1
|
McNeilage AG, Sim A, Nielsen S, Murnion B, Ashton-James CE. Experiences of misuse and symptoms of dependence among people who use gabapentinoids: A qualitative systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 133:104605. [PMID: 39388918 DOI: 10.1016/j.drugpo.2024.104605] [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: 04/29/2024] [Revised: 08/11/2024] [Accepted: 09/26/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND Gabapentinoids are among the most widely prescribed pain medications worldwide. However, there is growing evidence of harms associated with their use. The aim of this study was to systematically review and synthesise qualitative research exploring lived experiences of gabapentinoid (pregabalin and/or gabapentin) misuse and symptoms of dependence. METHODS Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) and grey literature sources were searched from inception to September 2023. The methodological quality of included studies was appraised using a modified 11-item version of the Critical Appraisal Skills Programme qualitative checklist, and higher quality studies were prioritised in the thematic synthesis. Confidence in the overall findings of the review was assessed using the GRADE-CERQual approach. The review was prospectively registered on PROSPERO (CRD42023401832). RESULTS Twenty-six articles representing 21 original studies were included. The majority used interview methods and were of high methodological quality. Motives for gabapentinoid misuse included getting high, potentiating or offsetting the effects of other drugs, self-medicating for pain, distress, insomnia, or withdrawal symptoms, and substituting for another drug. Symptoms of dependence included the rapid development of tolerance and a severe withdrawal syndrome often involving psychiatric symptoms. Harms including dissociation, loss of consciousness, and overdose were generally reported as a consequence of polysubstance use. Confidence in most of the review findings was moderate with low confidence in one finding. CONCLUSION This review provides rich qualitative insights into the potential motives for gabapentinoid misuse as well as the diverse lived experiences of dependence symptomatology. Considering the increasing prescribing of these medications globally, and the potential for public health challenges resulting from misuse, the findings of this review can be used to develop more effective harm reduction strategies.
Collapse
Affiliation(s)
- Amy G McNeilage
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Alison Sim
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia.
| | - Bridin Murnion
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
| | - Claire E Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
2
|
Chen A, Metzger E, Lee S, Osser D. A Proposed Algorithm for the Pharmacological Treatment of Generalized Anxiety Disorder in the Older Patient. J Geriatr Psychiatry Neurol 2024:8919887241289533. [PMID: 39352792 DOI: 10.1177/08919887241289533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND This is a new algorithm from the Psychopharmacology Algorithm Project at the Harvard South Shore Program, focused on generalized anxiety disorder (GAD) in older adults. Pertinent articles were identified and reviewed. RESULTS Selective serotonin reuptake inhibitors (SSRIs) are considered to be first-line medications, with a preference for sertraline or escitalopram. If avoiding sexual side effects is a priority, buspirone is an option for the relatively healthy older adult. If response is inadequate, the second recommended trial is with a different SSRI or one of the serotonin-norepinephrine update inhibitors (SNRIs), venlafaxine or duloxetine. For a third medication trial, additional alternatives added to the previous options now include pregabalin/gabapentin, lavender oil, and agomelatine. If there is an unsatisfactory response to the third option chosen, quetiapine may be considered. We recommend caution with the following for acute treatment in this population: benzodiazepines and hydroxyzine. Other agents given low priority but having some supportive evidence were vilazodone, vortioxetine, mirtazapine, and cannabidiol. Acknowledging that the median age of onset of GAD is in early adulthood, many patients with GAD will have been started on benzodiazepines (or other medications that require caution in the elderly) for GAD at a younger age. These medications may be continued with regular observation to see if the potential harms are starting to exceed the benefits and a switch to other recommended agents may be justified.
Collapse
Affiliation(s)
- Anderson Chen
- Psychiatry Department, Massachusetts General Hospital, Boston, MA, USA
| | - Eran Metzger
- Psychiatry Department, Hebrew Senior Life, Boston, MA, USA
| | - Soyoung Lee
- Psychiatry Department, Brigham and Women's Hospital, Boston, MA, USA
| | - David Osser
- Psychiatry Department, VA Boston Healthcare System, Brockton, MA, USA
| |
Collapse
|
3
|
Garnier C, Schein M, Lacroix C, Jouve E, Soeiro T, Gentile G, Lapeyre Mestre M, Micallef J. Patterns of Pregabalin Users from Substance Abuse Treatment Facilities: Results from the French OPPIDUM Program from 2008 to 2022. CNS Drugs 2024; 38:743-751. [PMID: 38990472 DOI: 10.1007/s40263-024-01095-y] [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] [Accepted: 05/02/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION In recent years, pregabalin has received growing attention due to its abuse liability. The aim of this study was to further characterize patterns of pregabalin users from substance abuse treatment facilities and detect changes in users profile over the study period. METHODS The data source was the Observation des Produits Psychotropes Illicites ou Détournés de leur Utilisation Médicamenteuse (OPPIDUM) program, an annual, repeated, cross-sectional, nationwide, multicenter survey that collects consumption data from patients with substance use disorders. First, we described the characteristics of pregabalin users and their consumption patterns. We compared these data between 2008 and 2018 (P1) and 2019 and 2022 (P2). Second, we conducted a multiple correspondence analysis to identify profiles of users. RESULTS From 2008 to 2022, 291 pregabalin users (0.37% of all users) from 116 substance abuse treatment facilities were identified. The number of pregabalin users was lower than 15 per year in P1 (n = 89) and between 40 and 60 per year in P2 (n = 202). The number of users who reported pregabalin as the first substance leading to dependence increased significantly in P2 compared with P1 (p < 0.005). When comparing P2 with P1, there was a significant increase in precarity (p < 0.001), users in prison (p = 0.002), withdrawal symptoms (p < 0.001), dependence (p < 0.001), use of higher dose of pregabalin (p = 0.029), and acquisition by deal/street market (p < 0.001). The multiple correspondence analysis allowed for the identification of distinct profiles of pregabalin users: (i) a cluster with mainly users from P1, who presented a simple use of pregabalin, and were older (> 45 years), were involved in opioid agonist treatment (OAT), and obtained pregabalin legally; and (ii) a cluster with mainly users from P2, who presented pregabalin dependence, and were younger (< 26 years), reported pregabalin as the first substance leading to dependence, used doses higher than the market authorization, were in severe precarity, and were in prison. CONCLUSIONS These data showed that the profile of pregabalin users has changed in the last years. Pregabalin use disorders also affect users without history of addiction.
Collapse
Affiliation(s)
- Clément Garnier
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et paramédicales, Marseille, France
| | - Martin Schein
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
- Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et paramédicales, Marseille, France
| | - Clémence Lacroix
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Elisabeth Jouve
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Thomas Soeiro
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Gaétan Gentile
- Département Universitaire de Médecine Générale, Faculté des Sciences Médicales et paramédicales, Marseille, France
| | - Maryse Lapeyre Mestre
- Service de Pharmacologie Médicale et Clinique, UFR Santé Université de Toulouse - Paul Sabatier, CEIP-Addictovigilance de Toulouse, CHU de Toulouse, CIC 1436, 31000, Toulouse, France
| | - Joëlle Micallef
- Service de Pharmacologie Clinique et Pharmacosurveillance, Centre d'évaluation et d'information sur la pharmacodépendance - Addictovigilance Aix Marseille Univ, APHM, INSERM, Inst Neurosci Syst, UMR 1106, University Hospital, 270 boulevard Sainte Marguerite, 13009, Marseille, France.
| |
Collapse
|
4
|
Teker C, Aslan R, İpekçi C, Tokdemir M, Akgür SA. Pregabalin Qualitative Detection in Turkish Forensic Cases Between 2017 to 2018. J Psychoactive Drugs 2024; 56:380-386. [PMID: 37343948 DOI: 10.1080/02791072.2023.2226138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 03/22/2023] [Indexed: 06/23/2023]
Abstract
Pregabalin (PGB) has been commonly subjected to diversion, from being a prescription drug to a recreational drug. In this study, pregabalin use (which is one of the substances subject to control in Turkey) and the concomitant use of other substances in cases admitted to the Izmir Forensic Medicine Institute was evaluated. Samples from 15,259 cases were screened, between June 2017 and December 2018, for the presence of PGB, and PGB positive cases were further analyzed. Of all cases screened, PGB was detected in 3.2% (n = 487). The mean age of PGB positive cases was 29.24 ± 10.34 years old (min: 14, max: 84), and 94% of them were male. Cannabis metabolite THC-COOH was the most common substance detected in the blood samples following PGB. Overall, 8 other substances were commonly used along with PGB. These substances were cannabis, morphine, hydromorphone, codeine, hydrocodone, heroin, paracetamol, and naproxen. Finally, we observed similar results in urine analysis. This research provides systematic data for PGB use in forensic cases in Turkey. The study findings indicate that PGB and multiple drug use increased over time, and providers should be particularly careful when prescribing PGB.
Collapse
Affiliation(s)
- Ceyda Teker
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Rukiye Aslan
- Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| | - Cahit İpekçi
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Mehmet Tokdemir
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
- Department of Forensic Medicine, Izmir Katip Çelebi University, Izmir, Turkey
| | - Serap Annette Akgür
- Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
| |
Collapse
|
5
|
Mathieson S, O'Keeffe M, Traeger AC, Ferreira GE, Abdel Shaheed C. Content and sentiment analysis of gabapentinoid-related tweets: An infodemiology study. Drug Alcohol Rev 2024; 43:45-55. [PMID: 36539307 DOI: 10.1111/dar.13590] [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: 09/28/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The increasing number of gabapentinoid (pregabalin and gabapentin) harms, including deaths observed across countries is concerning to health-care professionals and policy makers. However, it is unclear if the public shares these concerns. This study aimed to describe posts related to gabapentinoids, conduct a content analysis to identify common themes and describe adverse events or symptoms. METHODS Keywords of 'pregabalin' or 'Lyrica' or 'gabapentin' or 'Neurontin' were used to search for related tweets posted by people in the community between 8 March and 7 May 2021. Eligible tweets included a keyword in the post. We extracted de-identified data which included descriptive data of the total number of posts over time; and data on individual tweets including date, number of re-tweets and post content. Data were exported separately for pregabalin- and gabapentin-related tweets. A 20% random sample was used for the thematic analysis. RESULTS There were 2931 pregabalin-related tweets and 2736 gabapentin-related tweets. Thematic analysis revealed three themes (sharing positive experiences and benefits of taking gabapentinoids, people voicing their negative experiences, and people seeking opinions and sharing information). Positive experiences of gabapentinoids were related to sharing stories and giving advice. This was contrasted to negative experiences including ineffectiveness, withdrawals, side effects and frustration related to cost and insurance coverage. Brain fog was the most common adverse symptom reported. Gabapentinoid-related deaths were only mentioned in three tweets. DISCUSSION The increasing public health concern of gabapentinoid-related deaths was not translated to Twitter discussions.
Collapse
Affiliation(s)
- Stephanie Mathieson
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
6
|
Huddleston WR, Robert Lyness J, Quinn A. Review of the demographic factors and toxicology related to deaths due to pregabalin in Northern Ireland. J Forensic Leg Med 2024; 101:102635. [PMID: 38100952 DOI: 10.1016/j.jflm.2023.102635] [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: 06/05/2023] [Revised: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
The potential for recreational abuse of the analgesic and antiepileptic drug pregabalin is now well established in the literature. The potential minimum lethal dose in post mortem cases is however less defined. All post mortem examinations in Northern Ireland where the cause of death was found to be due to pregabalin were examined for demographic and toxicological analysis. Deaths are generally seen in young men, especially 30-39-year-olds, many of whom have a history of substance misuse and are often prescribed pregabalin. Until recently, prescription rates have been on the rise regionally. The overall median post mortem peripheral blood concentration of pregabalin found in this study is 10.6 mg/L, however this rises when concurrent drugs and alcohol are considered and in cases where pregabalin is considered responsible for death alone (i.e. outside of multidrug toxicity). Pregabalin peripheral blood concentrations returned in this study suggest previously offered minimum lethal dosages may need to be revised downward.
