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Ciesluk B, Inglis DG, Parke A, Troup LJ. Systematic review: The relationship between gabapentinoids, etizolam, and drug related deaths in Scotland. PLoS One 2024; 19:e0310655. [PMID: 39383139 PMCID: PMC11463789 DOI: 10.1371/journal.pone.0310655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/04/2024] [Indexed: 10/11/2024] Open
Abstract
In recent years Scotland has been experiencing a disproportionally high number of drug related deaths compared to other European countries, causing significant individual, societal and economic burden. A possible cause of this is the increase in average number of substances involved in Scottish drug related deaths, as well as the changing pattern of substances involved. Opioids, cocaine, and alcohol have been consistently involved in the culture of drug use in Scotland, however recently National Records Scotland have identified that designer benzodiazepines such as etizolam, and prescription drugs such as gabapentinoids are increasingly being detected in Scottish toxicology reports. A systematic literature review following PRISMA guidelines was conducted through searching PubMed and Google Scholar to identify peer-reviewed articles published in English between 2013 and 2023 that investigated Scottish population data on gabapentinoids and etizolam to establish their contribution to the rise in Scottish drug related deaths. 18 studies were included in the review. A high use prevalence of etizolam and gabapentinoids in Scotland has been identified, with both substance-related deaths showing recent increase, marked since 2015. This pattern is replicated in the Scottish prison system. There has also been a significant increase of gabapentinoids prescriptions in Scotland. Polydrug use was identified as the most common determinant of both etizolam and gabapentinoids related adverse effects and fatality in Scotland, especially concurrent opioid use. The results indicate the literature on individual characteristics of Scottish at-risk users of gabapentinoids and etizolam is limited, however the data shows both substances are being used by older cohort, with adverse effects seen more in older women.
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Affiliation(s)
- Beata Ciesluk
- University of the West of Scotland, School of Education and Social Sciences, Paisley, Scotland, United Kingdom
| | - Dr. Greig Inglis
- University of the West of Scotland, School of Education and Social Sciences, Paisley, Scotland, United Kingdom
| | - Adrian Parke
- University of the West of Scotland, School of Education and Social Sciences, Paisley, Scotland, United Kingdom
| | - Lucy J. Troup
- University of the West of Scotland, School of Education and Social Sciences, Paisley, Scotland, United Kingdom
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Åhman A, Wingren CJ, Håkansson A. Causes and circumstances of death in stimulant and opioid use-A comparative study. PLoS One 2024; 19:e0297838. [PMID: 38324514 PMCID: PMC10849257 DOI: 10.1371/journal.pone.0297838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
AIMS To investigate the individual characteristics, causes and circumstances around deaths in stimulant use, and to examine how individuals who died with stimulants in their body differ from individuals who died with opioids in their body. METHODS This study includes individuals who died during the years 2000-2018 and underwent a forensic autopsy at Forensic Medicine in Lund, Skåne County, Sweden. All individuals over 18 years of age with stimulants (n = 310), opioids (n = 2,039) or both stimulants and opioids (n = 385) in the body at the time of death, were included. The three groups were assessed regarding gender, age, place of death, BMI, other substances detected in forensic toxicological analysis, organ weights and underlying and contributing causes of death. The data were analysed by frequency and proportion calculations, cross-tabulations and comparisons of medians. RESULTS The median age at death of the study population (n = 2,734) was 45.5 years (interquartile range ☯IQR] 32-60 years) and 73.2% were men. The most common cause of death in the stimulant group was suicide (26.8%), higher proportion compared to the opioid group (20.8%) (p = 0.017) and in the polysubstance group accidental poisoning (38.2%), higher proportion compared to the opioid group (18.0%) (p<0.001). Death by transport accidents was significantly associated with the stimulant group (p<0.001) as well as death by other accidents (p = 0.016). CONCLUSIONS Individuals who died with stimulants in their body died at a higher rate from suicide, transport accidents and other accidents, compared to individuals who died with opioids in their body. This study indicates the need to identify and prevent psychiatric conditions, elevated suicide risk, and risk-taking behaviors among people who use stimulants.
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Affiliation(s)
- Ada Åhman
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
| | - Carl Johan Wingren
- Unit for Forensic Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden
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Wouldes TA, Lester BM. Opioid, methamphetamine, and polysubstance use: perinatal outcomes for the mother and infant. Front Pediatr 2023; 11:1305508. [PMID: 38250592 PMCID: PMC10798256 DOI: 10.3389/fped.2023.1305508] [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] [Received: 10/01/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024] Open
Abstract
The escalation in opioid pain relief (OPR) medications, heroin and fentanyl, has led to an increased use during pregnancy and a public health crisis. Methamphetamine use in women of childbearing age has now eclipsed the use of cocaine and other stimulants globally. Recent reports have shown increases in methamphetamine are selective to opioid use, particularly in rural regions in the US. This report compares the extent of our knowledge of the perinatal outcomes of OPRs, heroin, fentanyl, two long-acting substances used in the treatment of opioid use disorders (buprenorphine and methadone), and methamphetamine. The methodological limitations of the current research are examined, and two important initiatives that will address these limitations are reviewed. Current knowledge of the perinatal effects of short-acting opioids, OPRs, heroin, and fentanyl, is scarce. Most of what we know about the perinatal effects of opioids comes from research on the long-acting opioid agonist drugs used in the treatment of OUDs, methadone and buprenorphine. Both have better perinatal outcomes for the mother and newborn than heroin, but the uptake of these opioid substitution programs is poor (<50%). Current research on perinatal outcomes of methamphetamine is limited to retrospective epidemiological studies, chart reviews, one study from a treatment center in Hawaii, and the US and NZ cross-cultural infant Development, Environment And Lifestyle IDEAL studies. Characteristics of pregnant individuals in both opioid and MA studies were associated with poor maternal health, higher rates of mental illness, trauma, and poverty. Infant outcomes that differed between opioid and MA exposure included variations in neurobehavior at birth which could complicate the diagnosis and treatment of neonatal opioid withdrawal (NOWs). Given the complexity of OUDs in pregnant individuals and the increasing co-use of these opioids with MA, large studies are needed. These studies need to address the many confounders to perinatal outcomes and employ neurodevelopmental markers at birth that can help predict long-term neurodevelopmental outcomes. Two US initiatives that can provide critical research and treatment answers to this public health crisis are the US Environmental influences on Child Health Outcomes (ECHO) program and the Medication for Opioid Use Disorder During Pregnancy Network (MAT-LINK).
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Affiliation(s)
- Trecia A. Wouldes
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Barry M. Lester
- Center for the Study of Children at Risk, Warren Alpert Medical School, Brown University, Providence, RI, United States
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Ellis MS, Xu KY, Tardelli VS, Fidalgo TM, Buttram ME, Grucza RA. Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder. JAMA Psychiatry 2023; 80:1269-1276. [PMID: 37672238 PMCID: PMC10483381 DOI: 10.1001/jamapsychiatry.2023.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/05/2023] [Indexed: 09/07/2023]
Abstract
Importance Gabapentin prescriptions have drastically increased in the US due to off-label prescribing in settings such as opioid use disorder (OUD) treatment to manage a range of comorbid conditions and withdrawal symptoms, despite a lack of evidence. Objective To assess the purpose and associated risks of off-label gabapentin use in OUD treatment. Design, Setting, and Participants This retrospective recurrent-event case-control study with a crossover design used administrative claims data from MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Individuals aged 12 to 64 years with an OUD diagnosis and filling buprenorphine prescriptions were included in the primary analysis conducted from July 1, 2022, through June 1, 2023. Unit of observation was the person-day. Exposures Days covered by filled gabapentin prescriptions. Main Outcomes and Measures Primary outcomes were receipt of gabapentin in the 90 days after initiation of buprenorphine treatment and drug-related poisoning. Drug-related poisonings were defined using codes from International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Results A total of 109 407 patients were included in the analysis (mean [SD] age, 34.0 [11.2] years; 60 112 [54.9%] male). Among the 29 967 patients with Medicaid coverage, 299 (1.0%) were Hispanic, 1330 (4.4%) were non-Hispanic Black, 23 112 (77.1%) were non-Hispanic White, and 3399 (11.3%) were other. Gabapentin was significantly less likely to be prescribed to Black or Hispanic patients, and more likely to be prescribed to female patients, those with co-occurring substance use or mood disorders, and those with comorbid physical conditions such as neuropathic pain. Nearly one-third of persons who received gabapentin (4336 [31.1%]) had at least 1 drug-related poisoning after initiating buprenorphine treatment, compared with 13 856 (14.5%) among persons who did not receive gabapentin. Adjusted analyses showed that days of gabapentin use were not associated with hospitalization for drug-related poisoning (odds ratio, 0.98 [95% CI, 0.85-1.13]). Drug-related poisoning risks did not vary based on dosage. Conclusions and Relevance Gabapentin is prescribed in the context of a myriad of comorbid conditions. Even though persons receiving gabapentin are more likely to have admissions for drug-related poisoning, these data suggest that gabapentin is not associated with an increased risk of drug-related poisoning alongside buprenorphine in adjusted analyses. More data on the safety profile of gabapentin in OUD settings are needed.
