the board of pharmacy, or state legislative bodies, such as the senate, were considered for inclusion. RESULTS Results showed that 22 states and federal districts (43.1%) tightened regulation, while another 2 (3.9%) are considering doing so. Of the 22 states and federal districts with policy changes, 15 (68.2%) enrolled gabapentin into their prescription drug monitoring program, while 7 (31.8%) reclassified gabapentin as a Schedule V controlled substance (C-V). CONCLUSION Absent of federal guidance surrounding gabapentin misuse, the onus has fallen on individual states; thus, approaches have ranged from no intervention to reclassification as a C-V. These measures aim to reduce medication supply but fall short of addressing patient outcomes and reducing harm. Therefore, harm reduction-informed public health policies must be implemented to positively impact patient outcomes and enhance safety.
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Affiliation(s)
- Zoe A Karavolis
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, and School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew B Su
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Alyssa M Peckham
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
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9
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Aindow S, Crossin R, Toop L, Hudson B. Managing the misuse potential and risk of psychological harm from gabapentinoids in primary care in New Zealand. J Prim Health Care 2021; 13:302-307. [PMID: 34937640 DOI: 10.1071/hc21011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Gabapentinoid prescribing is increasing in New Zealand. International evidence suggests that this prescribing trend is followed by increasing harms, including misuse, dependence, overdose, and psychological harms including suicidal thoughts or behaviours. However, there is limited guidance for prescribers on how to manage these potential harms. Here, we summarise the current international literature and identify three main risk factors that can be used for screening purposes when considering prescribing a gabapentinoid, to identify patients that may be at greater risk of harm. Based on current knowledge of harms, we provide guidance to prescribers on monitoring patients taking gabapentinoids. Finally, we summarise the evidence regarding tapering, and highlight key knowledge gaps including other interventions, referral, and data from primary care populations.
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Affiliation(s)
- Shaun Aindow
- University of Otago Medical School, Christchurch, New Zealand
| | - Rose Crossin
- Department of Population Health, University of Otago Medical School, 34 Gloucester St, Christchurch, New Zealand; and Corresponding author.
| | - Les Toop
- Department of General Practice, University of Otago Medical School, Christchurch, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago Medical School, Christchurch, New Zealand
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Bouchard J, Yates C, Calello DP, Gosselin S, Roberts DM, Lavergne V, Hoffman RS, Ostermann M, Peng A, Ghannoum M. Extracorporeal Treatment for Gabapentin and Pregabalin Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Am J Kidney Dis 2021; 79:88-104. [PMID: 34799138 DOI: 10.1053/j.ajkd.2021.06.027] [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: 02/27/2021] [Accepted: 06/11/2021] [Indexed: 11/11/2022]
Abstract
Toxicity from gabapentin and pregabalin overdose is commonly encountered. Treatment is supportive, and the use of extracorporeal treatments (ECTRs) is controversial. The EXTRIP workgroup conducted systematic reviews of the literature and summarized findings following published methods. Thirty-three articles (30 patient reports and 3 pharmacokinetic studies) met the inclusion criteria. High gabapentinoid extracorporeal clearance (>150mL/min) and short elimination half-life (<5 hours) were reported with hemodialysis. The workgroup assessed gabapentin and pregabalin as "dialyzable" for patients with decreased kidney function (quality of the evidence grade as A and B, respectively). Limited clinical data were available (24 patients with gabapentin toxicity and 7 with pregabalin toxicity received ECTR). Severe toxicity, mortality, and sequelae were rare in cases receiving ECTR and in historical controls receiving standard care alone. No clear clinical benefit from ECTR could be identified although major knowledge gaps were acknowledged, as well as costs and harms of ECTR. The EXTRIP workgroup suggests against performing ECTR in addition to standard care rather than standard care alone (weak recommendation, very low quality of evidence) for gabapentinoid poisoning in patients with normal kidney function. If decreased kidney function and coma requiring mechanical ventilation are present, the workgroup suggests performing ECTR in addition to standard care (weak recommendation, very low quality of evidence).