Collapse
Affiliation(s)
| | - James Robert Lyness
- State Pathologist's Department, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Amy Quinn
- Forensic Science Northern Ireland, Seapark, 151 Belfast Road, Carrickfergus, BT38 8PL, UK
| |
Collapse
|
7
|
Covvey JR, Blakely ML, Singh R, Peckham AM, Evoy KE. Pharmacist, prescriber, and drug policy expert opinions on gabapentinoid misuse. Res Social Adm Pharm 2023; 19:599-609. [PMID: 36503683 DOI: 10.1016/j.sapharm.2022.12.001] [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: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gabapentinoids (gabapentin and pregabalin) are widely used in clinical practice, but recent evidence indicates that they carry an increased risk of misuse. As healthcare professionals (HCPs) and policymakers plan different strategies to promote harm reduction, it is important to understand different interested party viewpoints. OBJECTIVE To explore prescriber, pharmacist, and drug policy expert (DPE) awareness, opinions, and experiences regarding gabapentinoid misuse. METHODS A qualitative description study using individual semi-structured virtual interviews was conducted between February and April 2021. Participants included prescribers (physicians, physician assistants [PA], or nurse practitioners [NP]) and pharmacists practicing in outpatient, ambulatory, or community-based healthcare settings; individuals with relevant drug policy expertise were also included. Qualtrics (Provo, Utah) and Zoom (San Jose, California) were used to facilitate quantitative (for initial screening and participant characteristics) and qualitative (interview) data collection. Data were coded and organized into themes in NVivo (QSR International; Burlington, Massachusetts) using thematic analysis steps. RESULTS A total of 43 individuals participated in this study, including 16 (37.2%) pharmacists, 13 (30.2%) physicians, seven (16.3%) NPs, four (9.3%) DPEs, two (4.7%) pharmacist/DPEs, and one (2.3%) PA. Results were organized along four themes: (1) challenges/opportunities in gabapentinoid use; (2) gabapentinoid misuse awareness; (3) solutions to gabapentinoid misuse and (4) contributing barriers in pain management. Participants invoked different opinions in their consideration of gabapentinoid misuse, including the desire for harm reduction, the limitations of the current healthcare and insurance system, the lack of options for pain and substance use disorder treatment, and the influence of patient expectations. CONCLUSIONS Gabapentinoid misuse was commonly framed in comparative fashion to ongoing concerns with opioids, and proposed solutions often focused less on regulatory control and more toward patient and HCP education and an overhaul of the health system approach to substance use and healthcare overall.
Collapse
Affiliation(s)
- Jordan R Covvey
- Duquesne University School of Pharmacy, 600 Forbes Ave, Pittsburgh, PA, 15282, USA.
| | - Michelle L Blakely
- University of Wyoming School of Pharmacy, 1000 E University Ave, Laramie, WY, 82071, USA.
| | - Reshmi Singh
- University of Wyoming School of Pharmacy, 1000 E University Ave, Laramie, WY, 82071, USA.
| | - Alyssa M Peckham
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02115, USA.
| | - Kirk E Evoy
- The University of Texas at Austin College of Pharmacy, USA; UT Health San Antonio School of Medicine, 7703 Floyd Curl Drive - MC 6220; San Antonio, TX, 78229, USA.
| |
Collapse
|
8
|
Antunovic M, Vucinic S, Kotur-Stevuljevic J, Krstic K, Jovic-Stosic J, Kilibarda V, Perkovic-Vukcevic N, Djordjevic S. Rise of Pregabalin Poisoning and Abuse Cases in Serbia: A Ten-Year Retrospective Study. Int J Gen Med 2023; 16:1239-1250. [PMID: 37065979 PMCID: PMC10094400 DOI: 10.2147/ijgm.s405616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023] Open
Abstract
Purpose The aim of this study was to analyze data on gabapentinoid-related attendances to the National Poison Control Center of Serbia (NPCC), particularly abuse cases; to estimate its changes and to compare it with trends in national consumption rates of these drugs. We also aimed to analyze the main characteristics of the study population and to investigate the major clinical effects in poisoned patients. Patients and Methods This is a retrospective study of patients admitted to the NPCC for acute poisoning involving gabapentinoids from 1 May 2012 to 1 October 2022. Results There were 357 (95.5%) pregabalin-related and 17 (4.5%) gabapentin-related poisoning cases in 302 patients. Abuse of pregabalin was detected in 27.8% (84/302), while gabapentin abuse occurred in 0.7% (2/302) of all patients. A steady increase in rates of pregabalin poisoning and abuse cases strongly correlated with the increase in overall consumption of this drug, while there were no significant changes in rates of gabapentin consumption, poisoning and abuse rate during the study period. Most patients who abused pregabalin pregabalin were males (84.5%) and the median age was 26 years (range: 15-45 years). Almost 60% of patients who abused pregabalin (48/84) belonged to the migrant population. Co-ingestions occurred in 89.4% of pregabalin-related cases (319/357), resulting in more severe poisoning. The most often co-ingested drugs were benzodiazepines and among them clonazepam was detected in the largest number of cases. Conclusion The poisoning and abuse cases involving pregabalin are on the rise in Serbia, which coincided with an increase in its overall consumption during the study period. Isolated pregabalin ingestions resulted in mild poisoning, although severe symptoms such as coma and bradycardia were recorded. When prescribing pregabalin to patients at risk of abuse caution is needed. Strengthening the measures for dispensing of pregabalin may reduce the risks associated with its abuse.
Collapse
Affiliation(s)
- Marko Antunovic
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
- Correspondence: Marko Antunovic, National Poison Control Center, Military Medical Academy, Crnotravska 17, Belgrade, 11040, Serbia, Tel +381 11 3608 264, Fax +381 11 367 21 87 264, Email
| | - Slavica Vucinic
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| | - Jelena Kotur-Stevuljevic
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Kristijan Krstic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jasmina Jovic-Stosic
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| | - Vesna Kilibarda
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| | - Natasa Perkovic-Vukcevic
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| | - Snezana Djordjevic
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Xia Y, Forget P. Opioid and gabapentinoid prescriptions in England from 2015 to 2020. PLoS One 2022; 17:e0276867. [PMID: 36441772 PMCID: PMC9704625 DOI: 10.1371/journal.pone.0276867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/16/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Concerns gradually arose about misuse of gabapentinoids (gabapentin and pregabalin), especially when used in combination with opioids. Because it can be a driver of usage, trends in prescribing habits may be interesting to analyse. The aim of this study is to examine the evolution of prescriptions of opioids and gabapentinoids in England from 2015 to 2020 at a regional level. METHODS This study included data from April 2015 to February 2020, focusing on prescribing data, extracted the OpenPrescribing database. We described the evolution of the prescriptions of opioids and gabapentinoids and calculated their ratios for each month. We used Analyses of Variance (ANOVAs) to compare data between and within regions (over time). RESULTS During this period, opioid prescriptions remained stable (from -3.3% to +2.2%/year) and increased for gabapentinoids generally (from +1.5% to +2.2%). The ratio between gabapentinoid to opioid prescriptions increased by more than 20% in 2020 compared to 2015, variably between regions (F(6,406) = [120.2]; P<0.001; LSD Test: P<0.001; ANOVA for repeated measures: P<0.05). In 2019, a decline in the ratio occurred in all regions, but only persisting in the London commissioning region in 2020 (-14.4% in comparison with 2018, 95%CI: -12.8 to -16.3). CONCLUSIONS Gabapentinoids are increasingly prescribed in England. The ratio of gabapentinoid to opioid prescriptions in England increased from 2015 to 2020. The reclassification of gabapentinoids as controlled drugs, in 2019, may have been associated with a significant reduction, although larger prescribers may have been less influenced.
Collapse
Affiliation(s)
- Yixue Xia
- Epidemiology group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Patrice Forget
- Epidemiology group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Anaesthesia department, NHS Grampian, Aberdeen, United Kingdom
- The European Society of Anaesthesiology and Intensive Care (ESAIC), Pain AND Opioids after Surgery (PANDOS), Research Group, Brussels, Belgium
- * E-mail:
| |
Collapse
|
11
|
Badi ASA, Hashar AA, Riyami IA, Za'abi MA. A snapshot on the usage pattern of gabapentinoids in Oman. Pharm Pract (Granada) 2022; 20:2693. [PMID: 36733519 PMCID: PMC9851813 DOI: 10.18549/pharmpract.2022.3.2693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
Background Since their introduction as adjunct anticonvulsants, the use of gabapentinoids (gabapentin and pregabalin) has increased substantially worldwide to include a wide range of clinical conditions. Various reports have demonstrated that they possess addiction liability and can produce effects similar to traditional recreational drugs, such as significant euphoric effects, enhanced sociability, and relaxation. However, there is limited information on the use of these agents in the Middle East. Objectives Here, we describe the usage pattern of gabapentinoids at Sultan Qaboos University Hospital, a tertiary care medical institution in Oman. Methods Adult patients (≥18 years) who were prescribed gabapentinoids for six months (March-August 2019) were included in this retrospective cross-sectional study. Indications and dosing regimens were reviewed according to the Food and Drug Administration labeling. Controlled and restricted drugs were reviewed using Oman National Formulary. Institutional ethical approval was obtained before conducting the study. Results We analyzed 291 prescriptions. The mean (standard deviation, SD) age was 60.5 years (SD = 13.0) with the age group of ≥60 years being the most common (190, 65.3%). Most of patients were females (178, 61.2%). The majority of prescriptions were for outpatients (85.8%). Drugs were prescribed as refill and follow-up in 116 (40.0%) and 97 (33.4%) of prescriptions, respectively. Diabetic peripheral neuropathy (50, 79.4%) was the most labeled indication for both. Off-label use was 128 (51.8%) and 31 (70.5%) for pregabalin and gabapentin, respectively, with lower back pain as being the most common indication for both drugs. A total of 54 (19.0%) patients were using at least one of the psychotropic drugs. Conclusions Our findings indicate that gabapentinoids are frequently prescribed for off-label use. Awareness programs and the establishment of policy for the use of these drugs are required to ensure their rational use and prevent misuse and/or abuse.
Collapse
Affiliation(s)
- Abdulaziz Said Al Badi
- MSc, Department of Pharmacy, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
| | - Amna Al Hashar
- PhD. Department of Pharmacy, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman.
| | - Intisar Al Riyami
- MSc. Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Mohammed Al Za'abi
- MD, PhD. Professor, Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| |
Collapse
|
12
|
Bonnet U, McAnally HB. How prevalent and severe is addiction on GABAmimetic drugs in an elderly German general hospital population? Focus on gabapentinoids, benzodiazepines, and z-hypnotic drugs. Hum Psychopharmacol 2022; 37:e2822. [PMID: 34687489 DOI: 10.1002/hup.2822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Gabapentinoids (GPT) are reported to be increasingly misused by opioid- and polydrug-users, but the addictive potential of GPT outside of these populations remains understudied. Investigations comparing GPT abuse and dependence liability to that of other commonly prescribed Central Nervous System-acting medications are therefore warranted. We provide a comparison of GPT-abuse/dependence to that of other GABAmimetics within an elderly population. DESIGN DSM-IV-TR-based data (previously prospectively collected by SKID-I-interview) from a random sample of elderly patients admitted to a metropolitan German general hospital were reviewed. The prevalence and severity of GPT, benzodiazepine (BDZ), and z-hypnotic drug (ZD)-abuse and -dependence were compared, stratified also by mono-substance (no concurrent current or previous substance use) and de novo-substance (first)-abuse and -dependence states. RESULTS Among 400 patients (75 ± 6.4 years old; 63% females), neither current nor past abuse of BDZ, ZD or GPT, nor other illicit substances was observed. Dependence upon BDZ, ZD or GPT was observed among 55 (13.75%) individuals. The related lifetime/12-month prevalence-rates were: dependence condition (BDZ: 7%/2.45%; ZD: 4.25%/4.25%; GPT: 2.75/2.5%); mono-dependence condition (BDZ: 2.25%/0.75%; ZD: 1%/1%, GPT: 0%/0%); de novo-dependence condition (BDZ: 2.75%/1.75%; ZD: 1%/1%, GPT: 0.5%/0.5%). Opioid analgesic-dependence (N = 43/400) was significantly more frequently linked with BDZ than with GPT (p < 0.01) [Correction added on 29 December 2021, after first online publication: In the sentence 'Opioid analgesic-dependence…', the term 'and ZD' has been deleted]. For all three GABAmimetic classes, most mono- and de novo-dependence states were mild-to-moderate and lasted 2-6 years (median). CONCLUSION GABAmimetic-dependence was usually mixed with other substance-dependences. Every third to fourth instance of BDZ- or ZD-dependence was a mono-dependence condition, while a pure GPT-dependence was absent in this elderly (and illicit substance-naïve) population.