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Affiliation(s)
- Matthew S. Ellis
- Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, Missouri
| | - Kevin Y. Xu
- Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, Missouri
| | - Vitor S. Tardelli
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
- Translational Addictions Research Laboratory, Centre for Addictions and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Thiago M. Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mance E. Buttram
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville
| | - Richard A. Grucza
- Department of Family and Community Medicine, St Louis University, St Louis, Missouri
- Department of Health and Outcomes Research, St Louis University, St Louis, Missouri
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Gabapentin Use During Pregnancy and Lactation With and Without Concurrent Opioid Exposure: Considerations and Future Directions. J Addict Med 2023; 17:123-125. [PMID: 36069804 DOI: 10.1097/adm.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Gabapentin is a γ-aminobutyric acid analog formally indicated for the treatment of epilepsy and neuropathic pain that is gaining increased popularity. Gabapentin has been historically considered a safe medication, including during pregnancy and lactation, with low reported concerns for misuse and use disorders. However, new empirical efforts are revealing concerns regarding the safety of widespread gabapentin use, particularly in pregnancy and for individuals with a propensity toward substance misuse. The Food and Drug Administration's full prescribing information report on gabapentin provides concerning preclinical data and then states that gabapentin is potentially "developmentally toxic" and has an unknown risk of birth impacts. Concerns have also been raised surrounding in utero exposure to gabapentin due to the onset and presentation of atypical and/or difficult to control withdrawal signs and symptoms in neonates, including those dually exposed to opioids, as well as neonatal exposure to gabapentin via breastmilk. Moreover, nonprescribed gabapentin use has become an increasing problem, with opioid use disorder being the greatest risk factor for such misuse. This article summarizes the current literature regarding gabapentin use during pregnancy and related prenatal and neonatal exposure outcomes with special consideration for interactions between gabapentin and opioid use. Taken together, the current literature suggests that gabapentin use should be considered with caution during pregnancy and during the post-partum period. Well-controlled, prospective research studies are needed to determine the extent of the risks and benefits of prescribed and nonprescribed gabapentin exposure to pregnant people and their neonates.
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Ellis MS, Qureshi R, Buttram ME. Understanding motivations and use typologies of gabapentin with opioid agonist medications. Drug Alcohol Depend 2023; 242:109713. [PMID: 36462231 DOI: 10.1016/j.drugalcdep.2022.109713] [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] [Received: 09/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior research suggests a potential relationship between the nonmedical use of gabapentin and use of opioid agonist medications (OAMs), buprenorphine and methadone. However, this research has been limited in scope and understanding despite increases in gabapentin prescribing in opioid use disorder (OUD) treatment settings and increased detection in opioid overdose fatalities. METHODS Data were analyzed for 346 participants of a follow-up program to an ongoing national opioid surveillance program of new entrants to treatment for opioid use disorder. Data were sourced from a cross-sectional online survey distributed in July/August 2021. RESULTS Lifetime exposure to gabapentin was reported by 60.0 % of the sample, while lifetime history of nonmedical use was reported by 43.2 %. Of those nonmedically using gabapentin, 50.0 % did so while also on a dosage of either buprenorphine or methadone, with 28.4 % engaged in concurrent nonmedical use of both gabapentin and OATs. Motivations for concurrent nonmedical use included high-seeking (38.6 %), self-management of pain/physical symptoms (33.3 %), and self-management of OUD (22.2 %). CONCLUSIONS Gabapentin exposure in treatment-seeking persons with OUD appears to be quite common, and use, both medically and nonmedically, frequently occurs alongside OAMs. Motivations for concurrent nonmedical use of gabapentin and OATs mirrors motivations for off-label prescribing by healthcare providers, but may also serve as a form of self-management of OUD when OAM regimens are interrupted, insufficiently prescribed or prescribed at insufficient dosages. Further research should seek to understand the risks versus benefits of gabapentin in OAM treatment settings.
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Affiliation(s)
- Matthew S Ellis
- Washington University in St. Louis, School of Medicine, Department of Psychiatry. St. Louis, MO, USA.
| | - Rida Qureshi
- Washington University in St. Louis, St. Louis, MO, USA
| | - Mance E Buttram
- University of Arkansas, Department of Health, Human Performance & Recreation, Fayetteville, AR, USA
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Ghose R, Cowden F, Veluchamy A, Smith BH, Colvin LA. Characteristics of non-fatal overdoses and associated risk factors in patients attending a specialist community-based substance misuse service. Br J Pain 2022; 16:458-466. [PMID: 36032347 PMCID: PMC9411761 DOI: 10.1177/20494637221095447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction There are concerns about rising drug-related deaths and the potential contribution of prescription analgesics. There is limited understanding regarding the role of prescription analgesics in non-fatal overdoses (NFODs), nor is there a good understanding of what factors are associated with more severe overdose. Objectives To explore risk factors and characteristics of NFODs among people attending a specialist community-based substance misuse service. Methods After Caldicott approval, data on NFODs, in people attending the Tayside Substance Misuse Service (TSMS), were extracted from the Scottish Ambulance Service database, along with opioid replacement therapy (ORT) prescribing data. Statistical analysis was performed using R studio and Microsoft Excel. Results 557 people (78% [434/556] male, mean age ± standard deviation 38.4 ± 7.95) had an NFOD. Repeat NFODs were more likely in males compared to females (p < .0065). Males were more likely to be administered naloxone (OR = 1.94, 95% CI = 1.10-3.40, p < .02). NFODs at home were more likely to be moderate to severe (categorized by Glasgow Comma Scale [p < .02, OR = 4.95, 95% CI = 1.24-24.38]). Methadone (321/557, 57.63%), benzodiazepines (281/557, 50.45%) and heroin (244/557, 43.81%) were the commonest substances: prescribed methadone overdose was more likely than buprenorphine (p < .00001). Opioids and benzodiazepines were often taken together (275/557, 49.40%), with almost all gabapentinoid NFODs also involving opioids (60/61, 98.40%). Conclusions Polysubstance use with opioids prescribed for ORT, such as methadone, is highly likely to be implicated in NFOD, with males being at the highest risk of severe and repeat NFOD. Future work should focus on strategies to further reduce NFODs.
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Affiliation(s)
- Riya Ghose
- Department of Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | - Abirami Veluchamy
- Department of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Blair H Smith
- Department of Population Health Sciences, Medical Research Institute, Dundee, UK
| | - Lesley A Colvin
- Department of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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Hsiao F, Ma A, Muthukanagaraj P. Pregabalin Toxicity-Induced Posterior Reversible Encephalopathy Syndrome. Cureus 2022; 14:e25656. [PMID: 35784981 PMCID: PMC9249023 DOI: 10.7759/cureus.25656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
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Zhao D, Nunes AP, Baek J, Lapane KL. An algorithm to identify gabapentin misuse and/or abuse in administrative claims data. Drug Alcohol Depend 2022; 235:109429. [PMID: 35427982 DOI: 10.1016/j.drugalcdep.2022.109429] [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] [Received: 12/14/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite gabapentin's misuse and abuse potential and associated adverse events, few algorithms are available to detect gabapentin misuse and/or abuse in claims data. This study aims to develop an algorithm to identify gabapentin misuse and/or abuse in administrative claims data. METHODS We developed an algorithm to identify gabapentin misuse and/or abuse over a 12-month period based on input from 21 clinical experts. We implemented the algorithm among 334,128 patients with at least one dispensed prescription of gabapentin between December 1, 2017 and December 1, 2018 in the IBM® MarketScan® Research Databases. We described the characteristics of patients who potentially misused and/or abused gabapentin and assessed factors associated with misuse and/or abuse using logistic regression. RESULTS The algorithm identified 17.6% of patients with gabapentin use who potentially misused and/or abused gabapentin. Factors associated with potential gabapentin misuse and/or abuse included men (adjusted odds ratio (aOR): 1.08; 95% confidence interval (CI): 1.06-1.10), comorbid conditions (e.g., drug and alcohol dependence (aOR: 1.31; 95% CI: 1.24-1.39); bipolar disorder (aOR: 1.34; 95% CI: 1.27-1.41)), and medication use (e.g., opioids (aOR: 1.23; 95% CI: 1.20-1.26), muscle relaxants (aOR: 1.24; 95% CI: 1.21-1.27), or serotonin-norepinephrine reuptake inhibitors (aOR: 1.33; 95% CI: 1.29-1.36)). CONCLUSIONS Approximately one in six patients with gabapentin use potentially misused and/or abused gabapentin in a large commercial claims database. Multiple comorbidities and drug use were associated with gabapentin misuse and/or abuse. Monitoring requirements and individualized safety measures should be put in place for patients at elevated risks of gabapentin misuse and/or abuse.