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Affiliation(s)
- Josée Bouchard
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Christopher Yates
- Emergency Department and Clinical Toxicology Unit, Hospital Universitari Son Espases, SAMU 061, Balears, Spain; IdISBa Clinical Toxicology Workgroup, Palma de Mallorca, Spain
| | - Diane P Calello
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; New Jersey Poison Information and Education System, Newark, New Jersey
| | - Sophie Gosselin
- Centre Intégré de Santé et de Services Sociaux, Montérégie-Centre Emergency Department, Hôpital Charles-Lemoyne, Greenfield Park, Quebec, Canada; Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada; Centre Antipoison du Québec, Quebec City, Quebec, Canada
| | - Darren M Roberts
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Valéry Lavergne
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Robert S Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Marlies Ostermann
- Department of Critical Care & Nephrology, King's College, London, United Kingdom; Guy's & St Thomas Hospital, London, United Kingdom
| | - Ai Peng
- Department of Nephrology and Rheumatology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Marc Ghannoum
- Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada.
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11
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Weresch J, Kirkwood J, Korownyk CS. Gabapentin for alcohol use disorder. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:269. [PMID: 33853915 DOI: 10.46747/cfp.6704269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Justin Weresch
- Family physician at McMaster Family Practice in Hamilton, Ont
| | - Jessica Kirkwood
- Family physician at Boyle McCauley Health Centre in Edmonton, Alta
| | - Christina S Korownyk
- Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton
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12
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Khan NF, Bykov K, Glynn RJ, Barnett ML, Gagne JJ. Coprescription of Opioids With Other Medications and Risk of Opioid Overdose. Clin Pharmacol Ther 2021; 110:1011-1017. [PMID: 34048030 DOI: 10.1002/cpt.2314] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/23/2021] [Indexed: 12/26/2022]
Abstract
Polypharmacy is common among patients taking prescription opioids long-term, and the codispensing of interacting medications may further increase opioid overdose risk. To identify nonopioid medications that may increase opioid overdose risk in this population, we conducted a case-crossover-based screening of electronic claims data from IBM MarketScan and Optum Clinformatics Data Mart spanning 2003 through 2019. Eligible patients were 18 years of age or older and had at least 180 days of continuous enrollment and 90 days of prescription opioid use immediately before an opioid overdose resulting in an emergency room visit or hospitalization. The main analysis quantified the odds ratio (OR) between opioid overdose and each nonopioid medication dispensed in the 90 days immediately before the opioid overdose date after adjustment for prescription opioid dosage and benzodiazepine codispensing. Additional analyses restricted to patients without cancer diagnoses and individuals who used only oxycodone for 90 days immediately before the opioid overdose date. The false discovery rate (FDR) was used to account for multiple testing. We identified 24,866 individuals who experienced opioid overdose. Baclofen (OR 1.56; FDR < 0.01; 95% confidence interval (CI), 1.29 to 1.89), lorazepam (OR 1.53; FDR < 0.01; 95% CI, 1.25 to 1.88), and gabapentin (OR 1.16; FDR = 0.09; 95% CI, 1.04 to 1.28), among other nonopioid medications, were associated with opioid overdose. Similar patterns were observed in noncancer patients and individuals who used only oxycodone. Interventions may focus on prescribing safer alternatives when a potential for interaction exists.