Collapse
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, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heath B McAnally
- Northern Anesthesia & Pain Medicine, LLC, Eagle River, Alaska, USA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
13
|
Kritikos N, Iliou A, Kalampaliki AD, Gikas E, Kostakis IK, Michel BY, Dotsikas Y. Chemometrically Assisted Optimization of Pregabalin Fluorescent Derivatization Reaction with a Novel Xanthone Analogue and Validation of the Method for the Determination of Pregabalin in Bulk via a Plate Reader. Molecules 2022; 27:molecules27061954. [PMID: 35335315 PMCID: PMC8954069 DOI: 10.3390/molecules27061954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Quantitation of chromophore-free analytes is always a challenge. To this purpose, derivatization of the analyte constitutes a common strategy, leading to a product with a strong signal. In the current study, a novel xanthone analogue was utilized for the first time for the derivatization of pregabalin, a model analyte with a primary amine moiety that lacks a chromophore. The fact that only the xanthene-based derivative, formed after the derivatization reaction fluoresces, enables avoiding its chromatographic separation from the reagent and thus reducing the analysis time of a series of samples in 1–2 min via a plate reader. The reaction conditions were optimized via a central composite design (CCD), with fluorescence signal as the measure of the yield. The following factors that affect the derivatization reaction were chosen: (a) temperature, (b) reaction time, and (c) triethylamine solution volume used to drive the reaction to completion. After the identification of the optimal conditions, the method was validated according to ICH guidelines, using a fluorescence plate reader for signal measurement (λex = 540, λem = 615 nm). Finally, the newly developed high-throughput method was applied to the determination of drug content in pregabalin bulk.
Collapse
Affiliation(s)
- Nikolaos Kritikos
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, GR-157 71 Athens, Greece; (N.K.); (A.I.)
| | - Aikaterini Iliou
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, GR-157 71 Athens, Greece; (N.K.); (A.I.)
| | - Amalia D. Kalampaliki
- Division of Pharmaceutical Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, GR-157 71 Athens, Greece; (A.D.K.); (I.K.K.)
| | - Evangelos Gikas
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, GR-157 71 Athens, Greece;
| | - Ioannis K. Kostakis
- Division of Pharmaceutical Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, GR-157 71 Athens, Greece; (A.D.K.); (I.K.K.)
| | - Benoît Y. Michel
- Institut de Chimie de Nice, CNRS, UMR 7272, Université Côte d’Azur, Parc Valrose, CEDEX 2, 06108 Nice, France;
| | - Yannis Dotsikas
- Laboratory of Pharmaceutical Analysis, Department of Pharmacy, National and Kapodistrian University of Athens, Panepistimioupoli Zografou, GR-157 71 Athens, Greece; (N.K.); (A.I.)
- Correspondence: ; Tel.: +30-2107274696
| |
Collapse
|
14
|
Galliot G, Ponté C, Schmitt L, Hakimi Y, Sergent S, Lapeyre-Mestre M, Salles J. Case Report: the Comorbidity of Pregabalin-Use Disorder and Post-Traumatic Stress Disorder: Clinical and Pharmacological Issues. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00347-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
15
|
Hofmann M, Besson M. Gabapentinoids: The rise of a new misuse epidemics? Psychiatry Res 2021; 305:114193. [PMID: 34534775 DOI: 10.1016/j.psychres.2021.114193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022]
Abstract
Gabapentinoids and opioids have in common that they are used in medicine in the treatment of pain, and by addicts in recreational use. In recent years, in the context of the "opioid epidemics", gabapentinoids, which had a reputation for low risk of abuse, have been increasingly prescribed. This was accompanied by increasingly frequent abuses, the patients most at risk being those suffering from opiate addiction. However, gabapentinoids increase the risks associated with opioids or other sedatives, due to a synergy of central depressant effects. This leads to reconsider the framework of their prescription and the management of chronic pain.
Collapse
Affiliation(s)
- Michel Hofmann
- Department of Psychiatry, Service of psychiatric specialties, Mood disorder unit, Geneva University Hospitals, Rue de Lausanne 20, CH-1201, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland.
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive care and Pharmacology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
16
|
Daniel NH, Aravind A, Thakur P. Are ion channels potential therapeutic targets for Parkinson's disease? Neurotoxicology 2021; 87:243-257. [PMID: 34699791 DOI: 10.1016/j.neuro.2021.10.008] [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] [Received: 09/01/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/31/2023]
Abstract
Parkinson's disease (PD) is primarily associated with the progressive neurodegeneration of the dopaminergic neurons in the substantia nigra region of the brain. The resulting motor symptoms are managed with the help of dopamine replacement therapies. However, these therapeutics do not prevent the neurodegeneration underlying the disease and therefore lose their effectiveness in managing disease symptoms over time. Thus, there is an urgent need to develop newer therapeutics for the benefit of patients. The release of dopamine and the firing activity of substantia nigra neurons is regulated by several ion channels that act in concert. Dysregulations of these channels cause the aberrant movement of various ions in the intracellular milieu. This eventually leads to disruption of intracellular signalling cascades, alterations in cellular homeostasis, and bioenergetic deficits. Therefore, ion channels play a central role in driving the high vulnerability of dopaminergic neurons to degenerate during PD. Targeting ion channels offers an attractive mechanistic strategy to combat the process of neurodegeneration. In this review, we highlight the evidence pointing to the role of various ion channels in driving the PD processes. In addition, we also discuss the various drugs or compounds that target the ion channels and have shown neuroprotective potential in the in-vitro and in-vivo models of PD. We also discuss the current clinical status of various drugs targeting the ion channels in the context of PD.
Collapse
Affiliation(s)
- Neha Hanna Daniel
- School of Biology, Indian Institute of Science Education and Research (IISER)-Thiruvananthapuram, Kerala, 695551, India
| | - Ananya Aravind
- School of Biology, Indian Institute of Science Education and Research (IISER)-Thiruvananthapuram, Kerala, 695551, India
| | - Poonam Thakur
- School of Biology, Indian Institute of Science Education and Research (IISER)-Thiruvananthapuram, Kerala, 695551, India.
| |
Collapse
|
17
|
Kurdi A. Opioids and Gabapentinoids Utilisation and Their Related-Mortality Trends in the United Kingdom Primary Care Setting, 2010-2019: A Cross-National, Population-Based Comparison Study. Front Pharmacol 2021; 12:732345. [PMID: 34594223 PMCID: PMC8476961 DOI: 10.3389/fphar.2021.732345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background: There is growing concern over the increasing utilisation trends of opioids and gabapentinoids across but there is lack of data assessing and comparing the utilisation trends across the four United Kingdom countries. We assessed/compared opioids and gabapentinoids utilisation trends across the four United Kingdom countries then evaluated the correlation between their utilisation with related mortality. Methods: This repeated cross-national study used Prescription Cost Analysis (PCA) datasets (2010–2019). Opioids and gabapentinoids utilisation were measured using number of items dispensed/1,000 inhabitants and defined daily doses (DDDs)/1,000 inhabitant/day. Number of Opioids and gabapentinoids-related mortality were extracted from the United Kingdom Office for National Statistics (2010–2018). Data were analysed using descriptive statistics including linear trend analysis; correlation between the Opioids and gabapentinoids utilisation and their related mortality using Pearson correlation coefficient. Results: The results illustrated an overall significant increasing trend in the utilisation of opioids (12.5–14%) and gabapentinoids (205–207%) with substantial variations among the four United Kingdom countries. For opioids, Scotland had the highest level of number of items dispensed/1,000 inhabitant (156.6% higher compared to the lowest level in England), whereas in terms of DDD/1,000 inhabitant/day, NI had the highest level. Utilisation trends increased significantly across the four countries ranging from 7.7% in Scotland to 20.5% in NI (p < 0.001). Similarly, for gabapentinoids, there were significant increasing trends ranging from 126.5 to 114.9% in NI to 285.8–299.6% in Wales (p < 0.001) for number of items/1,000 inhabitants and DDD/1,000 inhabitant/day, respectively. Although the utilisation trends levelled off after 2016, this was not translated into comparable reduction in opioids and gabapentinoids-related mortality as the latter continued to increase with the highest level in Scotland (3.5 times more deaths in 2018 compared to England- 280.1 vs. 79.3 deaths/million inhabitants). There were significant moderate-strong positive correlations between opioids and gabapentinoids utilisation trends and their related mortality. Conclusion: The utilisation trends of opioids and gabapentinoids have increased significantly with substantial variations among the four United Kingdom countries. This coincided with significant increase in their related mortality. Our findings support the call for immediate actions including radical changes in official United Kingdom policies on drug use and effective strategies to promote best clinical practice in opioids and gabapentinoids prescribing.
Collapse
Affiliation(s)
- Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
18
|
Alshahrani SM, Orayj K, Alqahtani AM, Algahtany MA. Community Pharmacists' Perceptions towards the Misuse and Abuse of Pregabalin: A Cross-Sectional Study from Aseer Region, Saudi Arabia. Healthcare (Basel) 2021; 9:healthcare9101281. [PMID: 34682961 PMCID: PMC8535499 DOI: 10.3390/healthcare9101281] [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: 08/01/2021] [Revised: 09/15/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Pregabalin is a first-line therapy for neuropathic pain and for chronic pain. It has abuse potential. This study was conducted to assess community pharmacists’ perceptions towards pregabalin abuse and misuse in the Aseer region, Saudi Arabia, and identify predictors and associated factors. A cross-sectional survey using a structured questionnaire following a self-administrative study was conducted across community pharmacies in the Aseer region (Abha, Khamis Mushait, Mahayel, Sarat Abeeda, Ahad-Rufaida, and Bishah). A total of 206 respondents from community pharmacists participated in the study. Over the last six months, 136 respondents (66.0%) suspected pregabalin abuse in community pharmacies; male dominance in pregabalin abusers was also recorded (n = 165, 80.1%). Additionally, 40 (19.4%) respondents stated that a prescription was not issued for pregabalin demands. Over half (61.7%) of community pharmacists recorded an increased change in pregabalin abuse compared to the previous year. This is the first study to explore pharmacists’ perceptions in the community of the Aseer region towards customers’ misuse and abuse of pregabalin. Further monitoring and regulations on the prescribing and procurement of pregabalin are needed to avoid abuse.
