Understanding motivations and use typologies of gabapentin with opioid agonist medications

Gabapentin is anticonvulsant medication indicated for the management of partial seizures and post-herpetic neuralgia. However, significant increases in gabapentin prescriptions observed in recent years (Johansen, 2018) are more closely tied to its uptake in off-label prescribing to manage a range of conditions, including multimodal pain management as endorsed by the American Pain Society (Chou et al., 2016), psychiatric conditions (Hong et al., 2022, Ahmed et al., 2019), sleep disorders (Hong et al., 2022), and treatment of alcohol use disorder as endorsed by the American Psychiatric Association (Mattle et al., 2022, Reus et al., 2018). Notably, all of these conditions are widely prevalent among individuals with opioid use disorder (OUD), leading to its multipurpose utility in OUD treatment settings and in the self-management of OUD (Ahmed et al., 2019, Verduin et al., 2007, Smith et al., 2016).

In a recent article, utilizing data from a long-running national surveillance program of individuals entering treatment for opioid use disorder, we identified past month nonmedical use of opioid agonist medications (OAMs), buprenorphine or methadone, occurred in 64.1% of individuals engaging in past month nonmedical use of gabapentin (Ellis et al., 2022). These data suggest a potential relationship between the nonmedical use of gabapentin and OAMs. While prior reports have noted the use of gabapentin to potentiate the effects of substances such as alcohol, benzodiazepines and oxycodone (Castillo et al., 2022, Smith et al., 2016), this prior analysis was prompted by case reports of gabapentin being used to potentiate effects of OAMs (Baird et al., 2014, Reeves and Ladner, 2014), along with qualitative data suggesting use of gabapentin to self-manage opioid addiction (Buttram et al., 2019), the limitations of the study prevented a deeper understanding of the potentially unique and unstudied relationship between gabapentin and OAMs.

First, these data relied on past month use, which limits our understanding of broader exposure or use of gabapentin and OAMs. Importantly, since questions were framed as assessing nonmedical use only, we could not account for exposure through healthcare channels and use only as prescribed for therapeutic purposes. Secondly, endorsements of past month use did not allow us to understand whether these drugs were used separately or concurrently. Finally, these data were quantitative in nature, and did not allow for further exploration into the motivations for concurrent use of gabapentin and OAMs.

Despite the broad perception that gabapentin has a relatively low-risk safety profile and minimal abuse potential, recent reports have questioned the efficacy, safety, and abuse liability of gabapentin (Bykov et al., 2020, Evoy et al., 2021, Kharasch et al., 2020, Park et al., 2022, Smith et al., 2016), particularly when used with other substances such as alcohol, opioids and benzodiazepines (Castillo et al., 2022, Olopoenia et al., 2022, Smith et al., 2016). Notably, several studies have identified increased risks of respiratory depression and opioid-related overdoses as a result of concurrent gabapentin and opioid use, even within the therapeutic context (Gomes et al., 2017, Peckham et al., 2018, Tharp et al., 2019, Zhou et al., 2021). As there is growing conversation surrounding the risks versus benefits of gabapentin, particularly for managing a diversity of comorbid conditions in OUD settings, it is important to understand gabapentin’s role in the broader realm of the opioid crisis, whether in a therapeutic context (i.e., medical use) or by one’s own self-sought use (i.e., nonmedical use or abuse), which may parallel previous observations surrounding diverted buprenorphine. We aim to add to the evidence base by reporting data from of a follow-up sample stemming from the larger surveillance program that addresses the limitations of our previous report, and provide a richer understanding of the relationship between gabapentin and OAMs.

留言 (0)

沒有登入
gif