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Affiliation(s)
- Nazleen F Khan
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katsiaryna Bykov
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael L Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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13
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McAnally HB, Bonnet U. Response to Comment on "Gabapentinoid Benefit and Risk Stratification: Mechanisms Over Myth". Pain Ther 2021; 10:757-762. [PMID: 33565040 PMCID: PMC8119509 DOI: 10.1007/s40122-020-00224-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Heath B McAnally
- Northern Anesthesia and Pain Medicine, LLC, Eagle River, AK, USA. .,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Oh GY, Slavova S, Freeman PR. Characterization of gabapentin use in Kentucky after reclassification as a Schedule V controlled substance. J Am Pharm Assoc (2003) 2021; 61:e86-e92. [PMID: 33422420 DOI: 10.1016/j.japh.2020.12.012] [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: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Owing to increasing concern over the potential for gabapentin misuse, gabapentin was reclassified as a schedule V controlled substance in Kentucky (July 2017). OBJECTIVE This study aimed to characterize gabapentin use among Kentucky residents in the first year after its scheduling. METHODS This study used Kentucky All Schedule Prescription Electronic Reporting data (2018). Gabapentin use was defined as having at least 1 dispensed gabapentin prescription, and high-dose gabapentin use was defined as an average daily dose of more than 3600 mg at the patient level. The prevalence of gabapentin use, concurrent use of gabapentin with opioid analgesics (OAs) (gabapentin-OA), and gabapentin with OAs and benzodiazepines (BDZs) (gabapentin-OA-BDZ) were assessed. Estimated prevalence rate ratio and its 95% CI were reported to compare gabapentin use rates across different demographic groups. RESULTS A total of 16% of all 2018 controlled substance prescriptions were for gabapentin, and approximately 20% of Kentucky residents with controlled substance prescriptions received gabapentin at least once in 2018. The overall prevalence of gabapentin use was 63 per 1000 residents, with the highest rates among residents aged 55-64 years (126.9 per 1000). The prevalence of gabapentin use was higher in females (74.6 per 1000) versus males (50.6 per 1000) and in residents living in the Appalachian region (88.57 per 1000) versus Central (51.78 per 1000) and Delta (66.41 per 1000) regions. Among gabapentin users, 1% were high-dose users; 27.4% and 11.9% received gabapentin-OA or gabapentin-OA-BDZ concurrently, respectively. As the average daily dose increased from less than 900 mg to high-dose, the percentage of concurrent gabapentin-OA use increased from 13.4% to 50.7%. CONCLUSION Gabapentin is widely prescribed in Kentucky, with higher rates of use observed in females, those older than 55 years and individuals living in the Appalachian region. Concurrent use of gabapentin and OAs is common, especially in those receiving high-dose gabapentin. Future studies are needed to assess the risks associated with gabapentin use.
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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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Abstract
Baclofen, β-(4-chlorophenyl)-γ-aminobutyric acid, holds a unique position in neuroscience, remaining the only U.S. Food and Drug Administration (FDA) approved GABAB agonist. While intended to be a more brain penetrant, i.e, ability to cross the blood-brain barrier (BBB), version of GABA (γ-aminobutyric acid) for the potential treatment of epilepsy, baclofen's highly efficacious muscle relaxant properties led to its approval, as a racemate, for the treatment of spasticity. Interestingly, baclofen received FDA approval before its receptor, GABAB, was discovered and its exact mechanism of action was known. In recent times, baclofen has a myriad of off-label uses, with the treatment for alcohol abuse and drug addiction garnering a great deal of attention. This Review aims to capture the >60 year legacy of baclofen by walking through the history, pharmacology, synthesis, drug metabolism, routes of administration, and societal impact of this Classic in chemical neuroscience.
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Affiliation(s)
- Caitlin N. Kent
- Warren Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Chemistry, Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - Charlotte Park
- Warren Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
| | - Craig W. Lindsley
- Warren Center for Neuroscience Drug Discovery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
- Department of Chemistry, Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, Tennessee 37232, United States
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
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Hughes P, Ostrach B. Trends in exposure to over-reach: a comment on the methodology of Reynolds et al. 2019. Clin Toxicol (Phila) 2020; 59:85-86. [PMID: 32368941 DOI: 10.1080/15563650.2020.1761024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Bayla Ostrach
- UNC Health Sciences at MAHEC, Asheville, NC, USA.,Family Medicine, Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
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Clough I. Clinical News. Br J Hosp Med (Lond) 2019; 80:692-695. [PMID: 31822174 DOI: 10.12968/hmed.2019.80.12.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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