Collapse
Affiliation(s)
- Sultan M. Alshahrani
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha 61441, Saudi Arabia;
- Correspondence: ; Tel.: +96-650-874-7473
| | - Khalid Orayj
- Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha 61441, Saudi Arabia;
| | - Ali M. Alqahtani
- Pharmacology Department, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia;
| | - Mubarak A. Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha 62512-2291, Saudi Arabia;
| |
Collapse
|
19
|
Evoy KE, Peckham AM, Covvey JR, Tidgewell KJ. Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability. J Clin Pharmacol 2021; 61 Suppl 2:S89-S99. [PMID: 34396549 DOI: 10.1002/jcph.1833] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
This article will review the epidemiology and pharmacology of gabapentinoids (gabapentin and pregabalin) relevant to their emerging misuse potential and provide guidance for clinical and regulatory management. Gabapentinoids are γ-aminobutyric acid analogues that produce their therapeutic effects by inhibiting voltage-gated calcium channels and decreasing neurotransmitter release. Recently gabapentinoid prescribing and use have increased tremendously. Although traditionally thought to possess a favorable safety profile, gabapentinoid misuse has also risen significantly. Gabapentinoid misuse generally occurs in combination with other substances, most notably opioids, and may be for purposes of eliciting euphoric effects, enhancing the effects of other substances, or self-treating conditions such as withdrawal, pain, anxiety, or insomnia. Given its faster onset, increased bioavailability and potency, and nonsaturable absorption, pregabalin's pharmacokinetics theoretically enhance its misuse liability versus gabapentin. However, gabapentin can produce similar euphoric effects, and epidemiologic studies have identified higher rates of gabapentin misuse in the United States, likely because of greater availability and less regulated prescribing. Although adverse events of gabapentinoid-only ingestion are relatively benign, a growing body of evidence indicates that gabapentinoids significantly increase opioid-related morbidity and mortality when used concomitantly. In addition, significant withdrawal effects may occur on abrupt discontinuation. As a result of these trends, several US states have begun to further regulate gabapentinoid prescribing, reclassifying it as a controlled substance or mandating reporting to local prescription drug-monitoring programs. Although increased regulation of gabapentin prescribing may be warranted, harm reduction efforts and increased patient and provider education are necessary to mitigate this concerning gabapentinoid misuse trend.
Collapse
Affiliation(s)
- Kirk E Evoy
- The University of Texas at Austin College of Pharmacy, Austin, Texas, USA.,University Health System, San Antonio, Texas, USA
| | - Alyssa M Peckham
- School of Pharmacy, Northeastern University, Boston, Massachusetts, USA.,Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Kevin J Tidgewell
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
20
|
Phillips SJ, Oliveto A, Mancino MJ, Hendrickson HP. Development and validation of a rapid liquid chromatography/tandem mass spectrometry method to quantitate gabapentin and buprenorphine in human serum. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2021; 35:e9104. [PMID: 33860565 PMCID: PMC8959393 DOI: 10.1002/rcm.9104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
RATIONALE Gabapentin has shown initial promise as an opioid-sparing medication in pain patients as well as a treatment for opioid withdrawal and liquid chriomatography/tandem mass spectrometry (LC/MS/MS) is often used for clinical monitoring. Despite reports of validated tandem mass spectrometric methods for the determination of gabapentin and buprenorphine, mechanisms for the collision-induced fragmentation have not been adequetely described. METHODS A rapid analytical method has been developed to determine gabapentinoid, gabapentin, and the partial opioid agonist, buprenorphine, in 20 μL of human serum using LC/MS/MS with a chromatographic run time of 2 min. A simplified sample cleanup procedure using methanol precipitation of serum proteins/lipids followed by evaporation and reconstitution in mobile phase was demonstrated. Gabapentin and buprenorphine were detected following positive ion electrospray ionization using multiple-reaction monitoring. The internal standard approach was used for quantitation with labeled gabapentin-D10 and buprenorphine-D4 serving as internal standards. Using organic reaction principals and stable isotope labels, collision-induced fragmentation mechanisms for both gabapentin and buprenorphine are proposed. The method was validated according to the FDA Guidance for Industry - Bioanalytical Method Validation. RESULTS Accuracy was demonstrated by error values ≤15% for buprenorphine and ≤6% for gabapentin. The inter-day precision was ≤4.88% and 15.59% for gabapentin and buprenorphine and the intra-day precision was ≤5.20% and 11.65% for gabapentin and buprenorphine. The lower limit of quantitation corresponded to 10 ng/mL for gabapentin and 1 ng/mL for buprenorphine in serum. Recoveries were 104 ± 2.55% and 85 ± 2.03% for gabapentin and buprenorphine, respectively. CONCLUSIONS Concentrations of gabapentin and buprenorphine were determined for five authentic human serum samples to further validate the utility of the method and applicable to therapeutic drug monitoring beyond its use as a drug screening assay. Furthermore, new mechanisms for the collision-induced dissociation of gabapentin and buprenorphine have been proposed.
Collapse
Affiliation(s)
- Sarah J Phillips
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Alison Oliveto
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Michael J Mancino
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Howard P Hendrickson
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
- Department of Pharmaceutical Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Birmingham, AL, 35229, USA
| |
Collapse
|
21
|
Oldfield BJ, Li Y, Vickers-Smith R, Becker WC, Barry DT, Crystal S, Gordon KS, Kerns RD, Rentsch CT, Marshall BDL, Edelman EJ. Sociodemographic and clinical correlates of gabapentin receipt with and without opioids among a national cohort of patients with HIV. AIDS Care 2021; 34:1053-1063. [PMID: 34114904 PMCID: PMC8664891 DOI: 10.1080/09540121.2021.1939851] [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: 10/21/2022]
Abstract
Gabapentin is commonly prescribed for chronic pain, including to patients with HIV (PWH). There is growing concern regarding gabapentin's potential for harm, particularly in combination with opioids. Among PWH, we examined factors associated with higher doses of gabapentin receipt and determined if receipt varied by opioid use. We examined data from the Veterans Aging Cohort Study, a national prospective cohort including PWH, from 2002 through 2017. Covariates included prescribed opioid dose, self-reported past year opioid use, and other sociodemographic and clinical variables. We used multinomial logistic regression to determine independent predictors of gabapentin receipt. Among 3,702 PWH, 902 (24%) received any gabapentin during the study period at a mean daily dose of 1,469 mg. In the multinomial model, high-dose gabapentin receipt was associated with high-dose benzodiazepine receipt (adjusted odds ratio [aOR], 95% confidence interval [CI]= 1.53, [1.03-2.27]), pain interference (1.65 [1.39-1.95]), and hand or foot pain (1.81, [1.45-2.26]). High-dose gabapentin receipt was associated with prescribed high-dose opioids receipt (2.66 [1.95-3.62]) but not self-reported opioid use (1.03 [0.89-1.21]). PWH prescribed gabapentin at higher doses are more likely to receive high-dose opioids and high-dose benzodiazepines, raising safety concerns.
Collapse
Affiliation(s)
- Benjamin J Oldfield
- Yale School of Medicine, New Haven, CT, USA.,Fair Haven Community Health Care, New Haven, CT, USA
| | - Yu Li
- Brown University School of Public Health, Providence, RI, USA
| | - Rachel Vickers-Smith
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA.,University of Kentucky College of Public Health, Lexington, KY, USA
| | - William C Becker
- Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Stephen Crystal
- Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, NJ, USA
| | - Kirsha S Gordon
- Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert D Kerns
- Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher T Rentsch
- VA Connecticut Healthcare System, West Haven, CT, USA.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - E Jennifer Edelman
- Yale School of Medicine, New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| |
Collapse
|
22
|
Nahar KL, Murphy K, Paterson S. Toxicological Relevance of Pregabalin in Heroin Users: A Two-Year Post-Mortem Population Study. J Anal Toxicol 2021; 46:471-478. [PMID: 34114622 PMCID: PMC9122506 DOI: 10.1093/jat/bkab070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/03/2021] [Accepted: 11/15/2021] [Indexed: 01/27/2023] Open
Abstract
Pregabalin (PGL) is a gabapentinoid used to treat epilepsy, neuropathic pain and generalized anxiety disorder. PGL is also misused by heroin users as it enhances the effects of heroin. While it is thought those who misuse PGL take it in amounts greater than the recommended therapeutic dose, it is unknown whether there is a significant difference between the amounts of PGL used by heroin users compared to non-heroin users. This study hypothesised that the PGL concentrations in post-mortem samples taken from heroin users positive for PGL would be higher than those in non-heroin users. Between 01.01.2016 and 31.12.2017, a routine drugs screen and a specific screen for PGL was carried out on femoral-vein bloods from 3,750 post-mortem Coroners' cases. Of the cases screened, 354 were heroin users, of which 264 cases were negative for gabapentinoids and therefore used as the control-heroin users group. PGL was positive in 229 cases, of which 69 were heroin users and 160 were non-heroin users. On comparing the PGL concentrations, statistically higher concentrations were observed in the heroin users compared to non-heroin users (P = 0.002). There was no correlation between the concentrations of PGL and morphine (from heroin) in the heroin users (P = 0.95), and the amount of heroin (morphine) consumed was not dependant on whether PGL was consumed or not (P = 0.98). The prevalence of anti-depressants, benzodiazepines, methadone and non-heroin related opioids were seen to be significantly higher in heroin users that were positive for PGL than the control-heroin users (P = < 0.001 for all drugs). This study suggests that heroin users are using greater amounts of PGL compared to non-heroin users; however, the magnitude of the difference in use may not be sufficient to conclude that heroin users are at substantially greater risk of pregabalin toxicity compared to non-heroin users. Results indicate that heroin users who take PGL are more likely to use multiple depressant drugs, hence increasing the risk of multi-drug toxicity and death in this population.
Collapse
Affiliation(s)
- Khatun Limon Nahar
- Imperial College London, Toxicology Unit, Charing Cross Campus, St. Dunstan's Road, London W6 8RP, UK
| | - Kevin Murphy
- Imperial College London, Department of Endocrinology & Metabolism, Imperial College London, London W12 0NN, UK
| | - Sue Paterson
- Imperial College London, Toxicology Unit, Charing Cross Campus, St. Dunstan's Road, London W6 8RP, UK
| |
Collapse
|
23
|
Althobaiti YS, Almutairi FM, Alshehri FS, Altowairqi E, Marghalani AM, Alghorabi AA, Alsanie WF, Gaber A, Alsaab HO, Almalki AH, Hakami AY, Alkhalifa T, Almalki AD, Hardy AMG, Shah ZA. Involvement of the dopaminergic system in the reward-related behavior of pregabalin. Sci Rep 2021; 11:10577. [PMID: 34011976 PMCID: PMC8134490 DOI: 10.1038/s41598-021-88429-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
There has been an increase in cases of drug addiction and prescription drug abuse worldwide. Recently, pregabalin abuse has been a focus for many healthcare agencies, as highlighted by epidemiological studies. We previously evaluated the possibility of pregabalin abuse using the conditioned place preference (CPP) paradigm. We observed that a 60 mg/kg dose could induce CPP in mice and that pregabalin-rewarding properties were mediated through glutamate neurotransmission. Notably, the dopaminergic reward circuitry is also known to play a crucial role in medication-seeking behavior. Therefore, this study aimed to explore the possible involvement of dopaminergic receptor-1 in pregabalin-induced CPP. Mice were randomly allocated to receive saline or the dopamine-1 receptor antagonist SKF-83566 (0.03 mg/kg, intraperitoneal). After 30 min, the mice received either saline or pregabalin (60 mg/kg) during the conditioning phase. Among the control groups that received saline or SKF-83566, the time spent in the two conditioning chambers was not significantly altered. However, among the pregabalin-treated group, there was a marked increase in the time spent in the drug-paired chamber compared to the time spent in the vehicle-paired chamber. Notably, blocking dopamine-1 receptors with SKF-83566 completely prevented pregabalin-induced place preference, thus demonstrating the engagement of the dopaminergic system in pregabalin-induced reward-related behavior.
Collapse
Affiliation(s)
- Yusuf S Althobaiti
- Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia.
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia.