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Affiliation(s)
- Danni Zhao
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
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Ellis MS, Buttram ME, Kasper ZA. Nonmedical use of gabapentin and opioid agonist medications in treatment-seeking individuals with opioid use disorder. Drug Alcohol Depend 2022; 234:109400. [PMID: 35290917 DOI: 10.1016/j.drugalcdep.2022.109400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND As prescriptions for gabapentin have increased in recent years, nonmedical use and risk of adverse outcomes (e.g., hospitalizations and overdose) have been identified, particularly in association with opioids, including opioid agonist medications (OAMs) buprenorphine and methadone. However, there is a lack of systematic, nationwide data assessing the relationship between the nonmedical use of gabapentin and OAMs. METHODS Data were sourced from two nationwide opioid surveillance programs of treatment-seeking individuals with opioid use disorder (OUD). Both programs utilized an identical serial, cross sectional survey of 12,792 new entrants to one of 163 substance use treatment programs for OUD in 46 states and the District of Columbia from January 2019 to December 2020. RESULTS Past month nonmedical use of gabapentin was endorsed by 9.3% of the sample. Of those using gabapentin nonmedically, 64.1% also endorsed nonmedical use of an OAM, including concomitant use of methadone (35.3%), and buprenorphine (49.0%). Concomitant nonmedical use of gabapentin and OAMs was more prevalent (versus nonmedical use of gabapentin alone) in the Southern region, among those living in a street dwelling, those with chronic pain and healthcare professionals. CONCLUSIONS Nonmedical use of gabapentin in people with OUD appears to frequently coincide with nonmedical use of OAMs. As prescriptions and off-label use of gabapentin increase, provider education should include the risks of concomitant gabapentin and OAM use, particularly amongst buprenorphine prescribers. Future research should investigate motivations (e.g., OUD self-management) for nonmedical use of gabapentin and OAMs within the context of OUD treatment access and retention.
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Affiliation(s)
- Matthew S Ellis
- Washington University in St. Louis, School of Medicine. Department of Psychiatry, St. Louis, MO, USA.
| | - Mance E Buttram
- University of Arkansas, Department of Health, Human Performance & Recreation, Fayetteville, AR, USA
| | - Zachary A Kasper
- Washington University in St. Louis, School of Medicine. Department of Psychiatry, St. Louis, MO, USA
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Althunian TA, Alomran MI, Alsagri GM, Alrasheed MM, Alshammari TM. The Impact of Regulatory Restrictions on Pregabalin use in Saudi Arabia: An Interrupted Time series Analysis. Pharmacoepidemiol Drug Saf 2022; 31:577-582. [PMID: 35049110 DOI: 10.1002/pds.5408] [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: 05/25/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The Saudi Food and Drug Authority (SFDA) added pregabalin to the list of controlled substances in December 2017 to minimize the risk of its possible abuse and misuse. This study was aimed at assessing the impact of this decision on the overall use of pregabalin in Saudi Arabia and in comparison, with drugs prescribed to treat neuropathic pain therapy (i.e. vs. gabapentin, tramadol, duloxetine, and amitriptyline). METHODS This was an interrupted time-series analysis of the Saudi quarterly sale data of the study drugs from October/2015 to September/2020. These data were obtained from IQVIA and were converted into use estimates (defined daily dose per 1000 inhabitant-days [DDD/TID]). Segmented regression models were conducted to assess the direct (level) and prolonged (trend) changes in use data after the decision. All analyses were completed using RStudio Version 1.4.1103. RESULTS Before the SFDA's decision, there was an increased quarter-to-quarter use of pregabalin (DDD/TID: 0.16; 95% confidence interval [CI] 0.04 to 0.28). Pregabalin overall use dropped sharply by -1.85 DDD/TID (95%CI -2.71 to -0.99) directly after the decision with a prolonged quarter-to-quarter declining effect (DDD/TID: -0.22, CI to -0.37 to -0.05). The decision was associated with a direct increase in the use of gabapentin by 0.62 DDD/TID (95%CI 0.52 to 0.72) without any impact on the use of other drugs. CONCLUSIONS The results of our study showed that the SFDA decision was associated with a decrease in the overall use of pregabalin, which may help minimize the risk of its abuse and misuse. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Turki A Althunian
- Executive Directorate for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.,College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Maha I Alomran
- Executive Directorate for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.,College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Ghada M Alsagri
- Executive Directorate for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.,College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Meshael M Alrasheed
- Executive Directorate for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.,College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Thamir M Alshammari
- Executive Directorate for Research and Studies, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.,College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
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Gittins R, Vaziri R, Maidment I. Surveying Over the Counter and Prescription Only Medication Misuse in Treatment Services During COVID-19. SUBSTANCE ABUSE: RESEARCH AND TREATMENT 2022; 16:11782218221135875. [DOI: 10.1177/11782218221135875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
Background: A greater understanding of Over the Counter (OTC) and Prescription Only Medication (POM) misuse amongst adults accessing substance misuse services (SMS) during COVID-19 is required to identify how SMS can better meet the needs of the people who require treatment. Aim: To use a questionnaire to explore OTC/POM misuse during COVID-19 in adults accessing community SMS in England. Methods: In 2020 to 2021 anonymous self-administered online/paper questionnaires which collated quantitative and qualitative data were completed. They were piloted for suitability and ethical approval was obtained. Thematic analysis was conducted for qualitative data and chi-square tests used to assess the relationship between quantitative variables. Results: Participants were Caucasian (94.6% British), majority male (58.9%), aged 18 to 61 years. Most were prescribed medication for problematic substance use, with a 92.5% self-reported adherence rate. The misuse of benzodiazepines (22.2%) codeine products (30.8%) and pregabalin (14.5%) predominated and 37.5% misused 2 or more medicines. Administration was usually oral and concomitant use of other substances was common: alcohol 44.6% (52% daily), tobacco/vaping 73.2% and illicit substances 58.9%. There were statistically significant associations identified, including between changes during COVID-19 to OTC/POM misuse and illicit use. Only 56 questionnaires were included in the analysis: we believe this low number was because of infection control measures, limited footfall in services, pressures on staff limiting their capacity to distribute the paper questionnaires and reliance upon telephone consultations limiting online distribution. Increasing OTC/POM misuse and obtaining illicit supplies were reported when access to usual supplies were restricted; however, changes to doses/dispensing arrangement liberalisation in response to COVID-19 were positively viewed. Conclusion: OTC/POM misuse, including polypharmacy and concomitant use of other substances occurred during COVID-19: SMS need to be vigilant for these issues and mitigate the associated risks for example with harm reduction interventions. Further qualitative research is required to explore the issues identified.
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Affiliation(s)
- Rosalind Gittins
- Clinical Department, Humankind, Durham, UK
- Aston Pharmacy School, Aston University, Birmingham, UK
| | | | - Ian Maidment
- Aston Pharmacy School, Aston University, Birmingham, UK
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13
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Boggess T, Williamson JC, Niebergall EB, Sexton H, Mazur A, Egleton RD, Grover LM, Risher WC. Alterations in Excitatory and Inhibitory Synaptic Development Within the Mesolimbic Dopamine Pathway in a Mouse Model of Prenatal Drug Exposure. Front Pediatr 2021; 9:794544. [PMID: 34966707 PMCID: PMC8710665 DOI: 10.3389/fped.2021.794544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
The rise in rates of opioid abuse in recent years in the United States has led to a dramatic increase in the incidence of neonatal abstinence syndrome (NAS). Despite improved understanding of NAS and its acute symptoms, there remains a paucity of information regarding the long-term effects of prenatal exposure to drugs of abuse on neurological development. The primary goal of this study was to investigate the effects of prenatal drug exposure on synaptic connectivity within brain regions associated with the mesolimbic dopamine pathway, the primary reward pathway associated with drug abuse and addiction, in a mouse model. Our secondary goal was to examine the role of the Ca+2 channel subunit α2δ-1, known to be involved in key developmental synaptogenic pathways, in mediating these effects. Pregnant mouse dams were treated orally with either the opioid drug buprenorphine (commonly used in medication-assisted treatment for substance use patients), gabapentin (neuropathic pain drug that binds to α2δ-1 and has been increasingly co-abused with opioids), a combination of both drugs, or vehicle daily from gestational day 6 until postnatal day 11. Confocal fluorescence immunohistochemistry (IHC) imaging of the brains of the resulting wild-type (WT) pups at postnatal day 21 revealed a number of significant alterations in excitatory and inhibitory synaptic populations within the anterior cingulate cortex (ACC), nucleus accumbens (NAC), and medial prefrontal cortex (PFC), particularly in the buprenorphine or combinatorial buprenorphine/gabapentin groups. Furthermore, we observed several drug- and region-specific differences in synaptic connectivity between WT and α2δ-1 haploinsufficient mice, indicating that critical α2δ-1-associated synaptogenic pathways are disrupted with early life drug exposure.
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Affiliation(s)
| | | | | | | | | | | | | | - W. Christopher Risher
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
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14
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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.
