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Gabapentinoid Abuse: An Alarming Trend

Gabapentinoid Abuse: An Alarming Trend. Kirk Evoy , PharmD PGY2 Ambulatory Care Resident St. Joseph Regional Medical Center The speaker has no actual or potential conflicts of interest to disclose. The Current Issue. Gabapentin (GBP) and pregabalin (PRG) abuse on the rise

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Gabapentinoid Abuse: An Alarming Trend

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  1. Gabapentinoid Abuse: An Alarming Trend Kirk Evoy, PharmD PGY2 Ambulatory Care Resident St. Joseph Regional Medical Center The speaker has no actual or potential conflicts of interest to disclose

  2. The Current Issue Gabapentin(GBP) and pregabalin(PRG) abuse on the rise • PRG scripts ↑350% and GBP ↑150% in UK from 2007-2012 • 2010 list of new recreational psychoactive substances • Warning added to European PRG labeling • Growing black market • Increased reports of related fatalities Papazisis G, et al. Int J ClinPharmacolTher 2014. [Epub ahead of print] Schifano F. CNS Drugs 2014.;28:491-496 Spence D. BMJ 2013;347:f6747.

  3. Abuse Potential • Zacny et al. • 75 or 150 mg PRG +/- oxycodonein 16 non-drug-abusing volunteers • No abuse liability with or without oxycodone • Pfizer study • 450 mg PRG dose in 15 recreational drug users • “Good drug effect”, “liking”, “high” ≈ 30 mg diazepam Zacny et al. PharacolBiochemBehav2012;100:560-565. Papazisis G, et al. Int J ClinPharmacolTher 2014. [Epub ahead of print]

  4. Perceived Effects of High Doses Both sedative and dissociative/psychedelic properties • High/stoned • Euphoria • Improved sociability • Marijuana or benzodiazepine (BZD) like relaxation • Amphetamine like trip • Sedation • Amnesia • “Zombie-like” effects Papazisis G, et al. Int J ClinPharmacolTher 2014. [Epub ahead of print]. Schifano F. CNS Drugs 2014.;28:491-496. Spence D. BMJ 2013;347:f6747.

  5. Pattern of Abuse • Kapil et al. • Frequency of misuse of GBP, PRG, baclofen • Weekly: 13% • Between weekly and monthly: 50% • Monthly: 37% • Schifano et al. • Study of web reports from 108 websites • Doses >>> recommended max • Tolerance develops and wears off rapidly • Multiple routes of administration • PRG superior to GBP Papazisis G, et al. Int J ClinPharmacolTher 2014. [Epub ahead of print]. Schifano F, et al. Psychotherapy and Psychosomatics 2011.;80:118-122. Schifano F. CNS Drugs 2014;28:491-496. Gahr M et al. Eur J ClinPharmacol 2013;69:1335-1342.

  6. Dependence and Withdrawal • Cravings, self-titration, drug-seeking suggest dependence • BZD or alcohol-like withdrawals • Alleviated rapidly with resumption of gabapentenoid • Not relieved with BZDs • Multiple reports of relapse shortly after detox Filipetto F, et al. JAOA 2010;110:605-607. [Author not listed]. J Clin Psychiatry 2007;68;3:483-484. Hellwig TR, et al. Am J Health-SystPharm 2010;67:910-912. See S, et al. Ann Pharmacother 2011;45:e31. Victorri-Vigneau C, et al. Pharmacopsychiatry 2007;40:43-44 Kruszewksi SP, et al. Journal of Psychiatric Practice 2009;15:314-319. Gahr M, et al. J Addict Med 2013;7:147-149.

  7. Overdose • Reported doses up to 7.2g PRG and 90g GBP • Rarely sole cause of death • Completed suicide with 45g GBP • Survived suicide attempt with 90g GBP • Contributor in polysubstance abuse fatalities • Additive CNS depressant effects • Poisoning usually delayed response Baird C, et al. Eur Addict Res 2014;20:115-118 Hakkinen M, et al. Forensic Science International 2014;241:1-6. Middleton O. J Forensic Sci2011;56:1373-1375. Schauer SG, et al. Military Medicine2013;178:119. [Abstract].

  8. Typical Abuser • Young males • Low income • H/O recreational drug abuse • Concomitant opiate use • Consume very high gabapentenoid doses Boden R, et al. Eur J ClinPharmacol 2014:70;197-204. Schifano F. CNS Drugs 2014;28:491-496 Gahr M et al. Eur J ClinPharmacol 2013;69:1335-1342.

  9. Extent of the Problem • Swedish and German national registries point toward significant increase in abuse since 2008 • Growing trend, but number of patients still small • UK ED visit rates (per 100,000 population) Papazisis G, et al. Int J ClinPharmacolTher 2014. [Epub ahead of print] Schifano F. CNS Drugs 2014;28:491-496 Hakkinen M, et al. Forensic Science International 2014;241:1-6. Schwan S, et al. Eur J ClinPharmacol 2010;66:947-953 Howland RH. Journal of Psychosocial Nursing 2014;52:12-15.

  10. Next Time You Verify a Gabapentinoid,Consider… • Drug-seeking behaviors • History of/risk factors for abuse • Judicious dose escalation and prescription quantities • Avoid abrupt discontinuation • Appropriateness of off-label uses, especially in treating addiction • Urine drug screens • Alert physicians of abuse potential • Continued post-marketing surveillance is crucial Papazisis G, et al. Int J ClinPharmacolTher 2014. [Epub ahead of print] Smith BH. British Jounral of General Practice 2012: DOI:10.3399/bjgp12X653516. [Author not listed]. Rev Prescrire2012;32:116-118.

  11. Questions?

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