- General Administration for Precursors and Laboratories, General Directorate of Narcotics Control, Ministry of Interior, Riyadh, Saudi Arabia.
| | - Farooq M Almutairi
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
- Deanship of Scientific Research, Taif University, Taif, 21944, Saudi Arabia
- Department of Clinical Laboratories Sciences, University of Hafar Al-Batin, College of Clinical Laboratories Sciences, Hafar Al-Batin, 39923, Saudi Arabia
| | - Fahad S Alshehri
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Ebtehal Altowairqi
- Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Aliyah M Marghalani
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Amal A Alghorabi
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Walaa F Alsanie
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi Arabia
| | - Ahmed Gaber
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
- Department of Biology, Faculty of Science, Taif University, Taif, 21944, Saudi Arabia
| | - Hashem O Alsaab
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
- Department of Pharmaceutics and Pharmaceutical Technology, Taif University, Taif, 21944, Saudi Arabia
| | - Atiah H Almalki
- Addiction and Neuroscience Research Unit, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Alqassem Y Hakami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Turki Alkhalifa
- General Administration for Precursors and Laboratories, General Directorate of Narcotics Control, Ministry of Interior, Riyadh, Saudi Arabia
| | - Ahmad D Almalki
- General Administration for Precursors and Laboratories, General Directorate of Narcotics Control, Ministry of Interior, Riyadh, Saudi Arabia
| | - Ana M G 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
| |
Collapse
|
24
|
Kriikku P, Ojanperä I. Pregabalin and gabapentin in non-opioid poisoning deaths. Forensic Sci Int 2021; 324:110830. [PMID: 34000615 DOI: 10.1016/j.forsciint.2021.110830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
Post-mortem findings of gabapentinoids have often been connected to drug abuse and especially opioid use. We aimed to investigate whether gabapentinoids have been implicated in the cause of death without the presence of opioids. In a three-year study period from 2016 to 2018, a total of 907 Finnish post-mortem cases positive for pregabalin or gabapentin were found. In nearly half of the pregabalin cases and in a third of the gabapentin cases, the blood concentration was above the typical therapeutic range of the drug. Of the cases in which pregabalin was detected, in 35% the drug was implicated in a fatal poisoning with or without other drugs or alcohol. For gabapentin, the percentage was 22%. In most of the fatal gabapentinoid poisonings, opioids or other central nervous system depressants were additionally detected in relevant concentrations. There were eight non-opioid gabapentinoid poisonings, in which no relevant other drugs were detected. Many of these cases were unintentional poisonings with a relatively high gabapentinoid concentration in the blood. In all but one, the manner of death was accidental, or the intent was undetermined. This study confirmed the previous findings that gabapentinoids are mostly implicated in fatal poisoning together with opioids. Half of the non-opioid cases were related to drug abuse but in the other half the death was presumably caused by overuse of a prescribed drug or suicide. While the use of gabapentinoids is a well-known problem among people who use drugs, it is important to note other groups of users who may be at risk of overdose by gabapentinoids.
Collapse
Affiliation(s)
- Pirkko Kriikku
- Forensic Toxicology Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271 Helsinki, Finland; Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
| | - Ilkka Ojanperä
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland; Forensic Toxicology Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, 00271 Helsinki, Finland
| |
Collapse
|
25
|
Zhang Y, Castracane AR, Winstanley EL. Assessment of gabapentin misuse using prescription drug monitoring program data. Subst Abus 2021; 42:454-459. [PMID: 33689673 DOI: 10.1080/08897077.2021.1891602] [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: 10/22/2022]
Abstract
BACKGROUND Gabapentin is an anticonvulsant medication with potential misuse reported in case reports and population studies, highlighting the need to reexamine its abuse liability. The purpose of this study was to describe gabapentin dispensing patterns and assess potential misuse. Methods: We used data from Ohio's Prescription Drug Monitoring Program (PDMP) from December 1, 2016 to March 31, 2017 and restricted the population to adults who filled at least one gabapentin prescription (N = 379,372). Gabapentin dispensing patterns are described and multiple strategies were used to assess potential misuse, including Lorenz-1 curve analysis. Supratherapeutic dosing, number of prescribers and number of pharmacies used were compared for individuals who were co-dispensed medications for opioid use disorder (MOUD) and those who were not. Results: More than one million gabapentin prescriptions were dispensed during the 4-month period, with a mean dose of 1103.8 mg. While few individuals received supratherapeutic dosing, exceptionally high doses were observed. Half of the individuals (50.9%) were co-dispensed gabapentin and opioids. The Lorenz-1 value for gabapentin (5.5%) did not exceed the threshold for misuse potential. Individuals co-dispensed MOUD were more likely to have supratherapeutic dosing; however, they had a lower Lorenz-1 value compared to individuals not co-dispensed MOUD. Conclusions: Among Ohio residents dispensed gabapentin, there was no evidence of misuse using PDMP data based on the Lorenz-1 value, yet supratherapeutic dosing of gabapentin was observed and was associated with OUD. New strategies may be needed to identify the non-medical use of gabapentin.
Collapse
Affiliation(s)
- Yifan Zhang
- School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | | | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.,Department of Neuroscience, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
26
|
Welson NN, Rofaeil RR, Ahmed SM, Gaber SS, Batiha GES, Shahataa MG. Vitamin E protects against gabapentin-induced chronic hepatic and renal damage associated with the inhibition of apoptosis and tissue injury in rats. Life Sci 2021; 267:118940. [PMID: 33359747 DOI: 10.1016/j.lfs.2020.118940] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/19/2022]
Abstract
AIMS This study aimed to investigate the potential protective effects of vitamin E against gabapentin-induced chronic liver and kidney injury associated with the inhibition of biomarkers of apoptosis and tissue injury. MATERIALS AND METHODS Four groups of adult male rats were included; control, gabapentin (100 mg/kg/day), Vitamin E (80 mg/kg/day), and a combination of gabapentin and Vitamin E for 90 days. Serum levels of AST, ALT, LDH, ALP, urea, and creatinine were measured in addition to malondialdehyde (MDA), and reduced glutathione (GSH) tissue levels. P53 gene expression, histological, and immunohistochemical examinations were performed in liver and kidney tissue samples. KEY FINDINGS Gabapentin increased AST, ALT, LDH, ALP, urea, creatinine, MDA, and p53 gene expression and it reduced GSH. Moreover, gabapentin administration caused structural changes in the hepatic and renal architecture with a weak Periodic acid-Schiff (PAS) reaction that reflects glycogen deposition in the liver and kidney and a positive immunoreaction for BCL2-associated X protein (BAX) that reflects activated apoptosis. Vitamin E significantly (p<0.05) reversed the biochemical alterations associated with chronic gabapentin administration and improved the histopathological picture of hepatic and renal tissue with a partial inhibition of BAX. SIGNIFICANCE Chronic administration of gabapentin causes hepatic and renal impairments, which is ameliorated by Vitamin E; possibly due to the inhibition of biomarkers of apoptosis and tissue injury.
Collapse
Affiliation(s)
- Nermeen N Welson
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Remon R Rofaeil
- Department of Pharmacology, Faculty of Medicine, Minia University, Minia, Egypt; Department of Pharmacology, Faculty of Pharmacy, Deraya University, New Minia City, Egypt
| | - Sabreen Mahmoud Ahmed
- Department of Human Anatomy and Embryology, Faculty of Medicine, Minia University, delegated to Deraya University, New Minia City, Egypt
| | - Shereen S Gaber
- Department of Biochemistry, Faculty of Medicine, Minia University, delegated to Deraya University, New Minia City, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
| | - Mary Girgis Shahataa
- Department of Pharmacology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| |
Collapse
|
27
|
Tambon M, Ponté C, Jouanjus E, Fouilhé N, Micallef J, Lapeyre-Mestre M. Gabapentinoid Abuse in France: Evidence on Health Consequences and New Points of Vigilance. Front Psychiatry 2021; 12:639780. [PMID: 33613345 PMCID: PMC7886797 DOI: 10.3389/fpsyt.2021.639780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Gabapentinoid drugs (gabapentin and pregabalin) are widely used worldwide for epileptic and pain disorders. First signals of gabapentinoid abuse occurred in the last decade. This study aims to describe clinical characteristics of gabapentinoid use related disorders and health consequences in France. Materials and Methods: We designed a multisource investigation reviewing data reported to the French Addictovigilance Network (FAN) with pregabalin and gabapentin from 2010 to 2019. Information was obtained through the analysis of Spontaneous Reports (SRs) notified by health professionals and the pharmacoepidemiological surveys OSIAP (suspicious prescriptions forms indicators of potential abuse), OPPIDUM (observation of illicit drugs and misuse of psychotropic medications), DRAMES (death related to prescription drugs and other substances), and DTA (toxic deaths due to analgesics). Results: Over 2010-2019 period, were collected: (i) 265 SRs (258 pregabalin; 7 gabapentin); (ii) 816 forged prescription forms (805 pregabalin, 10 gabapentin, 1 involving both drugs); (iii) 145 cases of gabapentinoid use in people who use drugs (121 pregabalin; 24 gabapentin) and (iv) 31 cases of gabapentinoid-related deaths (25 pregabalin; 6 gabapentin). Risk factors of gabapentinoid abuse were opioid use disorders or psychiatric history, but cases of primary abuse in subjects without any substance abuse history were observed. Adverse outcomes concern almost exclusively pregabalin, with coma, dyspnea, convulsion, and conduction disorders. Treatment demands increased from 10.6% in 2018 to 23.1% in 2019, with pregabalin cited as the first substance leading to addictological care in the 2019 OPPIDUM survey. Gabapentinoid-related deaths increased over time. Pregabalin has become the first drug mentioned in forged prescriptions in 2019 (23.8% of OSIAP), while it ranked at the 15th position in 2017 (2.6%). Discussion: This study shows the importance of addictovigilance monitoring for gabapentinoids. Addictovigilance data helped to make visible the gabapentinoid-abuse related health harms (hospitalization for serious neurologic, psychiatric or cardiac effects, requests for addictological support and deaths) and to confirm the intrinsic abuse potential of pregabalin. These data highlight new points of vigilance considering observed primary abuse. At this point in France, the risk of abuse and related complications is very apparent with pregabalin. Still, it is identical to that observed elsewhere with gabapentin.
