Gabapentin is an anticonvulsant medication with potential misuse reported in case reports and population studies, highlighting the need to reexamine its abuse liability. The purpose of this study was to describe gabapentin dispensing patterns and assess potential misuse.
Methods
We used data from Ohio's Prescription Drug Monitoring Program (PDMP) from December 1, 2016 to March 31, 2017 and restricted the population to adults who filled at least one gabapentin prescription (N = 379,372). Gabapentin dispensing patterns are described and multiple strategies were used to assess potential misuse, including Lorenz-1 curve analysis. Supratherapeutic dosing, number of prescribers and number of pharmacies used were compared for individuals who were co-dispensed medications for opioid use disorder (MOUD) and those who were not.
Results
More than one million gabapentin prescriptions were dispensed during the 4-month period, with a mean dose of 1103.8 mg. While few individuals received supratherapeutic dosing, exceptionally high doses were observed. Half of the individuals (50.9%) were co-dispensed gabapentin and opioids. The Lorenz-1 value for gabapentin (5.5%) did not exceed the threshold for misuse potential. Individuals co-dispensed MOUD were more likely to have supratherapeutic dosing; however, they had a lower Lorenz-1 value compared to individuals not co-dispensed MOUD.
Conclusions
Among Ohio residents dispensed gabapentin, there was no evidence of misuse using PDMP data based on the Lorenz-1 value, yet supratherapeutic dosing of gabapentin was observed and was associated with OUD. New strategies may be needed to identify the non-medical use of gabapentin.
AndrewsCO, FischerJH.Gabapentin: a new agent for the management of epilepsy. Ann Pharmacother. 1994;28(10):1188–1196.
2.
CaiK, NangaRPR, LamprouL, . The impact of gabapentin administration on brain GABA and glutamate concentrations: a 7T 1H-MRS study. Neuropsychopharmacology. 2012;37(13):2764–2771.
WallachJD, RossJS.Gabapentin approvals, off-label use, and lessons for postmarketing evaluation efforts. JAMA. 2018;319(8):776–778.
5.
PaulyNJ, DelcherC, SlavovaS, LindahlE, TalbertJ, FreemanPR.Trends in gabapentin prescribing in a commercially insured U.S. Adult population, 2009–2016. J Manag Care Spec Pharm. 2020;26(3):246–252.
6.
JohansenME.Gabapentinoid use in the United States 2002 through 2015. JAMA Intern Med. 2018;178(2):292–294.
7.
SmithRV, HavensJR, WalshSL.Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160–1174.
8.
LeungJG, Hall-FlavinD, NelsonS, SchmidtKA, SchakKM. The role of gabapentin in the management of alcohol withdrawal and dependence. Ann Pharmacother. 2015;49(8):897–906.
9.
AhmedS, BachuR, KotapatiP, . Use of gabapentin in the treatment of substance use and psychiatric disorders: a systematic review. Front Psychiatry. 2019;10:228.
10.
KranzlerHR, FeinnR, MorrisP, HartwellEE. A meta-analysis of the efficacy of gabapentin for treating alcohol use disorder. Addiction. 2019;114(9):1547–1555.
PeckhamAM, EvoyKE, OchsL, CovveyJR.Gabapentin for off-label use: evidence-based or cause for concern?Subst Abuse. 2018;12:1178221818801311.
13.
HamerAM, HaxbyDG, McFarlandBH, KetchumK.Gabapentin use in a managed medicaid population. J Manag Care Pharm. 2002;8(4):266–271.
14.
SchifanoF.Misuse and abuse of pregabalin and gabapentin: cause for concern?CNS Drugs. 2014;28(6):491–496.
15.
PeckhamAM, FairmanKA, SclarDA.Prevalence of gabapentin abuse: comparison with agents with known abuse potential in a commercially insured US population. Clin Drug Investig. 2017;37(8):763–773.
16.
ReynoldsK, KaufmanR, KorenoskiA, FennimoreL, ShulmanJ, LynchM.Trends in gabapentin and baclofen exposures reported to U.S. poison centers. Clin Toxicol. 2020;58(7):763–772.
17.
SmithRV, LofwallMR, HavensJR. Abuse and diversion of gabapentin among nonmedical prescription opioid users in Appalachian Kentucky. Am J Psychiatry. 2015;172(5):487–488.
18.
DriotD, JouanjusE, OustricS, DupouyJ, Lapeyre‐MestreM.Patterns of gabapentin and pregabalin use and misuse: results of a population‐based cohort study in France. Br J Clin Pharmacol. 2019;85(6):1260–1269.
