A major new study in the journal Clinical Toxicology on the use of common non-opioid medications suggests these drugs also appear to be associated with substance abuse risk.
Investigators analyzed the non-opioid medications, gabapentin and baclofen, and discovered “worrying” increases in related suicide attempts and hospital admissions in U.S. adults since 2013, coinciding with a decrease in opioid prescriptions.
Researchers explain that active campaigns to warn of the risks associated with opioid use have resulted in a dramatic decline in prescriptions in the United States following a peak in 2010-2012.
However, with millions of US adults still living with chronic pain, non-opioid medications are widely viewed as safer alternatives for pain management. Prescriptions for gabapentin have increased 64 percent from 39 million in 2012 to 64 million by 2016 (when it was the 10th most commonly prescribed medication in the U.S.).
In the new study, researchers from the University of Pittsburgh looked at over 90,000 cases of exposure to the medications and saw large increases in misuse and toxicity, with isolated abuse instances of using gabapentin (from 2013 to 2017) rising by 119.9 percent, and baclofen (2014-2017) 31.7 percent.
The study appears .
Upon a review of data in the National Poison Data system, investigators discovered that all U.S. states have seen increases in gabapentin exposures. Most states also saw increases in baclofen exposures, gabapentin misuse/abuse, and baclofen misuse/abuse. Specific findings include:
• During the five-year period (2013-2017), there were 74,175 gabapentin exposures.
o Total gabapentin exposures increased by 72.3%;
o Isolated exposures increased by 67.1% and isolated abuse/misuse increased by 119.9%.
• During the four-year period (2014 to 2017), there were 15,937 baclofen exposures.
o Total baclofen exposures increased by 36.2%;
o Isolated exposures of baclofen increased by 35% and isolated misuse/abuse increased by 31.7%.
Investigators also discovered that admissions to a health care facility were required in 16.7% of isolated gabapentin exposures and 52.1% of isolated baclofen exposures.
Intentional suspected suicide attempts increased by 80.3% for isolated gabapentin exposures over a five-year-period and 43% for baclofen over a four-year-period. Co-ingestion of sedatives and opioids were common for both medications.
Lead author Dr. Kimberly Reynolds of the University of Pittsburgh said, “We are seeing a worrying increase in harmful exposures to gabapentin and baclofen in U.S. adults over recent years, which may be an unintended consequence of the move away from opioid prescriptions for pain management.
“Building a better understanding of the risks carried by these non-opioid medications is necessary so that providers and patients can make better-informed decisions about their role in pain management — and could also lead to the introduction of new public health measures.”
Due to growing concerns related to the misuse of gabapentin, new measures have been introduced in several U.S. states during the final year or after the data collection period of the study.
The new measures include either re-classifying the drug as a Schedule V controlled substance or mandating the reporting of prescriptions. Re-evaluations of prescribing and exposure trends in these states may provide insight into the effects of such programs.
As a result of their findings, study authors recommend that patients who are prescribed these medications should be screened for substance use disorders, mood disorders and suicidal ideation utilizing validated screening tools. Moreover, the prescriptions for the medications should be placed in the electronic database that tracks controlled substance prescriptions in a state (prescription drug monitoring program).
Source: Taylor & Francis