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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
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15
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Okoye NC, McMillin GA. Patterns of Neonatal Co-Exposure to Gabapentin and Commonly Abused Drugs Observed in Umbilical Cord Tissue. J Anal Toxicol 2021; 45:506-512. [PMID: 32860706 DOI: 10.1093/jat/bkaa118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/18/2020] [Accepted: 08/25/2020] [Indexed: 01/10/2023] Open
Abstract
Gabapentin was thought to have low abuse potential, but it is increasingly being abused by people with substance use disorder in an attempt to potentiate the euphoric effects from opioids and other CNS depressants. Additionally, infants co-exposed to gabapentin and opioids during pregnancy tend to exhibit prolonged and more severe neonatal abstinence syndrome. In this study, we describe positivity rates among commonly abused drugs and rates of co-medication with gabapentin in a large dataset of umbilical cord tissue specimens (n = 25,422) submitted for routine newborn drug testing at a national clinical reference laboratory (ARUP Laboratories, Salt Lake City, UT, USA). Detection of prenatal drug exposure in umbilical cord tissue specimens was accomplished using a semi-quantitative liquid chromatography-tandem mass spectrometry assay designed to detect 47 specific drugs and drug metabolites including opioids, stimulants, sedative-hypnotics and hallucinogens. A positive result for at least one of the measured drugs or drug metabolites was reported in 7,054 (28%) of the umbilical cord tissues analyzed. Gabapentin had a positivity rate of ~2% with 562 positive results. Of the 562 gabapentin-positive samples, 395 (70%) also had a positive result for at least one other drug or drug metabolite, with the highest co-positivity rate observed for norbuprenorphine (32%, n = 182) followed by amphetamine (15%, n = 84), buprenorphine (13%, n = 74), methamphetamine (12%, n = 68), morphine (11%, n = 64), fentanyl (10%, n = 54) and naloxone (10%, n = 54). Notably, the concentration of gabapentin in gabapentin-positive umbilical cord specimens was higher in buprenorphine-containing specimens as compared to specimens containing other opioids, stimulants or benzodiazepines. Identification of neonatal co-exposure to gabapentin and opioids, particularly buprenorphine, may guide clinicians in rapid initiation of monitoring and intervention for neonatal abstinence syndrome.
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Affiliation(s)
- Nkemakonam C Okoye
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Gwendolyn A McMillin
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
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16
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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.
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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
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17
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Manandhar P, Murnion BP, Grimsey NL, Connor M, Santiago M. Do gabapentin or pregabalin directly modulate the µ receptor? PeerJ 2021; 9:e11175. [PMID: 33954038 PMCID: PMC8048397 DOI: 10.7717/peerj.11175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pregabalin and gabapentin improve neuropathic pain symptoms but there are emerging concerns regarding their misuse. This is more pronounced among patients with substance use disorder, particularly involving opioids. Co-ingestion of gabapentinoids with opioids is increasingly identified in opioid related deaths, however, the molecular mechanism behind this is still unclear. We have sought to determine whether pregabalin or gabapentin directly modulates acute μ receptor signaling, or μ receptor activation by morphine. METHODS The effects of pregabalin and gabapentin were assessed in HEK 293 cells stably transfected with the human μ receptor. Their effect on morphine induced hyperpolarization, cAMP production and ERK phosphorylation were studied using fluorescent-based membrane potential assay, bioluminescence based CAMYEL assay and ELISA assay, respectively. Pregabalin/gabapentin effects on morphine-induced hyperpolarization were also investigated in AtT20 cells. RESULTS Pregabalin or gabapentin (1 µM, 100 µM each) did not activate the µ receptor or affect K channel activation or ERK phosphorylation produced by morphine. Neither drug affected the desensitization of K channel activation produced by prolonged (30 min) application of morphine. Gabapentin (1 µM, 100 µM) and pregabalin (1 µM) did not affect inhibition of forskolin-stimulated cAMP production by morphine. However, pregabalin (100 µM) potentiated forskolin mediated cAMP production, although morphine still inhibited cAMP levels with a similar potency to control. DISCUSSION Pregabalin or gabapentin did not activate or modulate µ receptor signaling in three different assays. Our data do not support the hypothesis that gabapentin or pregabalin augment opioid effects through direct or allosteric modulation of the µ receptor. Pregabalin at a high concentration increases cAMP production independent of morphine. The mechanism of enhanced opioid-related harms from co-ingestion of pregabalin or gabapentin with opioids needs further investigation.
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Affiliation(s)
- Preeti Manandhar
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
| | - Bridin Patricia Murnion
- Drug and Alcohol Services, Central Coast Local Health District, Hamlyn Terrace, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Natasha L. Grimsey
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - Mark Connor
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
| | - Marina Santiago
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
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18
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Campbell LS, Coomer TN, Jacob GK, Lenz RJ. Gabapentin controlled substance status. J Am Pharm Assoc (2003) 2021; 61:e218-e224. [PMID: 33674205 DOI: 10.1016/j.japh.2021.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Gabapentin is approved to treat postherpetic neuralgia and epilepsy with partial-onset seizures. The large majority of gabapentin prescribing is off label. Gabapentin may be abused for euphoria, potentiating the high from opiates, reduction of alcohol cravings, a cocaine-like high, as well as sedation or sleep. Individuals at the highest risk for abusing gabapentin include those with opioid abuse, mental illness, or previous history of prescription drug abuse. States are now taking action to track gabapentin use through prescription monitoring programs, and some states have reclassified it as a Schedule V controlled substance. This commentary summarizes gabapentin's abuse potential, identifies state-level actions regarding gabapentin monitoring, and discusses possible clinical implications and ways to enhance patient safety when prescribing gabapentin.
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Bargel S, Becam J, Chanu L, Lanot T, Martin M, Vaucel J, Willeman T, Fabresse N. Les gabapentinoïdes : une revue de la littérature. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Kuhn D, Müller TJ, Mutschler J. [Pregabalin abuse and dependence in various European countries: Association with substitution policies]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:553-561. [PMID: 33440453 DOI: 10.1055/a-1324-3379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pregabalin was first approved in 2004 for the treatment of peripheral neuropathic pain and focal epileptic seizures, with or without secondary generalization. Prescription frequency has increased significantly since approval. In the early days, little attention was paid to the problem of misuse and dependence on pregabalin; in recent years, there has been a significant increase in the number of publications focusing on this problem. This review deals with these risk factors and risk groups of pregabalin abuse and dependence in different European countries and their drug policies. RESULTS Pregabalin abuse and dependence has increased significantly since its introduction to the market. It was shown that solo abuse of pregabalin is rare. In most cases, pregabalin was combined with other substances, which is also a predictor of pregabalin abuse. There were different reasons for the non-prescription use of pregabalin; it was used to increase the psychotropic effect, on the one hand, and to alleviate withdrawal symptoms, on the other hand. Furthermore, in Sweden, pregabalin was found in 28% of fatal intoxications among drug addicts. Young people were particularly affected. Abuse of pregabalin was detected in countries with restrictive substitution programmes, while in countries with liberal drug policies, no abuse was detected. However, the data situation in Switzerland with a liberal substitution programme is based on only one study, which is why pregabalin use in liberal substitution programmes cannot be conclusively clarified. CONCLUSIONS There seems to be a connection between a country's drug policy and the illegal use of pregabalin among persons in a substitution programme in that country. There are also risk factors and risk groups for pregabalin dependence and abuse.
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Affiliation(s)
| | | | - Jochen Mutschler
- Zentrum für Translationale Psychiatrie, Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern
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21
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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.
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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
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22
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Abstract
This review summarizes current evidence on the abuse and misuse of the gabapentinoids pregabalin and gabapentin. Pharmacovigilance studies, register-based studies, surveys, clinical toxicology studies, and forensic toxicology studies were identified and scrutinized with the goal to define the problem, identify risk factors, and discuss possible methods to reduce the potential for abuse and misuse. Studies found that gabapentinoids are abused and misused and that individuals with a history of psychiatric disorders or substance use disorder seem to be at high risk. Moreover, some evidence supports the notion that patients with opioid use disorders may be at an increased risk of abusing gabapentinoids. Available evidence also suggests that abuse and misuse are more frequent in users of pregabalin compared with users of gabapentin. Health professionals and prescribers should be aware of the risk for misuse of pregabalin and gabapentin, which eventually could lead to abuse, substance dependence, and intoxications. Prescribing to patients belonging to risk populations such as those with psychiatric disorders or substance use disorder should be avoided if possible and, if prescribed, signs of misuse and abuse should be monitored.
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Affiliation(s)
- Staffan Hägg
- Futurum, Jönköping, Region Jönköping County and Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Futurum, Hus B4, Ryhov Hospital, S-551 85, Jönköping, Sweden.
| | - Anna K Jönsson
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
| | - Johan Ahlner
- Division of Drug Research, Department of Biomedicine and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
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Yu D, Appleyard T, Cottrell E, Peat G. Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017. Rheumatology (Oxford) 2020; 60:1942-1950. [DOI: 10.1093/rheumatology/keaa586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/12/2020] [Indexed: 02/04/2023] Open
Abstract
Abstract
Objectives
To produce national and regional estimates and trends for gabapentinoid–opioid co-prescribing rates in patients with OA, both in absolute terms and relative to matched controls without OA.