19.
SmithRV, BolandEM, YoungAM, . A qualitative analysis of gabapentin misuse and diversion among people who use drugs in Appalachian Kentucky. Psychol Addict Behav. 2018;32(1):115–121.
20.
SmithBH, HigginsC, BaldacchinoA, KiddB, BannisterJ.Substance misuse of gabapentin. Br J Gen Pract. 2012;62(601):406–407.
21.
ButtramME, KurtzSP, DartRC, MargolinZR.Law enforcement-derived data on gabapentin diversion and misuse, 2002-2015: diversion rates and qualitative research findings. Pharmacoepidemiol Drug Saf. 2017;26(9):1083–1086.
22.
QuinteroGC.Review about gabapentin misuse, interactions, contraindications and side effects. JEP. 2017;9:13–21. Published online.
23.
SchifanoF, D'OffiziS, PiccioneM, . Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychother Psychosom. 2011;80(2):118–122.
24.
EckhardtK, AmmonS, HofmannU, RiebeA, GugelerN, MikusG.Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg. 2000;91(1):185–191.
25.
GilronI, BiedermanJ, JhamandasK, HongM.Gabapentin blocks and reverses antinociceptive morphine tolerance in the rat paw-pressure and tail-flick tests. Anesthesiology. 2003;98(5):1288–1292.
26.
BonnetU, RichterE-L, IsbruchK, ScherbaumN.On the addictive power of gabapentinoids: a mini-review. Psychiatr Danub. 2018;30(2):142–149.
27.
GomesT, JuurlinkDN, AntoniouT, MamdaniMM, PatersonJM, van den BrinkW.Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case–control study. PLoS Med. 2017;14(10):e1002396.
28.
SlavovaS, MillerA, BunnTL, . Prevalence of gabapentin in drug overdose postmortem toxicology testing results. Drug Alcohol Depend. 2018;186(January):80–85.
29.
PeckhamAM, FairmanKA, SclarDA.All-cause and drug-related medical events associated with overuse of gabapentin and/or opioid medications: a retrospective cohort analysis of a commercially insured US population. Drug Saf. 2018;41(2):213–228.
BlackmerJ, LindahlE, StrahlA, SchadlerA, FreemanPR.Regulating gabapentin as a drug of abuse: a survey study of Kentucky community pharmacists. J Am Pharm Assoc (2003). 2019;59(3):379–382.
36.
WinstanleyEL, ZhangY, MashniR, . Mandatory review of a prescription drug monitoring program and impact on opioid and benzodiazepine dispensing. Drug Alcohol Depend. 2018;188:169–174.
37.
WeinerSG, BakerO, RodgersAF, . Opioid prescriptions by specialty in Ohio, 2010–2014. Pain Med. 2018;19(5):978–989.
38.
BirtJ, JohnstonJ, NelsonD.Exploration of claims-based utilization measures for detecting potential nonmedical use of prescription drugs. J Manag Care Spec Pharm. 2014;20(6):639–646.
39.
GjerdenP, BramnessJG, SlørdalL.The use and potential abuse of anticholinergic antiparkinson drugs in Norway: a pharmacoepidemiological study. Br J Clin Pharmacol. 2009;67(2):228–233.
40.
CochranG, WooB, Lo-CiganicWH, GordonAJ, DonohueJM, GelladWF.Defining nonmedical use of prescription opioids within health care claims: a systematic review. Subst Abus. 2015;36(2):192–202.
StataCorp.Stata statistical software: release 15.1. College Station, TX: StataCorp LP. Published online 2017.
43.
PeckhamAM, EvoyKE, CovveyJR, OchsL, FairmanKA, SclarDA.Predictors of gabapentin overuse with or without concomitant opioids in a commercially insured U.S. population. Pharmacotherapy. 2018;38(4):436–443.
44.
AraiYCP, MatsubaraT, ShimoK, . Low-dose gabapentin as useful adjuvant to opioids for neuropathic cancer pain when combined with low-dose imipramine. J Anesth. 2010;24(3):407–410.
45.
KeskinboraK, PekelAF, AydinliI.Gabapentin and an opioid combination versus opioid alone for the management of neuropathic cancer pain: a randomized open trial. J Pain Symptom Manage. 2007;34(2):183–189.
FairmanKA, PeckhamAM, RuckerML, RuckerJH, SclarDA.Use of power-law analysis to predict abuse or diversion of prescribed medications: proof-of-concept mathematical exploration. BMC Res Notes. 2018;11(1):523.