Collapse
Affiliation(s)
- Marine Tambon
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Camille Ponté
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France
| | - Emilie Jouanjus
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France
| | - Nathalie Fouilhé
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie-Pharmacosurveillance, CHU Grenoble-Alpes, Grenoble, France
| | - Joelle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France.,CEIP-Addictovigilance PACA Corse, Marseille, France
| | - Maryse Lapeyre-Mestre
- Centre d'Evaluation et Information sur la Pharmacodépendance-Addictovigilance, Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, Toulouse, France.,Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France
| | | |
Collapse
|
28
|
Gaisl T, Musli N, Baumgartner P, Meier M, Rampini SK, Blozik E, Battegay E, Kohler M, Saxena S. The Swiss Prison Study (SWIPS): Protocol for Establishing a Public Health Registry of Prisoners in Switzerland. JMIR Res Protoc 2020; 9:e23973. [PMID: 33099459 PMCID: PMC7755536 DOI: 10.2196/23973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/04/2020] [Accepted: 10/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background The health aspects, disease frequencies, and specific health interests of prisoners and refugees are poorly understood. Importantly, access to the health care system is limited for this vulnerable population. There has been no systematic investigation to understand the health issues of inmates in Switzerland. Furthermore, little is known on how recent migration flows in Europe may have affected the health conditions of inmates. Objective The Swiss Prison Study (SWIPS) is a large-scale observational study with the aim of establishing a public health registry in northern-central Switzerland. The primary objective is to establish a central database to assess disease prevalence (ie, International Classification of Diseases-10 codes [German modification]) among prisoners. The secondary objectives include the following: (1) to compare the 2015 versus 2020 disease prevalence among inmates against a representative sample from the local resident population, (2) to assess longitudinal changes in disease prevalence from 2015 to 2020 by using cross-sectional medical records from all inmates at the Police Prison Zurich, Switzerland, and (3) to identify unrecognized health problems to prepare successful public health strategies. Methods Demographic and health-related data such as age, sex, country of origin, duration of imprisonment, medication (including the drug name, brand, dosage, and release), and medical history (including the International Classification of Diseases-10 codes [German modification] for all diagnoses and external results that are part of the medical history in the prison) have been deposited in a central register over a span of 5 years (January 2015 to August 2020). The final cohort is expected to comprise approximately 50,000 to 60,000 prisoners from the Police Prison Zurich, Switzerland. Results This study was approved on August 5, 2019 by the ethical committee of the Canton of Zurich with the registration code KEK-ZH No. 2019-01055 and funded in August 2020 by the “Walter and Gertrud Siegenthaler” foundation and the “Theodor and Ida Herzog-Egli” foundation. This study is registered with the International Standard Randomized Controlled Trial Number registry. Data collection started in August 2019 and results are expected to be published in 2021. Findings will be disseminated through scientific papers as well as presentations and public events. Conclusions This study will construct a valuable database of information regarding the health of inmates and refugees in Swiss prisons and will act as groundwork for future interventions in this vulnerable population. Trial Registration ISRCTN registry ISRCTN11714665; http://www.isrctn.com/ISRCTN11714665 International Registered Report Identifier (IRRID) DERR1-10.2196/23973
Collapse
Affiliation(s)
- Thomas Gaisl
- Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, United States
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Naser Musli
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Marc Meier
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Silvana K Rampini
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Shekhar Saxena
- Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Association Between Cognitive Impairment and Substance Use Disorder Attributed to Pregabalin in Egypt: A Case-Control Study. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Molecular and hormonal changes caused by long-term use of high dose pregabalin on testicular tissue: the role of p38 MAPK, oxidative stress and apoptosis. Mol Biol Rep 2020; 47:8523-8533. [PMID: 33051752 DOI: 10.1007/s11033-020-05894-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/03/2020] [Indexed: 01/20/2023]
Abstract
In 1990, pregabalin was introduced as a novel antiepileptic drug that acts by binding selectively to the alpha-2-delta subunits of voltage-gated calcium channels resulting in increasing neuronal GABA levels and inhibiting the release of exciting neurotransmitters. The aim of our study is to assess the hazardous effects of prolonged high-dose pregabalin (like that abused by addicts) on testes and to clarify the potential causative mechanisms. The current study was conducted on 70 adult male Wistar albino rats which were divided into 7 groups. In our study we evaluated the effect of pregabalin, at concentrations 150 and 300 mg/kg/day for 90 days, on hormones; FSH, LH, testosterone and prolactin secretion. Our study also evaluated the expression of apoptosis-related genes BAX and BCL2 in testicular tissue in addition to the western blotted analysis of p38 Mitogen activated protein kinases (p38 MAPK). The levels of reduced glutathione, malondialdehyde and superoxide dismutase were also measured. Pregabalin decreased testosterone level while FSH, LH and prolactin showed a significant increase. It also produced genotoxicity through reversal of the BAX/BCL2 ratio; increased p38 MAPK level and induction of oxidative stress markers. The concomitant administration of vitamin E significantly reduced all the previously mentioned biochemical and hormonal adverse effects caused by pregabalin. Pregabalin can adversely affect male fertility particularly in addicts and patients who are being treated with it for long periods as those suffering from neuropathies and seizures. Antioxidants like vitamin E could have a role in amelioration.
Collapse
|
32
|
Schifano F. Coming Off Prescribed Psychotropic Medications: Insights from Their Use as Recreational Drugs. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:274-282. [PMID: 32615566 DOI: 10.1159/000507897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom,
| |
Collapse
|
33
|
Shokry DA, El Nabrawy N, Yassa HD, Gaber SS, Batiha GES, Welson NN. Pregabalin induced reproductive toxicity and body weight changes by affecting caspase3 and leptin expression: Protective role of wheat germ oil. Life Sci 2020; 260:118344. [PMID: 32853651 DOI: 10.1016/j.lfs.2020.118344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/06/2020] [Accepted: 08/22/2020] [Indexed: 01/23/2023]
Abstract
Pregabalin (PGB) drug abuse is common among the youth. It substituted tramadol before its recent schedule as a controlled drug since April 2019. PGB is an antiepileptic drug acting on the central nervous system. It blocks calcium channels regulating the action of neurotransmitters and causing prolonged depolarization. The present study aimed to investigate the toxic effect of long term pregabalin abuse on the reproductive function and body weight in both male and female albino rats and to evaluate the ameliorative effect of wheat germ oil (WGO). Forty-eight rats were randomly divided into eight groups. The first four groups were males and they were treated as follows: control group (1.5 mL saline), WGO group (1.5 mL L/kg), PGB group (300 mg/kg), and protective group (PGB + WGO). All doses were administrated once per day for 60 days by gastric gavage. The second four groups were females. They were divided and treated the same as the male groups. Pregabalin caused significant weight loss, decreased serum triglyceride level, and increased leptin gene expression in all rats. PGB affected male rats reproduction by decreasing total testosterone serum level and inhibiting spermatogenesis. Reproductive toxicity in females was caused by decreasing pituitary steroids, increasing gonadal hormones, and increasing the number of atretic ovarian follicles. Mechanism of toxicity may be attributed to the PGB oxidative stress effect that induced apoptosis and caused diffuse gonadal atrophy. WGO showed a protective effect on PGB induced toxicity as all measured parameters were relatively improved.
Collapse
Affiliation(s)
- Dina A Shokry
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Cairo University, Egypt
| | - Naglaa El Nabrawy
- National Research Center, Faculty of Medicine, Cairo University, Egypt
| | - Hanan D Yassa
- Anatomy and Embryology Department, Faculty of Medicine, Beni-Suef University, Egypt
| | - Shereen S Gaber
- Biochemistry Department, Faculty of Medicine, Minia University, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Egypt
| | - Nermeen N Welson
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Beni-Suef University, Egypt.
| |
Collapse
|
34
|
Daveluy A, Micallef J, Sanchez-Pena P, Miremont-Salamé G, Lassalle R, Lacueille C, Grelaud A, Corand V, Victorri-Vigneau C, Batisse A, Le Boisselier R, Peyrière H, Frauger E, Lapeyre-Mestre M, Haramburu F. Ten-year trend of opioid and nonopioid analgesic use in the French adult population. Br J Clin Pharmacol 2020; 87:555-564. [PMID: 32496599 DOI: 10.1111/bcp.14415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Analgesics are the most widely used medicines worldwide. In parallel, opioid abuse has increased and is of major concern. The accessibility of pharmacologically powerful medicines and the addictovigilance signals in France about the risk of opiates addiction call for an overview of analgesic use. The objective of this study was to investigate the use of analgesics reimbursed in France over a 10-year period through its prevalence. METHODS A cross-sectional study repeated yearly was conducted by using data from the French reimbursement database from 2006 to 2015. Analgesics were classified according to their pharmacological potency: prevalence of use for each category and sociodemographic characteristics of patients treated were analysed. RESULTS The annual prevalence of analgesic use was high and increased during the study period (59.8%, 253 976 users in 2015). In 2015, prevalence was always higher in women and increased with age, except for those older than 84 years. Peripheral analgesics were the most used (55.3%, 234 739 users). The prevalence of weak analgesic use decreased (21.3%, 90 257 users), mainly due to the definitive withdrawal of dextropropoxyphene in France in 2011, which was not offset by an increase in the consumption of other weak analgesics. For strong analgesics (1.2%, 5129 users), morphine was the most widely used, with a dramatic increase in oxycodone use, especially in the elderly. CONCLUSION The prevalence of analgesic use is high: approximately 31 million adults had at least 1 analgesic reimbursed in 2015. The most widely used analgesics were peripheral analgesics, far ahead of opioid analgesics.
Collapse
Affiliation(s)
- Amélie Daveluy
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| | - Joëlle Micallef
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | - Paola Sanchez-Pena
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France
| | - Ghada Miremont-Salamé
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | | | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Virginie Corand
- Centre d'Etude et de Traitement de la Douleur, CHU Bordeaux, Bordeaux, France
| | | | - Anne Batisse
- Centre d'addictovigilance de Paris, AP-HP, France
| | | | - Hélène Peyrière
- Centre d'addictovigilance de Montpellier, CHU, Montpellier, France
| | - Elisabeth Frauger
- Aix Marseille Univ, AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Marseille, France
| | | | - Françoise Haramburu
- Centre d'addictovigilance, Service de pharmacologie médicale, CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team, Pharmacoepidemiology, Bordeaux, France
| |
Collapse
|
35
|
Abstract
After participating in this activity, learners should be better able to:• Assess the misuse potential of clonazepam• Characterize the nonmedical use of clonazepam• Identify the health problems associated with long-term use of clonazepam ABSTRACT: Clonazepam, a benzodiazepine, is commonly used in treating various conditions, including anxiety disorders and epileptic seizures. Due to its low price and easy availability, however, it has become a commonly misused medication, both in medical and recreational contexts. In this review, we aim to highlight the behavioral and pharmacological aspects of clonazepam and its history following its approval for human use. We examine the circumstances commonly associated with the nonmedical use of clonazepam and raise points of particular concern. Clonazepam, alone or in combination with other psychoactive substances, can lead to unwanted effects on health, such as motor and cognitive impairment, sleep disorders, and aggravation of mood and anxiety disorders. Prolonged use of clonazepam may lead to physical dependence and tolerance. There is therefore a need to find safer therapeutic alternatives for treating seizures and anxiety disorders. Greater awareness of its frequent nonmedical use is also needed to achieve safer overall use of this medication.
Collapse
|
36
|
Roche S, Blaise M. [Pregabalin and risk of addiction: A new care issue?]. Encephale 2020; 46:372-381. [PMID: 32471706 DOI: 10.1016/j.encep.2020.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Pregabalin (PRG) is a gamma-aminobutyric acid (GABA) analogue used for treatment of epilepsy, neuropathic pain, generalised anxiety disorder and currently being studied for other indications. Supported by the results of case studies and a limited number of studies, there is an ongoing debate about the addictive potential of PRG. However, evidence is scarce and no definitive assessment on the potential for abuse and dependence to PRG is available. The objective of our study was to identify the number of cases of abuse or dependence to PRG published and to study potential risk factors of addiction to PRG. METHODS We have identified on PubMed and ScienceDirect published case studies of PRG abuse or dependence and analysed these cases on the basis of several clinical parameters. RESULTS A total of 118 cases of PRG abuse or dependence were identified, including 21 isolated cases (mean age 33 years, 67 % men). The mean daily dose of PRG was 2,9 g. Current or past polydrug abuse was present in the majority of cases. Psychiatric diagnoses, other than substance-related disorders, were reported in as many patients, and almost all patients experienced withdrawal symptoms when PRG was discontinued. CONCLUSION Current literature suggests an important and growing concern for the abuse of PRG. Male sex, psychiatric and/or addiction history, including opioid addiction, may be potential risk factors for the development of addictive behaviours associated with PRG.
Collapse
Affiliation(s)
- S Roche
- Centre médical Marmottan, 17-19, rue d'Armaillé, 75017 Paris, France.
| | - M Blaise
- Centre médical Marmottan, 17-19, rue d'Armaillé, 75017 Paris, France
| |
Collapse
|
37
|
The neurotoxic effect of long-term use of high-dose Pregabalin and the role of alpha tocopherol in amelioration: implication of MAPK signaling with oxidative stress and apoptosis. Naunyn Schmiedebergs Arch Pharmacol 2020; 393:1635-1648. [DOI: 10.1007/s00210-020-01875-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/17/2020] [Indexed: 12/31/2022]
|
38
|
Lancia M, Gambelunghe A, Gili A, Bacci M, Aroni K, Gambelunghe C. Pregabalin Abuse in Combination With Other Drugs: Monitoring Among Methadone Patients. Front Psychiatry 2020; 10:1022. [PMID: 32116826 PMCID: PMC7026508 DOI: 10.3389/fpsyt.2019.01022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In recent years, there has been an increase in the non-medical use of psychoactive prescription drugs including pregabalin (PGB). Studies have shown that multiple drug users and patients in methadone treatment programs administered PGB at high dosages in order to achieve euphoria, reduce withdrawal symptoms, or potentiate the effects of methadone. For these reasons, accurate toxicological monitoring is required for these high-risk individuals. MATERIALS AND METHODS The present study investigated whether PGB could be detected in the hair samples of 250 patients with a history of opiate dependency, and under toxicological surveillance assess their compliance with methadone maintenance therapy. RESULTS Opiates were found in 54/250 of all hair samples, while cannabis was present in 74/250 patients, cocaine was detected in 21/250 patients, and benzodiazepines without prescription were identified in 49/250 patients. As expected, methadone was present in all 250 patients (100%). PGB without prescription was found in the hair samples of 35/250 patients (14%). Of these, 91.43% were male, 48.57% were <30 y old, and 45.71% were between ages 30 and 50 y. There were no apparent associations among PGB use, daily methadone dosage, and duration of methadone maintenance therapy. Psychiatric comorbidities were present in 25.71% of the patients abusing PGB. Anxiety (55.56%) and depression (33.33%) were the most prevalent psychiatric disorders. DISCUSSION Most of the patients taking PGB (57.14%) used other drugs (especially opiates) concurrently. The utility of hair analysis is explained by easy and rapid sample collection and the ability of the hair to reflect long-term drug use and incorporate drug metabolites. The findings of this study suggested that PGB has significant potential for abuse by high-risk populations such as opioid users and patients with dual diagnosis. These risks are particularly high in cases of poly-drug use and drug intake that are not in compliance with prescription guidelines.