Methods
Using the UK Clinical Practice Research Datalink database we first constructed age–sex–practice–date 1:1 matched cohorts of patients aged ≥40 years with and without a new diagnosis of OA between 1995–2017 and estimated the relative incidence of a first gabapentinoid prescription. Incident gabapentinoid users in both cohorts were followed to estimate and compare the event rate of gabapentinoid–opioid co-prescription (prescription from both classes within the same 28-day window).
Results
The incidence of first gabapentinoid prescription was 3-fold higher in patients with OA than in matched controls [n = 215 357; incidence rate ratio (IRR) 2.93; 95% CI: 2.87, 3.00]. Among incident gabapentinoid users with OA (n = 27 374, median follow-up 3.9 years) the event rate of gabapentinoid–opioid co-prescription was 4.03 (4.02–4.05) per person-year. The rate was higher in OA patients classed as long-term gabapentinoid users (6.24; 6.22–6.26). These rates were significantly higher than in incident gabapentinoid users without OA [adjusted-IRR: 1.29 (1.28–1.30)]. This elevated risk was observed across age, sex, geographic regions, and calendar years, when restricted to strong opioids and to long-term gabapentinoid users, and when co-prescription was defined as within 14 days and same-day prescribing.
Conclusions
Patients with OA not only have a higher risk of being prescribed a gabapentinoid but, once prescribed a gabapentinoid, are also at greater risk of opioid co-prescription. Strict restriction of gabapentinoid–opioid co-prescription, and improved access to, and uptake of, effective non-pharmacological and surgical alternatives for OA are required.
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Affiliation(s)
- Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
| | - Tom Appleyard
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
| | - Elizabeth Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Community and Social Care, Keele University, Keele, UK
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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.
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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.
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Buttram ME, Kurtz SP. Descriptions of Gabapentin Misuse and Associated Behaviors among a Sample of Opioid (Mis)users in South Florida. J Psychoactive Drugs 2020; 53:47-54. [PMID: 32748701 DOI: 10.1080/02791072.2020.1802087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Gabapentin has received increased attention due to a growing number of reports of misuse and diversion. However, significant details about gabapentin misuse are scant. Data are drawn from a mixed-methods study examining gabapentin misuse in South Florida. The sample includes 49 respondents who were age 18 or over and reported past year use of illicit opioids and/or the misuse of prescription opioid medications, as well as, recent (past 90 days) gabapentin misuse. Respondents were female (40.8%), Hispanic (30.6%), Black (16.3%), white (49.0%), and other race/ethnicity (4.1%). Mean age was 37.6. Many respondents (43%) misused gabapentin without ever receiving a prescription and 14% misused prior to being prescribed. Mean frequency of recent misuse was 25.4 days and included a mean of 51.65 pills/doses. Prevalent routes of administration included swallowing (85.7%) and snorting (10.2%). Gabapentin misuse occurred concomitantly with any opioid (44.9%), benzodiazepines (38.8%), alcohol (24.5%), and powder cocaine (24.5), among others. Respondents' descriptions indicate that gabapentin produces feelings reminiscent of alcohol intoxication or opioid-induced euphoria, but for some it produces no noticeable effect or only alleviates pain. Greater understanding of gabapentin misuse, especially associated behaviors and concomitant use is needed to inform prevention and intervention efforts, and to guide policy approaches.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, USA
| | - Steven P Kurtz
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, FL, USA
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Torrance N, Veluchamy A, Zhou Y, Fletcher EH, Moir E, Hebert HL, Donnan PT, Watson J, Colvin LA, Smith BH. Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth 2020; 125:159-167. [PMID: 32571568 DOI: 10.1016/j.bja.2020.05.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ∼7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006-2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs. METHODS National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases. RESULTS From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 'recurrent users' (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08-2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription. CONCLUSIONS Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication.
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Affiliation(s)
- Nicola Torrance
- School of Nursing & Midwifery, Robert Gordon University, Aberdeen, UK
| | - Abirami Veluchamy
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Yiling Zhou
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Emma H Fletcher
- NHS Tayside Directorate of Public Health, King's Cross, Dundee, UK
| | - Eilidh Moir
- NHS Tayside Directorate of Public Health, King's Cross, Dundee, UK
| | - Harry L Hebert
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Dundee Epidemiology and Biostatistics Unit, Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Jennifer Watson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Lesley A Colvin
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.
| | - Blair H Smith
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
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Boggess T, Risher WC. Clinical and basic research investigations into the long-term effects of prenatal opioid exposure on brain development. J Neurosci Res 2020; 100:396-409. [PMID: 32459039 DOI: 10.1002/jnr.24642] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 12/26/2022]
Abstract
Coincident with the opioid epidemic in the United States has been a dramatic increase in the number of children born with neonatal abstinence syndrome (NAS), a form of withdrawal resulting from opioid exposure during pregnancy. Many research efforts on NAS have focused on short-term care, including acute symptom treatment and weaning of the infants off their drug dependency prior to authorizing their release. However, investigations into the long-term effects of prenatal opioid exposure (POE) on brain development, from the cellular to the behavioral level, have not been as frequent. Given the importance of the perinatal period for human brain development, opioid-induced disturbances in the formation and function of nascent synaptic networks and glia have the potential to impact brain connectivity and cognition long after the drug supply is cutoff shortly after birth. In this review, we will summarize the current state of NAS research, bringing together findings from human studies and preclinical animal models to highlight what is known about how POE can induce significant, prolonged deficits in brain structure and function. With rates of NAS continuing to rise, particularly in regions that already face substantial socioeconomic challenges, we speculate as to the most promising avenues for future research to alleviate this growing multigenerational threat.
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Affiliation(s)
- Taylor Boggess
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine at Marshall University, Huntington, WV, USA
| | - W Christopher Risher
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine at Marshall University, Huntington, WV, USA
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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.
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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
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Shapira B, Berkovitz R, Rosca P, Neumark Y. Recent Use of Synthetic Cannabinoids, Synthetic Opioids, and Other Psychoactive Drug Groups among High-risk Drug Users. J Psychoactive Drugs 2020; 52:334-343. [DOI: 10.1080/02791072.2020.1754534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Barak Shapira
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Ronny Berkovitz
- Division of Enforcement and Inspection, Israel Ministry of Health, Jerusalem, Israel
| | - Paola Rosca
- Department for the Treatment of Substance Abuse, Israel Ministry of Health, Jerusalem, Israel
| | - Yehuda Neumark
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
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Applewhite D, Regan S, Koenigs K, Mackin S, Schmidt C, Wakeman SE. Use of promethazine, gabapentin and clonidine in combination with opioids or opioid agonist therapies among individuals attending a syringe service program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102752. [PMID: 32330837 DOI: 10.1016/j.drugpo.2020.102752] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clonidine, gabapentin, and promethazine are commonly used by people who use opioids, including heroin, raising concern for increased morbidity and mortality in a vulnerable population. We aimed to characterize how and why individuals use opioids in combination with these three psychoactive medications (PAMs). METHODS Participants (n = 103) were a convenience sample of adults attending a syringe service program who reported using a PAM in addition to opioids or opioid agonist therapies (buprenorphine or methadone). Face-to-face structured interviews consisted of closed and open-ended questions. RESULTS Patterns of PAM use varied. Risky use, including use of high doses and with other sedating medications, was common. Most individuals reported multiple medical reasons for use, even while reporting the PAM had mind-altering effects. Use of high doses of PAMs was associated with a history of overdose. Among those with a history of overdose, 32% reported that a PAM was involved. CONCLUSION The use of clonidine, gabapentin and promethazine among individuals who use opioids is complex. Providers should take individualized approaches to PAM prescribing, recognizing both the risks of PAMs and the potential unintended consequences of supply-side interventions in the era of the overdose crisis. Harm reduction interventions are needed to prevent PAM-involved overdoses.
