Overlapping prescriptions of gabapentin and opioids grew over a 12-year interval, pharmacy claims information confirmed.
Concurrent prescriptions elevated from 1.9% in 2006 to 7.6% in 2018, a relative improve of 344%, reported Evan Peet, PhD, of the RAND Company in Washington, D.C., and co-authors, in a analysis letter revealed in JAMA Inside Drugs.
“Because the opioid disaster continues all through the nation, clinicians are dealing with growing restrictions on prescribing opioids,” Peet advised MedPage At the moment.
“This examine examines a method during which prescribers could also be responding to those restrictions: prescribing gabapentin off-label concurrently with opioids,” Peet stated.
“This method to ache administration has unsure effectiveness and is probably harmful because of an affiliation with all-cause and drug-related hospitalizations,” he identified.
Gabapentin is permitted for seizures and post-herpetic neuralgia; gabapentin enacarbil is permitted for stressed legs syndrome. Regardless of restricted indications, gabapentin and pregabalin (one other gabapentinoid) are broadly prescribed off-label for varied different ache syndromes. Proof is sparse for many off-label makes use of.
Frequent negative effects of gabapentinoids embrace drowsiness, dizziness, blurry or double imaginative and prescient, and issue with coordination and focus.
In 2019, the FDA warned about severe respiration issues which will happen in sufferers utilizing gabapentin or pregabalin who’ve respiratory threat components. These components embrace taking opioids or different medicine that depress the central nervous system, having situations like continual obstructive pulmonary illness (COPD) that cut back lung perform, and being older in age.
Of their evaluation, Peet and colleagues evaluated pharmacy claims information from 2006 to 2018 in IQVIA real-world longitudinal prescription data, which captured about 90% of prescriptions crammed at retail pharmacies nationally.
The researchers outlined opioid analgesic and gabapentin episodes by the primary prescription fill date via the final day of the prescription’s provide. Subsequent prescriptions inside 60 days of the prior one prolonged an episode by the quantity of overlap, whereas prescriptions crammed greater than 60 days after the final prescription started a brand new episode.
In 2006, there have been 37.4 million opioid episodes, which climbed to a excessive of 56.0 million earlier than falling to 42.1 million in 2018. There have been 1.5 million gabapentin episodes in 2006, which rose frequently to eight.1 million in 2018.
Between 2006 and 2018, 18.1% of all overlap durations consisted of opioids and gabapentin episodes that started in the identical week. By 2018, most overlap durations concerned beginning gabapentin earlier than opioids.
Concurrent prescriptions had been mostly written by ache specialists (19.2% vs 4.2% for different specialties). “Variations between specialties could also be exacerbated by circumstances during which gabapentin could have modest impression (e.g., continual and/or neuropathic ache), by the complexity of circumstances total, or as a result of opioid prescribing restrictions extra severely have an effect on ache administration methods for advanced circumstances,” Peet and colleagues noticed.
Overlaps in prescribing occurred extra amongst feminine sufferers, sufferers 66 and older, and sufferers who lived in rural, high-poverty, and predominantly white counties.
The findings instructed that will increase in concurrent prescriptions is likely to be an unintended consequence of opioid prescribing restrictions, the researchers famous.
The evaluation checked out disbursed — not written — prescriptions, Peet and co-authors acknowledged. Knowledge had been restricted to retail pharmacies solely. As well as, the researchers didn’t have details about sufferers’ scientific standing.
This work was supported by grants from the Nationwide Institute on Drug Abuse (NIDA).
Peet reported receiving grant funding from the NIH. Co-authors reported receiving grant funding from the CDC and NIDA outdoors the submitted work.