Collapse
Affiliation(s)
- Massimo Lancia
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Angela Gambelunghe
- Occupational Medicine, Respiratory Diseases and Toxicology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alessio Gili
- Hygiene and Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Mauro Bacci
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Kyriaki Aroni
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| | - Cristiana Gambelunghe
- Forensic and Sports Medicine Section, Department of Surgery and Biomedical Science, University of Perugia, Perugia, Italy
| |
Collapse
|
39
|
Deeb S, Wylie FM, Torrance HJ, Scott KS. An Insight into Gabapentin and Pregabalin in Scottish Prisoners. J Anal Toxicol 2020; 44:504-513. [DOI: 10.1093/jat/bkz105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/03/2019] [Accepted: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
The aim of this study was to evaluate the prevalence and abuse potential of antiepileptic drugs (AEDs) among prison populations in Scotland, UK. Participants consisted of all admitted and released prisoners over a 1 month period who consented to provide samples. Urine samples were collected and analyzed by liquid chromatography coupled with triple quadrupole tandem mass spectrometry using a method validated for the simultaneous quantification of 21 AEDs in urine. A total of 904 samples were collected. The samples were also screened for drugs of abuse by using point-of-care testing kits. A total of 18% of the samples were positive for AEDs. Gabapentin (GBP) was identified in 118 samples (13%) and pregabalin (PRG) in 32 samples (3.5%). Interestingly, 12 samples contained both drugs (1.3%). The concentrations ranged from 0.5 to 1,100 mg/L (median, 15 mg/L) for GBP and from 0.5 to 440 mg/L (median, 7.3 mg/L) for PRG. Four samples were found to have concentrations >400 mg/L, two samples for GBP and two samples for PRG. These concentrations are at least 20 times above the median concentrations. Other AEDs detected were levetiracetam (four samples), vigabatrin (four samples), lamotrigine (three samples), valproic acid (three samples), carbamazepine (two samples) and topiramate (one sample). Illicit or non-prescribed drugs were detected in 81% of urine samples of which 80% were from admitted prisoners and 20% from released prisoners. Benzodiazepines, opiates and cannabis were the most frequently detected drugs. Other drugs found in positive AED samples were methadone (26%), cocaine (18%), buprenorphine (17%), amphetamines (4%), methamphetamines (4%) and barbiturates (4%). This study shows a high prevalence of AEDs within the Scottish prison system, primarily due to GBP and PRG; however, due to the anonymity of the sample collection, it is unknown if these are prescribed or illicit drug ingestions.
Collapse
Affiliation(s)
- Shaza Deeb
- Work Place Drug Testing Unit, Eurofins Forensic Services, Teddington TW11 0LY, UK
- Forensic Medicine and Science, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Fiona M Wylie
- Forensic Medicine and Science, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Hazel J Torrance
- Forensic Medicine and Science, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - Karen S Scott
- Forensic Medicine and Science, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
- Forensic Science, Arcadia University, Glenside, PA, USA
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Elsayed M, Zeiss R, Gahr M, Connemann BJ, Schönfeldt-Lecuona C. Intranasal Pregabalin Administration: A Review of the Literature and the Worldwide Spontaneous Reporting System of Adverse Drug Reactions. Brain Sci 2019; 9:brainsci9110322. [PMID: 31766153 PMCID: PMC6896010 DOI: 10.3390/brainsci9110322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background: It is repeatedly reported that pregabalin (PRG) and gabapentin feature a potential for abuse/misuse, predominantly in patients with former or active substance use disorder. The most common route of use is oral, though reports of sublingual, intravenous, rectal, and smoking administration also exist. A narrative review was performed to provide an overview of current knowledge about nasal PRG use. Methods: A narrative review of the currently available literature of nasal PRG use was performed by searching the MEDLINE, EMBASE, and Web of Science databases. The abstracts and articles identified were reviewed and examined for relevance. Secondly, a request regarding reports of cases of nasal PRG administration was performed in the worldwide spontaneous reporting system of adverse drug reactions of the European Medicines Agency (EMA, EudraVigilance database). Results: The literature search resulted in two reported cases of nasal PRG use. In the analysis of the EMA-database, 13 reported cases of nasal PRG use (11 male (two not specified), mean age of users = 34.2 years (four not specified)) were found. In two cases fatalities occurred related to PRG nasal use. Conclusions: Even if only little evidence can be found in current literature, the potential for misuse/abuse of PRG via nasal route might be of particular importance in the near future in PRG users who misuse it. Physicians should be aware of these alternative routes of administration.
Collapse
Affiliation(s)
- Mohamed Elsayed
- Correspondence: ; Tel.: +49-(0)-731-500-61411; Fax: +49-(0)-731-500-61412
| | | | | | | | | |
Collapse
|
42
|
De La Vega H, Fox K, Pardi J, Santiago-Tirado W, Cooper G. Validation of a High-throughput Screening and Quantification Method for the Determination of Gabapentinoids in Blood Using a Combination of LC-TOF-MS and LC-MS-MS. J Anal Toxicol 2019; 43:696-702. [PMID: 31436295 DOI: 10.1093/jat/bkz070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 01/19/2023] Open
Abstract
Gabapentinoids such as gabapentin (GP) and pregabalin (PGL) have been used to treat a wide range of neurological and psychiatric disorders. In recent years, there has been an increasing awareness of GP and PGL misuse among individuals with a history of polysubstance use. Both GP and PGL are understood to potentiate the effects of opioids, with fatalities involving GP and PGL being reported with increasing frequency. An efficient procedure was developed to screen and quantitate GP and PGL in blood samples using a combination of liquid chromatography time-of-flight mass spectrometry (LC-TOF-MS) and liquid chromatography tandem mass spectrometry (LC-MS-MS). The developed LC-MS-MS method was linear from 0.5-50 mg/L, with a limit of detection (LOD) of 0.1 mg/L for GP and PGL. An LOD of 0.5 mg/L was determined for both analytes on the LC-TOF-MS screen. A total of 1,091 blood specimens were subjected to a protein crash with methanol, in the presence of deuterated internal standards, PGL-d6 and GP-d10, to minimize the effects of varying matrix conditions. Specimens tested included both post-mortem blood and preserved blood specimens collected for the purposes of investigating drug-impaired driving and suspected drug-facilitated crimes. Of the total of specimens tested, 101 (9.3%) screened positive using the developed LC-TOF-MS method for GP while only 13 (1.2%) blood specimens screened positive for PGL. All (100%) of the cases that screened positive for GP and PGL were confirmed positive by LC-MS-MS. Blood concentrations of GP and PGL ranged from <0.5 to 215 mg/L and from <0.5 to 32 mg/L, respectively. Of the blood specimens that had previously screened negative by LC-TOF-MS, 10% (N = 100) were randomly selected and tested by LC-MS-MS with 100% confirmed negative for GP and PGL. The developed methods provide a fast and reliable high-throughput screening and confirmation testing strategy for the detection of GP and PGL in blood specimens.
Collapse
Affiliation(s)
- Hilda De La Vega
- Department of Forensic Toxicology, New York City Office of Chief Medical Examiner, New York City, NY 10016 USA
| | - Kim Fox
- Department of Forensic Toxicology, New York City Office of Chief Medical Examiner, New York City, NY 10016 USA
| | - Justine Pardi
- Department of Forensic Toxicology, New York City Office of Chief Medical Examiner, New York City, NY 10016 USA
| | - Wendy Santiago-Tirado
- Department of Forensic Toxicology, New York City Office of Chief Medical Examiner, New York City, NY 10016 USA
| | - Gail Cooper
- Department of Forensic Toxicology, New York City Office of Chief Medical Examiner, New York City, NY 10016 USA
| |
Collapse
|
43
|
Parsons B, Freynhagen R, Schug S, Whalen E, Ortiz M, Bhadra Brown P, Knapp L. The relationship between the reporting of euphoria events and early treatment responses to pregabalin: an exploratory post-hoc analysis. J Pain Res 2019; 12:2577-2587. [PMID: 31686899 PMCID: PMC6709807 DOI: 10.2147/jpr.s199203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Euphoria is a complex, multifactorial problem that is reported as an adverse event in clinical trials of analgesics including pregabalin. The relationship between the reporting of euphoria events and pregabalin early treatment responses was examined in this exploratory post-hoc analysis. Methods Data were from patients with neuropathic or non-neuropathic chronic pain enrolled in 40 randomized clinical trials, who received pregabalin (75–600 mg/day) or placebo. Reports of treatment-emergent euphoria events were based on the Medical Dictionary of Regulatory Activities preferred term “euphoric mood”. Prevalence rates of euphoria events overall and by indication were assessed. Post-treatment endpoints included ≥30% improvements in pain and sleep scores up to 3 weeks as well as a ≥1-point improvement in daily pain score up to 11 days after treatment. Results 13,252 patients were analyzed; 8,501 (64.1%) and 4,751 (35.9%) received pregabalin and placebo, respectively. Overall, 1.7% (n=222) of patients reported euphoria events. Among pregabalin-treated patients, a larger proportion who reported euphoria events achieved an early pain response compared with those who did not report euphoria (30% pain responders in week 1 with euphoria events [43.0%], without euphoria events [24.2%]). Results were similar for weeks 2 and 3. For Days 2–11, a larger proportion of pregabalin-treated patients with (relative to without) euphoria events were 1-point pain responders. Findings were similar in pregabalin-treated patients for sleep endpoints (30% sleep responders in week 1 with euphoria events [50.7%], without euphoria events [36.1%]). Similar results were found for weeks 2 and 3. Patients who received placebo showed similar patterns, although the overall number of them who reported euphoria events was small (n=13). Conclusion In patients who received pregabalin for neuropathic or non-neuropathic chronic pain, those who experienced euphoria events may have better early treatment responses than those who did not report euphoria events.