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Affiliation(s)
- Dinah Applewhite
- Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States.
| | - Susan Regan
- Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
| | - Kathleen Koenigs
- Harvard University School of Medicine, 25 Shattuck St, Boston, Massachusetts, 02115, United States
| | - Sarah Mackin
- AHOPE Harm Reduction Program, 1010 Massachusetts Ave, Boston, Massachusetts, 02118 United States
| | - Clare Schmidt
- AHOPE Harm Reduction Program, 1010 Massachusetts Ave, Boston, Massachusetts, 02118 United States
| | - Sarah E Wakeman
- Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
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Pauly NJ, Delcher C, Slavova S, Lindahl E, Talbert J, Freeman PR. Trends in Gabapentin Prescribing in a Commercially Insured U.S. Adult Population, 2009-2016. J Manag Care Spec Pharm 2020; 26:246-252. [PMID: 32105169 PMCID: PMC7155217 DOI: 10.18553/jmcp.2020.26.3.246] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Gabapentin is prescribed for a variety of conditions and is often used off label. It is important to understand the prevalence of gabapentin prescribing and the characteristics of individuals who are prescribed gabapentin, given increasing concern regarding its potential for misuse. OBJECTIVES To (a) examine state- and region-level prevalence and trends in gabapentin prescribing from 2009 to 2016 and (b) characterize demographic and clinical characteristics of individuals prescribed gabapentin in a nationwide population of commercially insured adults. METHODS This retrospective, longitudinal study examined trends in gabapentin prescribing from 2009 to 2016. The study population included individuals aged 18-64 years who were enrolled in a commercial insurance plan at any point from 2009 to 2016. Individuals who were prescribed gabapentin were defined as beneficiaries with at least 1 gabapentin prescription claim in a calendar year (CY). A cross-sectional descriptive analysis was performed to examine differences in demographic and clinical characteristics of individuals prescribed or not prescribed gabapentin in CY 2016. RESULTS The prevalence of gabapentin prescribing nearly doubled from 2009 to 2016. During this time, gabapentin prescribing increased in every state (range: 44%-179%). State-specific prevalence rates in 2016 varied from 12.7 to 43.9 per 1,000 beneficiaries. Overall, 2.7% of beneficiaries filled ≥ 1 gabapentin prescription in 2016. Individuals prescribed gabapentin were more likely to fill opioid prescriptions (60.8% vs. 16.5%, P < 0.01); reside in the South (53.7% vs. 47%, P < 0.01); be female (62.5% vs. 52.3%, P < 0.01); and be aged 55-64 years (41.7% vs. 21.2%, P < 0.01) compared with the comparator. Individuals who were prescribed gabapentin also had significantly higher rates of seizure disorders, neuropathic pain, mental health disorders, substance use disorders, and diabetes. CONCLUSIONS The prevalence of gabapentin prescribing among a U.S. privately insured population has increased steadily in recent years. Additional research should examine coprescribing of gabapentin in the context of the opioid epidemic. DISCLOSURES The project described in this study was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. This study was also partially supported by grant number 2017-PM-BX-K026 (Data-Driven Responses to Prescription Drug Misuse in Kentucky) awarded by the Bureau of Justice Assistance. Viewpoints or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice or the official views of the NIH. The authors do not have any conflicts of interest to report. Portions of this study have been previously presented in poster presentations at the 2019 Academy Health Annual Research Meeting; June 2-4, 2019; Washington, DC, and the 2019 University of Kentucky Substance Use Research Day; March 3, 2019; Lexington, KY.
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Affiliation(s)
- Nathan J. Pauly
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown
| | - Chris Delcher
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington
| | - Svetla Slavova
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington
| | - Eric Lindahl
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington
| | - Jeff Talbert
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington
| | - Patricia R. Freeman
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington
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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.
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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
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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.
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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
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Buttram ME, Surratt HL. Factors Associated with Gabapentin Misuse among People Who Inject Drugs in Appalachian Kentucky. Subst Use Misuse 2020; 55:2364-2370. [PMID: 32917119 PMCID: PMC7643539 DOI: 10.1080/10826084.2020.1817082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gabapentin is misused to potentiate the euphoric effects of opioids, self-treat physical pain, and moderate opioid withdrawal symptoms. Because examinations of gabapentin misuse among people who inject drugs (PWID) are scant, the aim of this study is to identify factors associated with gabapentin misuse among this population. Methods: Data are drawn from a study examining the uptake of syringe service programs (SSPs) in Appalachian Kentucky. The sample includes 324 PWID who were age 18 and over and reported past month drug injection. Logistic regression models were constructed to examine recent (past 90 days) gabapentin misuse. Results: Participants are female (50.0%); Hispanic (2.2%), Black (1.5%), white (90.7%), and other race/ethnicity (4.6%). Mean age is 37. Participants reporting gabapentin misuse had higher odds of reporting (mis)use of marijuana, cocaine, methamphetamine, prescription opioids, benzodiazepines, prescription stimulants, fentanyl, and buprenorphine (p < .042); severe substance use disorder (p < .000); and recent physical pain (p < .003). In multivariable models, findings related to misuse of prescription opioids and buprenorphine; severe substance use disorder; and recent physical pain or discomfort, remained significant (p < .042). Conclusions: This is one of the first studies to examine gabapentin misuse among PWID. It is possible that individuals reporting recent gabapentin misuse are attempting to self-treat physical pain when healthcare is limited. Gabapentin may also be misused to achieve desired central nervous system effects and to potentiate opioid highs. Syringe service programs can educate PWID about the potential dangers of polydrug use involving gabapentin and to connect PWID with needed healthcare services.
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Affiliation(s)
- Mance E Buttram
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida, USA
| | - Hilary L Surratt
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Vickers-Smith R, Sun J, Charnigo RJ, Lofwall MR, Walsh SL, Havens JR. Gabapentin drug misuse signals: A pharmacovigilance assessment using the FDA adverse event reporting system. Drug Alcohol Depend 2020; 206:107709. [PMID: 31732295 PMCID: PMC7762328 DOI: 10.1016/j.drugalcdep.2019.107709] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although there have been increasing reports of intentional gabapentin misuse, epidemiological evidence for the phenomenon is limited. The purpose of this study was to determine whether there are pharmacovigilance abuse signals for gabapentin. METHODS Using FDA Adverse Events Reporting System reports from January 1, 2005 to December 31, 2015, we calculated pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayes geometric mean) for abuse-related adverse event (AR-AE)-gabapentin pairs. Loglinear modeling assessed the frequency of concurrent reporting of abuse-related and abuse-specific AEs (AS-AEs) associated with gabapentin. Findings were compared to a positive (pregabalin) and negative (duloxetine) control. RESULTS From 2005-2015 there were 5,951,229 unique AE reports submitted to the FDA including 99,977 for gabapentin, 73,977 for duloxetine, and 97,813 for pregabalin. Significant drug-AR-AE pair signals involving gabapentin included: drug abuser, multiple drug overdose, and substance-induced psychotic disorder. Significant drug AR-AE signals involving gabapentin and pregabalin, but not duloxetine, were: ataxia, dependence, drug abuse, increased drug tolerance, and overdose. Compared to duloxetine, gabapentin had significantly greater odds of a co-report for an AS-AE with drug withdrawal syndrome (OR: 6.55), auditory hallucinations (OR: 4.57), delusions (OR: 2.36), euphoric mood (OR: 5.45), ataxia (OR: 2.85), drug abuser (OR: 3.01), aggression (OR: 1.98), psychotic disorder (OR: 1.96), and feeling abnormal (OR: 1.31). CONCLUSIONS We identified abuse-related signals for gabapentin and highlighted several CNS effects that may be associated with its abuse. Gabapentin prescribers should be aware of the drug's abuse liability and effects that may accompany its use.
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Affiliation(s)
- Rachel Vickers-Smith
- University of Louisville School of Nursing, Louisville, KY 40202, USA; Department of Biostatistics, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA; Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Jiangwen Sun
- Department of Computer Science, Old Dominion University, Norfolk, VA 23529, USA
| | - Richard J Charnigo
- Department of Biostatistics, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
| | - Michelle R Lofwall
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Sharon L Walsh
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA; Department of Pharmaceutical Sciences, University of Kentucky College of Pharmacy, 789 South Limestone, Lexington, KY 40508, USA
| | - Jennifer R Havens
- Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA
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Stein MD, Kenney SR, Anderson BJ, Conti MT, Bailey GL. Prescribed and non-prescribed gabapentin use among persons seeking inpatient opioid detoxification. J Subst Abuse Treat 2019; 110:37-41. [PMID: 31952626 DOI: 10.1016/j.jsat.2019.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/11/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Persons with opioid use disorder (OUD) are at increased risk for gabapentin misuse. Rising rates of concomitant gabapentin-opioid use in the U.S. are concerning given heightened risk of fatal overdose. OBJECTIVE To examine predictors of ever using gabapentin among persons seeking treatment for opioid use and to assess if reasons for gabapentin use differed by gender and how gabapentin was procured (prescribed, non-prescribed, or both). METHOD Persons with OUD were recruited from a managed withdrawal program. t-Tests and Pearson χ2 tests of independence were used to compare reasons for gabapentin use by gender and source of acquisition. RESULTS Among participants (n = 401; 69.1% male, 84.5% White, 86.8% sought treatment for heroin use, 90.0% insured), female gender, higher educational attainment, injection drug use (IDU), history of overdose, and chronic pain were associated with gabapentin use. Overall, reasons for use were similar across genders among those reporting a history of gabapentin use (65.8%), although males were more likely to use to get high than females. About half (47.0%) reported only using gabapentin that was not prescribed, 20.5% had only used prescribed gabapentin, and 32.5% reported prescribed and non-prescribed use. Persons prescribed gabapentin were most likely to use it to control pain (81.5%); for those using diverted gabapentin only and those reporting both prescribed and non-prescribed gabapentin use, the most common reasons for intake were to: get high, increase effects of heroin, substitute for opioids, and help with opioid withdrawal. CONCLUSIONS In this sample of people with OUD entering inpatient detoxification program, a majority reported a history of gabapentin use, with most using diverted gabapentin. The range of reasons for gabapentin use point to the need to better understand why co-use is common.
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Affiliation(s)
- Michael D Stein
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Boston University School of Public Health, Boston, MA 02118, United States of America
| | - Shannon R Kenney
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America; Warren Alpert Medical School of Brown University, Providence, RI 02912, United States of America.
| | - Bradley J Anderson
- Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United States of America
| | - Micah T Conti
- Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States of America
| | - Genie L Bailey
- Warren Alpert Medical School of Brown University, Providence, RI 02912, United States of America; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720, United States of America
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Reynolds K, Kaufman R, Korenoski A, Fennimore L, Shulman J, Lynch M. Trends in gabapentin and baclofen exposures reported to U.S. poison centers. Clin Toxicol (Phila) 2019; 58:763-772. [DOI: 10.1080/15563650.2019.1687902] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Robert Kaufman
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | | | - Laura Fennimore
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Joshua Shulman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Lynch
- Pittsburgh Poison Center, Pittsburgh, PA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Jenny Wei YJ, Chen C, Schmidt SO, LoCiganic WH, Winterstein AG. Trends in prior receipt of prescription opioid or adjuvant analgesics among patients with incident opioid use disorder or opioid-related overdose from 2006 to 2016. Drug Alcohol Depend 2019; 204:107600. [PMID: 31586806 PMCID: PMC6927577 DOI: 10.1016/j.drugalcdep.2019.107600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/22/2019] [Accepted: 07/21/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND With increasing efforts to scrutinize and reduce opioid prescribing, limited data exist on the recent trend in receipt of prescription pain medications before diagnosis of opioid use disorder (OUD) or opioid-related overdose (OD). METHODS Using 2005-2016 Truven MarketScan Commercial Claims databases, we assessed trends in annual 1) incidence of OUD or OD and 2) prevalence of receipt of prescription opioids or four commonly-prescribed adjuvant analgesics among patients newly diagnosed with OUD/OD. Trends were examined in the overall sample and by 3 age groups, including youths (≤18 years), adults (19-64 years), and older adults (≥65 years). RESULTS The incidence of diagnosed OUD or OD increased more than 3-fold from 4.99 to 23.81 per 10,000 persons from 2006 to 2016, with the highest increase (14.18-fold) seen in older adults, followed by adults (3.53-fold), and youths (0.16-fold). Between 2006 and 2016, the proportion of patients with incident OUD/OD who received anticonvulsant adjuvant analgesics in the year before diagnosis increased (from 23.4% to 34.3% [P-trend = .005]) whereas the proportion receiving high-dose prescriptions opioids decreased (from 45.5% to 34.8% [P-trend =< .001]). A decreasing trend was observed in general for tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors. DISCUSSION In US commercially insured patients newly diagnosed with OUD/OD, receipt of high-dose opioid prescriptions preceding the diagnosis decreased over time, paralleled by increased use of anticonvulsants commonly prescribed for pain conditions. Further investigations are warranted to understand how prescribed and anticonvulsants contribute to the development of OUD/OD.
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Affiliation(s)
- Yu-Jung Jenny Wei
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, Florida 32610, USA,Center for Drug Evaluation and Safety, College of Pharmacy, 1225 Center Drive, Gainesville, Florida 32610, USA
| | - Cheng Chen
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, Florida 32610, USA
| | - Siegfried O. Schmidt
- Department of Community Health and Family Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, Florida 32610, USA
| | - Wei-Hsuan LoCiganic
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, Florida 32610, USA
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, 1225 Center Drive, Gainesville, Florida 32610, USA,Department of Epidemiology, University of Florida Colleges of Medicine and Public Health and Health Professions, 2004 Mowry Road, Gainesville, Florida 32610, USA,Center for Drug Evaluation and Safety, College of Pharmacy, 1225 Center Drive, Gainesville, Florida 32610, USA
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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.
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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
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Murnion BP, Rivas C, Demirkol A, Hayes V, Lintzeris N, Nielsen S. Acute Experimental Pain Responses in Methadone- and Buprenorphine/Naloxone-Maintained Patients Administered Additional Opioid or Gabapentin: A Double-Blind Crossover Pilot Study. PAIN MEDICINE 2019; 21:1188-1198. [DOI: 10.1093/pm/pnz178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Objective
The study objective was to identify the analgesic efficacy of three different pharmacological strategies in patients receiving methadone or buprenorphine as opioid agonist treatment (OAT). The three pharmacological approaches, a) increasing maintenance methadone/buprenorphine dose by 30%, b) adding oxycodone, or c) adding a single dose of gabapentin, were compared with a control condition of the participant’s usual OAT dose.
Design
A randomized, controlled, double-blinded, double-dummy, within-subject crossover study.
Subjects
Nine participants on stable doses of methadone and eight participants on stable doses of buprenorphine were recruited.
Setting
An outpatient opioid treatment clinic in inner city Sydney, Australia.
Methods
The cold pressor tolerance test was used to examine experimental pain threshold and tolerance. Ratings of subjective drug effects and safety measures (physiological and cognitive) were assessed.
Results
There was no difference in the primary outcome measures of pain thresholds or tolerance between the conditions examined. Interindividual variability was evident. Differences in some subjective measures were identified, including lower pain recall, lower “bad effects,” and higher global satisfaction in the additional methadone condition. In the buprenorphine arm, increased drug liking and “bad effects” were detected with oxycodone administration, while increased subjective intoxication was identified with gabapentin.
Conclusions
There was no evidence of an objective improvement in analgesia with any condition compared with control. Further research is required to optimize pain management strategies in this population.
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Affiliation(s)
- Bridin Patricia Murnion
- Drug and Alcohol Services, Central Coast Local Health District, Hamlyn Terrace, Australia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Consuelo Rivas
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Apo Demirkol
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Vicky Hayes
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
| | - Nicholas Lintzeris
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia
- Discipline of Addiction Medicine, University of Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia
- National Drug and Alcohol Centre, University of New South Wales, Sydney, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
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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.
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Eckhard L, Jones T, Collins JE, Shrestha S, Fitz W. Increased postoperative dexamethasone and gabapentin reduces opioid consumption after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:2167-2172. [PMID: 30826856 DOI: 10.1007/s00167-019-05449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Dexamethasone and gabapentin are used in multimodal pain management protocols to reduce postoperative pain after total knee arthroplasty. For both analgesic adjuvants, the optimal dose regimen to reduce opioid usage is still unclear. METHODS The opioid consumption of patients undergoing primary TKA before and after a change of the analgesic adjuvant medication in our protocol (old protocol: 4 mg of dexamethasone daily for 2 days, 600 mg gabapentin daily for 1 week; new protocol: 10 mg dexamethasone daily for 2 days, 300 mg gabapentin every 8 h for 1 week) were retrospectively compared. All surgeries were performed under spinal anesthesia. Peri- and postoperative pain medication remained unchanged. RESULTS A total of 186 patients who received TKA between 11/29/2016 and 06/09/2017 were screened. Six patients who received general anesthesia, 4 patients who underwent simultaneous bilateral TKA, and 16 patients with ongoing opioid consumption at the time of surgery were excluded, leaving 80 patients in each group. Opioid consumption within 24 h [morphine equivalents in mg: mean 50.5, standard deviation (SD) 30.0 (old) vs. 39.8, SD 24.2 (new); P = 0.0470], cumulative consumption over 48 h (97.3, SD 64.4 vs. 70.4, SD 51.2; P = 0.0040) and cumulative consumption over 72 h (108.1, SD 79.5 vs. 82.5, SD 72.6; P = 0.0080), were all significantly lower in the new protocol. CONCLUSION Increased postoperative administration of dexamethasone and gabapentin after TKA is associated with lower opioid consumption. Within the first 48 h, up to about 25% of opioids can be spared, comparing high-dose to low-dose protocols. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Lukas Eckhard
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 850 Boylston Street, Chestnut Hill, MA, 02467, USA.
| | - Todd Jones
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 850 Boylston Street, Chestnut Hill, MA, 02467, USA
| | - Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA
| | - Swastina Shrestha
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA
| | - Wolfgang Fitz
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 850 Boylston Street, Chestnut Hill, MA, 02467, USA
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Lawrence R, Mogford D, Colvin L. Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain. Br J Anaesth 2019; 119:1092-1109. [PMID: 28981581 DOI: 10.1093/bja/aex316] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 12/27/2022] Open
Abstract
Background Misuse of prescription opioids, and other drugs prescribed for chronic pain, has increased, with major concerns about harm. This review was undertaken to identify validated measurement tools for risk assessment and monitoring of chronic non-cancer pain patients being considered for, or currently prescribed, analgesic drugs with abuse potential. Methods Selected databases (Embase, Medline, Cochrane library/CENTRAL, PsycINFO, PubMed, CINAHL) were systematically searched for studies evaluating tools for risk of analgesic misuse, either before, or during, analgesic therapy for chronic pain, using predetermined inclusion/exclusion criteria. Two independent reviewers assessed abstracts, selected full texts, extracted data and assessed quality. Results 30 studies from 1844 met inclusion criteria, including three systematic reviews, with an additional four studies from bibliography review. The studies covered 14 tools pertaining to opioid use, with none for non-opioid analgesics. Conclusions For predicting prescription opioid misuse, the pain medication questionnaire (PMQ) and the screener and opioid assessment for patients with pain (SOAPP) had the best evidence; both developed and validated in five separate studies (four each of acceptable quality). The current opioid misuse measure (COMM) performed best screening for current misuse, developed and validated in three studies of acceptable quality. A small number of tools may accurately predict, or identify, opioid misuse. There are none for non-opioid analgesics, where there is a potential need.