Collapse
Affiliation(s)
| | - Rainer Freynhagen
- Department of Anesthesiology, Critical Care Medicine, Pain Therapy & Palliative Care, Pain Center Lake Starnberg, Benedictus Hospital, Tutzing, Germany.,Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephan Schug
- Discipline of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia
| | | | | | | | | |
Collapse
|
44
|
Mick G, Gillet D, Heritier S, Garcia-Porra C, Bochet E. Prescriptions et usages de prégabaline : analyse d’une cohorte de 419 patients en centre d’étude et de traitement de la douleur et revue de la littérature. ACTA ACUST UNITED AC 2019. [DOI: 10.3166/dea-2019-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Du fait de l’augmentation du nombre de prescription de prégabaline dans le domaine de la douleur chronique et de cas relevés de mésusage récréatif ou toxicomaniaque avec ce médicament dans le monde, dans le contexte de la crise sanitaire en cours avec l’usage des opioïdes aux États-Unis, la crainte d’un risque addictif directement lié à l’usage de cette molécule a incité les autorités de divers pays à une surveillance accrue. Les recueils effectués par les centres de pharmacovigilance concernant la prégabaline relevant avant tout les situations considérées comme anormales, la description de l’usage de cette molécule au quotidien par un ensemble de prescripteurs et d’utilisateurs durant une période prolongée reflète mieux les conditions naturelles d’emploi de cette molécule et permet d’identifier les divers types de comportements des professionnels et usagers de santé à son égard. Une analyse rétrospective des dossiers de patients utilisateurs de prégabaline reçus et suivis dans une structure d’évaluation et prise en charge de la douleur pendant six ans a été réalisée, comprenant des données précises concernant les conditions d’usage et les effets du médicament. Les données issues de la littérature internationale et celles issues de l’étude montrent que le risque de mésusage et addictif est faible dans un contexte de prescription antalgique et de suivi médical adéquat, alors qu’il est élevé et directement lié à un mésusage de type récréatif ou toxicomaniaque en association avec les opioïdes ou l’alcool, en particulier dans la population jeune et en dehors du milieu des soins. Des recommandations d’usage de la prégabaline sont proposées aux professionnels afin de rappeler ces facteurs de risque.
Collapse
|
45
|
Coutens B, Mouledous L, Stella M, Rampon C, Lapeyre-Mestre M, Roussin A, Guiard BP, Jouanjus E. Lack of correlation between the activity of the mesolimbic dopaminergic system and the rewarding properties of pregabalin in mouse. Psychopharmacology (Berl) 2019; 236:2069-2082. [PMID: 30879119 DOI: 10.1007/s00213-019-05198-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/13/2019] [Indexed: 12/21/2022]
Abstract
RATIONALE Pregabalin is a psychoactive drug indicated in the treatment of epilepsy, neuropathic pain, and generalized anxiety disorders. Pregabalin acts on different neurotransmission systems by inactivating the alpha2-delta subunit of voltage-gated calcium channels. In light of this pharmacological property, the hypothesis has been raised that pregabalin may regulate the mesolimbic dopamine pathway and thereby display a potential for misuse or abuse as recently observed in humans. Although some preclinical data support this possibility, the rewarding properties of gabapentinoid are still a matter for debate. OBJECTIVE The aim of this work was to evaluate the rewarding properties of pregabalin and to determine its putative mechanism of action in healthy mice. RESULTS Pregabalin alone (60 mg/kg; s.c.) produced a rewarding effect in the conditioned place preference (CPP) test albeit to a lower extent than cocaine (30 mg/kg; s.c.). Interestingly, when assessing locomotor activity in the CPP, the PGB60 group, similarly to the cocaine group, showed an increased locomotor activity. In vivo single unit extracellular recording showed that pregabalin had mixed effects on dopamine (DA) neuronal activity in the ventral tegmental area since it decreased the activity of 50% of neurons and increased 28.5% of them. In contrast, cocaine decreased 75% of VTA DA neuronal activity whereas none of the neurons were activated. Intracerebal microdialysis was then conducted in awake freely mice to determine to what extent such electrophysiological parameters influence the extracellular DA concentrations ([DA]ext) in the nucleus accumbens. Although pregabalin failed to modify this parameter, cocaine produced a robust increase (800%) in [DA]ext. CONCLUSIONS Collectively, these electrophysiological and neurochemical experiments suggest that the rewarding properties of pregabalin result from a different mode of action than that observed with cocaine. Further experiments are warranted to determine whether such undesirable effects can be potentiated under pathological conditions such as neuropathic pain, mood disorders, or addiction and to identify the key neurotransmitter system involved.
Collapse
Affiliation(s)
- Basile Coutens
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), Université Paul Sabatier Toulouse III, Bât4R3, 118 Route de Narbonne, 31062, Toulouse, Cedex 09, France
| | - Lionel Mouledous
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), Université Paul Sabatier Toulouse III, Bât4R3, 118 Route de Narbonne, 31062, Toulouse, Cedex 09, France
| | - Manta Stella
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), Université Paul Sabatier Toulouse III, Bât4R3, 118 Route de Narbonne, 31062, Toulouse, Cedex 09, France
| | - Claire Rampon
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), Université Paul Sabatier Toulouse III, Bât4R3, 118 Route de Narbonne, 31062, Toulouse, Cedex 09, France
| | - Maryse Lapeyre-Mestre
- Pharmacoepidemiology Research Unit, INSERM-Université Toulouse 3, UMR 1027, 31000, Toulouse, France
| | - Anne Roussin
- Pharmacoepidemiology Research Unit, INSERM-Université Toulouse 3, UMR 1027, 31000, Toulouse, France
| | - Bruno P Guiard
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), Université Paul Sabatier Toulouse III, Bât4R3, 118 Route de Narbonne, 31062, Toulouse, Cedex 09, France. .,Faculté de Pharmacie, Université Paris Sud, Université Paris-Saclay, 92290, Chatenay-Malabry, France. .,CNRS UMR-5169, UPS, 31000, Toulouse, France.
| | - Emilie Jouanjus
- Pharmacoepidemiology Research Unit, INSERM-Université Toulouse 3, UMR 1027, 31000, Toulouse, France
| |
Collapse
|
46
|
Commentary on "A Call for Caution in Prescribing Gabapentin to Individuals with Concurrent Polysubstance Abuse: A Case Report". J Psychiatr Pract 2019; 25:308-312. [PMID: 31291213 DOI: 10.1097/pra.0000000000000404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Gabapentin is an anticonvulsant medication with an indication from the US Food and Drug Administration for use in partial onset seizures and postherpetic neuralgia in the United States. Currently, gabapentin is only classified as a controlled substance subject to stricter prescribing and distributing regulations in certain states, as opposed to pregabalin, an anticonvulsant with a similar mechanism of action which is a considered a Schedule V medication under federal law. Gabapentin shares a structural similarity to pregabalin, and several case reports have suggested that gabapentin has a similar propensity for abuse. The mechanisms of the gabapentin reward pathway, addiction, and withdrawal, however, are not well known. This case report describes a patient with long-term polysubstance abuse and new onset gabapentin dependence and demonstrates the need for increased surveillance of gabapentin prescribing.
Collapse
|
47
|
A Call for Caution in Prescribing Gabapentin to Individuals With Concurrent Polysubstance Abuse: A Case Report. J Psychiatr Pract 2019; 25:308-312. [PMID: 31291212 DOI: 10.1097/pra.0000000000000403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gabapentin is an anticonvulsant medication with an indication from the US Food and Drug Administration for use in partial onset seizures and postherpetic neuralgia in the United States. Currently, gabapentin is only classified as a controlled substance subject to stricter prescribing and distributing regulations in certain states, as opposed to pregabalin, an anticonvulsant with a similar mechanism of action which is a considered a Schedule V medication under federal law. Gabapentin shares a structural similarity to pregabalin, and several case reports have suggested that gabapentin has a similar propensity for abuse. The mechanisms of the gabapentin reward pathway, addiction, and withdrawal, however, are not well known. This case report describes a patient with long-term polysubstance abuse and new onset gabapentin dependence and demonstrates the need for increased surveillance of gabapentin prescribing.
Collapse
|
48
|
Neicun J, Steenhuizen M, van Kessel R, Yang JC, Negri A, Czabanowska K, Corazza O, Roman-Urrestarazu A. Mapping novel psychoactive substances policy in the EU: The case of Portugal, the Netherlands, Czech Republic, Poland, the United Kingdom and Sweden. PLoS One 2019; 14:e0218011. [PMID: 31242225 PMCID: PMC6594604 DOI: 10.1371/journal.pone.0218011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/23/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The rapid rise in trade and use of NPS and the lack of information concerning their potential toxicity pose serious challenges to public health authorities across the world. Policy measures towards NPS taken so far have a special focus on their legal status, while the implementation of a public health strategy seems to be still missing. The aim of this study is to perform a general assessment of NPS-related policy (including regulatory measures and public health strategies) implemented by six European countries: Portugal, the Netherlands, Czech Republic, Poland, the United Kingdom and Sweden. METHODS Six EU countries were included in this scoping review study. Drug policies (including legal responses and public health strategies) were analysed. UNODC drug policy classification system was used as a benchmark, while path dependency approach was used for data analysis; a net of inter-dependencies between international, EU and national policies was highlighted. RESULTS AND DISCUSSION The countries included in this study can be placed in a wide spectrum according to their formulation of drug policy, from Portugal and the UK that have specific legal responses to NPS but have differently focused on harm reduction strategies at one end, to Sweden whose drug-free society goal is not translated into a specific regulation of NPS at the other end. CONCLUSION The findings of the study reveal limited development towards harmonisation of national drug policies-particularly with regard to NPS. To tackle the challenge presented by NPS, EU Member states have formulated legislation and public health strategies independently. National approaches to NPS are therefore in line with their already existing drug policies, reflecting cultural values towards substance abuse and national political interests, while the homogenization at an international level has so far mostly been focused on law enforcement and drugs use preventive strategies.
Collapse
Affiliation(s)
- Jessica Neicun
- Care and Public Health Research Centre, Department of International Health, University of Maastricht, Maastricht, The Netherlands
- Novel Psychoactive Substance Unit, Centre for Clinical & Health Research Services, University of Hertfordshire, Hatfield, United Kingdom
| | - Marthe Steenhuizen
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Robin van Kessel
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Justin C. Yang
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Attilio Negri
- Novel Psychoactive Substance Unit, Centre for Clinical & Health Research Services, University of Hertfordshire, Hatfield, United Kingdom
| | - Katarzyna Czabanowska
- Care and Public Health Research Centre, Department of International Health, University of Maastricht, Maastricht, The Netherlands
| | - Ornella Corazza
- Novel Psychoactive Substance Unit, Centre for Clinical & Health Research Services, University of Hertfordshire, Hatfield, United Kingdom
| | - Andres Roman-Urrestarazu
- Care and Public Health Research Centre, Department of International Health, University of Maastricht, Maastricht, The Netherlands
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
49
|
Greenblatt HK, Greenblatt DJ. Gabapentin and Pregabalin for the Treatment of Anxiety Disorders. Clin Pharmacol Drug Dev 2019; 7:228-232. [PMID: 29579375 DOI: 10.1002/cpdd.446] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
50
|
Molero Y, Larsson H, D'Onofrio BM, Sharp DJ, Fazel S. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden. BMJ 2019; 365:l2147. [PMID: 31189556 PMCID: PMC6559335 DOI: 10.1136/bmj.l2147] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicidal behaviour, unintentional overdoses), and criminality. DESIGN Population based cohort study. SETTING High quality prescription, patient, death, and crime registers, Sweden. PARTICIPANTS 191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for gabapentinoids (pregabalin or gabapentin) during 2006 to 2013. MAIN OUTCOME MEASURES Primary outcomes were suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidents and offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. Participants served as their own control, thus accounting for time invariant factors (eg, genetic and historical factors), and reducing confounding by indication. Additional adjustments were made by age, sex, comorbidities, substance use, and use of other antiepileptics. RESULTS During the study period, 10 026 (5.2%) participants were treated for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. In within-individual analyses, gabapentinoid treatment was associated with increased hazards of suicidal behaviour and deaths from suicide (age adjusted hazard ratio 1.26, 95% confidence interval 1.20 to 1.32), unintentional overdoses (1.24, 1.19 to 1.28), head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences (1.13, 1.06 to 1.20). Associations with arrests for violent crime were less clear (1.04, 0.98 to 1.11). When the drugs were examined separately, pregabalin was associated with increased hazards of all outcomes, whereas gabapentin was associated with decreased or no statistically significant hazards. When stratifying on age, increased hazards of all outcomes were associated with participants aged 15 to 24 years. CONCLUSIONS This study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences. Pregabalin was associated with higher hazards of these outcomes than gabapentin.
Collapse
Affiliation(s)
- Yasmina Molero
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - David J Sharp
- Division of Brain Sciences, Imperial College London, London, UK
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| |
Collapse
|