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Affiliation(s)
- R Lawrence
- Ritson Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK
| | - D Mogford
- Ritson Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK
| | - L Colvin
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK
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Driot D, Jouanjus E, Oustric S, Dupouy J, Lapeyre-Mestre M. Patterns of gabapentin and pregabalin use and misuse: Results of a population-based cohort study in France. Br J Clin Pharmacol 2019; 85:1260-1269. [PMID: 30737829 DOI: 10.1111/bcp.13892] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 02/01/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of this study was to assess the use and factors associated with the misuse of gabapentin and pregabalin in the general French population, through a cohort study in the EGB (General Sample of Beneficiaries), a national representative sample of the French general population. METHODS New users of gabapentin and pregabalin were identified from June 2006 to December 2014, and new users of duloxetine served as control group. Misuse was defined as a use of higher daily doses than recommended. Cox proportional hazard regression models were performed to identify associated factors of misuse. RESULTS Misuse was more frequent in the 8692 new users of pregabalin (12.8%) than in the 1963 gabapentin (6.6%) or the 3214 duloxetine new users (9.7%) (P < 0.001). Factors associated with misuse were pregabalin (hazard ratio [HR] 1.48; 95% confidence interval [CI] [1.29-1.69]), age (HR[18-45] versus > 70 years 1.98 [1.70-2.31] and HR[58-70] versus > 70 years 1.25 [1.06-1.47]), multiple prescribers (HR2 or 3 versus 1 prescriber 1.29 [1.15-1.45]; HR4 or more versus 1 prescriber 1.54 [1.30-1.83]), cancer (1.28 [1.11-1.47]), multiple sclerosis (1.53 [1.07-2.18]), neuropathy (1.85 [1.19-2.89]), depression (1.26 [1.07-1.49]) and methadone (2.61 [1.16-5.84]). After this first episode of drug misuse, 11.6% of gabapentin and 10.7% of pregabalin misusers developed a primary addiction. CONCLUSION In a cohort of new users, misuse is more likely to occur in new users of pregabalin, with different associated factors of misuse compared to gabapentin and duloxetine. Health professionals and prescribers must be aware of this misuse potential, which could lead to abuse and dependence.
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Affiliation(s)
- Damien Driot
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Emilie Jouanjus
- Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France.,Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP), Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, France
| | - Stéphane Oustric
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Julie Dupouy
- Département universitaire de médecine générale, Faculté de Médecine, Université de Toulouse, France.,Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France
| | - Maryse Lapeyre-Mestre
- Unité Mixte de Recherche, 1027 Inserm-Université, Pharmacoépidémiologie, Université de Toulouse, France.,Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP), Service de Pharmacologie Médicale et Clinique, CHU de Toulouse, France.,Centre d'Investigation Clinique, 1436 Inserm CHU, CHU de Toulouse, France
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Tharp AM, Hobron K, Wright T. Gabapentin‐related Deaths: Patterns of Abuse and Postmortem Levels. J Forensic Sci 2019; 64:1105-1111. [DOI: 10.1111/1556-4029.14021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Amy M. Tharp
- Office of the Chief Medical Examiner, Western District Commonwealth of Virginia 6600 Northside High School Road Roanoke VA
| | - Kathrin Hobron
- Office of the Chief Medical Examiner Forensic Epidemiology Commonwealth of Virginia 400 E. Jackson St. Richmond VA 23219
| | - Trista Wright
- Department of Forensic Sciences Commonwealth of Virginia 500 North 7th Street Richmond VA
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Toce MS, Chai PR, Burns MM, Boyer EW. Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity. J Med Toxicol 2018; 14:306-322. [PMID: 30377951 PMCID: PMC6242798 DOI: 10.1007/s13181-018-0685-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
Opioid use disorder continues to be a significant source of morbidity and mortality in the USA and the world. Pharmacologic treatment with methadone and buprenorphine has been shown to be effective at retaining people in treatment programs, decreasing illicit opioid use, decreasing rates of hepatitis B, and reducing all cause and overdose mortality. Unfortunately, barriers exist in accessing these lifesaving medications: users wishing to start buprenorphine therapy require a waivered provider to prescribe the medication, while some states have no methadone clinics. As such, users looking to wean themselves from opioids or treat their opioid dependence will turn to alternative agents. These agents include using prescription medications, like clonidine or gabapentin, off-label, or over the counter drugs, like loperamide, in supratherapeutic doses. This review provides information on the pharmacology and the toxic effects of pharmacologic agents that are used to treat opioid use disorder. The xenobiotics reviewed in depth include buprenorphine, clonidine, kratom, loperamide, and methadone, with additional information provided on lofexidine, akuamma seeds, kava, and gabapentin.
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Affiliation(s)
- Michael S Toce
- Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Peter R Chai
- Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michele M Burns
- Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Edward W Boyer
- Harvard Medical Toxicology Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA, USA
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Davies T. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 169:662. [PMID: 30398630 DOI: 10.7326/l18-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Todd Davies
- Joan C. Edwards School of Medicine at Marshall University, Huntington, West Virginia (T.D.)
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Duru UB, Pawar G, Barash JA, Miller LE, Thiruselvam IK, Haut MW. An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use. Ann Intern Med 2018; 169:662-663. [PMID: 30398631 PMCID: PMC6464382 DOI: 10.7326/l18-0411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Uzoma B Duru
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Gauri Pawar
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | | | - Liv E Miller
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Indrani K Thiruselvam
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
| | - Marc W Haut
- West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)
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50
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Wachman EM, Warden AH, Thomas Z, Thomas-Lewis JA, Shrestha H, Nikita FNU, Shaw D, Saia K, Schiff DM. Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity. Drug Alcohol Depend 2018; 192:45-50. [PMID: 30205307 DOI: 10.1016/j.drugalcdep.2018.07.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Among opioid-exposed infants, psychiatric medication co-exposure is common. Our objective was to compare Neonatal Abstinence Syndrome (NAS) outcomes based on individual psychiatric medication co-exposures. METHODS A retrospective study of 744 opioid-exposed mother-infant dyads from a single institution was performed. Mothers on pharmacotherapy with methadone or buprenorphine at delivery were included. Data were collected on maternal demographics, psychiatric medication use, and NAS outcomes, including any medication treatment, adjunctive medication treatment, length of hospital stay (LOS), and opioid treatment days. The extent to which individual psychiatric medication and polypharmacy exposure were associated with NAS outcomes was assessed using multivariable regression. RESULTS Fifty-four percent of the mothers were on ≥1 psychiatric medication, with 32% on ≥2 or psychiatric medications (polypharmacy group). In adjusted models, polypharmacy exposure was associated with longer LOS (β = 4.31 days, 95% CI 2.55-6.06) and opioid treatment days (β = 3.98 days, 95% CI 2.24-5.72) and more treatment with adjunctive medication for NAS (aOR = 2.49, 95% CI 1.57-3.95). Benzodiazepines were associated with longer LOS (β = 4.94, 95% CI 2.86-7.03) and opioid treatment days (β = 4.86, 95% CI 2.61-6.75), and more adjunctive medication treatment (aOR = 2.57, 95% CI 1.49-4.42). Gabapentin was associated with longer LOS (β = 2.79, 95% CI 0.54-5.03), more NAS medication treatment (aOR = 2.96, 95% CI 1.18-7.42) including more adjunctive medications (aOR = 1.92, 95% CI 1.05-3.53). CONCLUSION For infants of mothers with OUD who are also on concurrent psychiatric medications, polypharmacy was associated with worse NAS severity. When medically indicated, limiting use of multiple psychiatric medications, particularly benzodiazepines and gabapentin, during pregnancy should be considered to improve NAS outcomes.
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Affiliation(s)
- Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - A Hutcheson Warden
- Department of Obstetrics and Gynecology, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Zoe Thomas
- University of Massachusetts, 300 Massachusetts Ave, Amherst, MA, 01003, USA.
| | - Jo Ann Thomas-Lewis
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Hira Shrestha
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - F N U Nikita
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 021178, USA.
| | - Daniel Shaw
- Department of Psychiatry, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
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