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Intentional Drug Overdose Involving Pregabalin and Gabapentin: Findings from the National Self-Harm Registry Ireland, 2007–2015

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Abstract

Introduction

Intentional drug overdose (IDO) is a significant public health problem. Concerns about the misuse of gabapentinoids, i.e. pregabalin and gabapentin, including their consumption in IDO have grown in recent years. This paper examines the trends in the prevalence of gabapentinoids taken in IDO, the profile of individuals taking them, and associated overdose characteristics.

Methods

Presentations to emergency departments involving IDO, recorded by the National Self-Harm Registry Ireland between 1 January 2007 and 31 December 2015 were examined. Data items included patient demographics, drug names, total tablet quantity consumed and alcohol involvement.

Results

Gabapentinoids were involved in 2115 (2.9%) of the 72,391 IDOs recorded. Presentations involving a gabapentinoid increased proportionally from 0.5% in 2007 to 5.5% in 2015. The majority of IDOs involving a gabapentinoid were made by females (59.9%), with over one-third (37.2%) involving alcohol. Compared with IDOs involving other drugs, presentations with a gabapentinoid were made by persons who were older (median 37 vs. 32 years) and involved a significantly greater median quantity of tablets (30 vs. 21, p ≤ 0.001), with over one-quarter (27.4%) of these involving the ingestion of 50 tablets or more. Admission to hospital was significantly more common following IDOs with a gabapentinoid compared with those without (49.4% vs. 41.4%, p ≤ 0.001).

Conclusions

This study identified the increasing use of gabapentinoids in IDO, describing the profile and overdose characteristics of presentations. It is important for clinicians to exercise vigilance while prescribing gabapentinoids, including being aware of other medications that their patients may have access to. Our findings support the need for routine monitoring for signs of misuse among those prescribed gabapentinoids.

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References

  1. Griffin E, Corcoran P, Cassidy L, O’Carroll A, Perry IJ, Bonner B. Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland. BMJ Open. 2014;4(7):e005557.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hawton K, Haw C, Casey D, Bale L, Brand F, Rutherford D. Self-harm in Oxford, England: epidemiological and clinical trends, 1996–2010. Soc Psychiatry Psychiatr Epidemiol. 2015;50(5):695–704.

    Article  PubMed  Google Scholar 

  3. Hawton K, Bergen H, Cooper J, Turnbull P, Waters K, Ness J, et al. Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000–2012. J Affect Disord. 2015;175:147–51.

    Article  PubMed  Google Scholar 

  4. Hawton K, Saunders K, Topiwala A, Haw C. Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. J Affect Disord. 2013;151(3):821–30.

    Article  PubMed  Google Scholar 

  5. Cooper J, Kapur N, Dunning J, Guthrie E, Appleby L, Mackway-Jones K. A clinical tool for assessing risk after self-harm. Ann Emerg Med. 2006;48(4):459–66.

    Article  PubMed  Google Scholar 

  6. Hawton K, Bergen H, Casey D, Simkin S, Palmer B, Cooper J, et al. Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol. 2007;42(7):513–21.

    Article  PubMed  Google Scholar 

  7. Perry IJ, Corcoran P, Fitzgerald AP, Keeley HS, Reulbach U, Arensman E. The incidence and repetition of hospital-treated deliberate self harm: findings from the world’s first national registry. PLoS One. 2012;7(2):e31663.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ness J, Hawton K, Bergen H, Cooper J, Steeg S, Kapur N, et al. Alcohol use and misuse, self-harm and subsequent mortality: an epidemiological and longitudinal study from the multicentre study of self-harm in England. Emerg Med J. 2015;32(10):793–9.

    Article  PubMed  Google Scholar 

  9. Bergen H, Hawton K, Waters K, Cooper J, Kapur N. Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007. Br J Psychiatry. 2010;197(6):493–8.

    Article  PubMed  Google Scholar 

  10. Corcoran PHB, Griffin E, Perry IJ, Arensman E. Psychotropic medication involved in intentional drug overdose: implications for treatment. Neuropsychiatry. 2013;3(3):285–93.

    Article  Google Scholar 

  11. Townsend EHK, Harriss L, Bale E, Bond A. Substances used in deliberate self-poisoning 1985–1997: trends and associations with age, gender, repetition and suicide intent. Soc Psychiatry Psychiatr Epidemiol. 2001;36(5):228–34.

    Article  CAS  PubMed  Google Scholar 

  12. Baldessarini RJ, Leahy L, Arcona S, Gause D, Zhang W, Hennen J. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv. 2007;58(1):85–91.

    Article  PubMed  Google Scholar 

  13. Spina E, Perugi G. Antiepileptic drugs: indications other than epilepsy. Epileptic Disord. 2004;6(2):57–75.

    PubMed  Google Scholar 

  14. Italiano D, Capuano A, Alibrandi A, Ferrara R, Cannata A, Trifiro G, et al. Indications of newer and older anti-epileptic drug use: findings from a southern Italian general practice setting from 2005–2011. Br J Clin Pharmacol. 2015;79(6):1010–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Goodman CW, Brett AS. Gabapentin and pregabalin for pain—is increased prescribing a cause for concern? N Engl J Med. 2017;377(5):411–4.

    Article  PubMed  Google Scholar 

  16. Kharasch ED, Eisenach JC. Wherefore gabapentinoids? Was there rush too soon to judgment? Anesthesiology. 2016;124(1):10–2.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs. 2017;77(4):403–26.

    Article  CAS  PubMed  Google Scholar 

  18. Schwan S, Sundstrom A, Stjernberg E, Hallberg E, Hallberg P. A signal for an abuse liability for pregabalin: results from the Swedish spontaneous adverse drug reaction reporting system. Eur J Clin Pharmacol. 2010;66(9):947–53.

    Article  PubMed  Google Scholar 

  19. Public Health England and National Health Service England. Advice for prescribers on the risk of the misuse of pregabalin and gabapentin. 2014. Available at: http://guildfordadvancedcourses.co.uk/wp-content/uploads/2017/10/PHE-2014.pdf. Accessed 1 Sept 2017.

  20. Elliott SP, Burke T, Smith C. Determining the toxicological significance of pregabalin in fatalities. J Forensic Sci. 2017;62(1):169–73.

    Article  CAS  PubMed  Google Scholar 

  21. Schifano F. Misuse and abuse of pregabalin and gabapentin: cause for concern? CNS Drugs. 2014;28(6):491–6.

    Article  CAS  PubMed  Google Scholar 

  22. Chiappini S, Schifano F. A decade of gabapentinoid misuse: an analysis of the european medicines agency’s ‘Suspected Adverse Drug Reactions’ database. CNS Drugs. 2016;30(7):647–54.

    Article  PubMed  Google Scholar 

  23. Lyndon A, Audrey S, Wells C, Burnell ES, Ingle S, Hill R, et al. Risk to heroin users of polydrug use of pregabalin or gabapentin. Addiction. 2017;112(9):1580–9.

    Article  PubMed  Google Scholar 

  24. Simonsen KW, Edvardsen HM, Thelander G, Ojanpera I, Thordardottir S, Andersen LV, et al. Fatal poisoning in drug addicts in the Nordic countries in 2012. Forensic Sci Int. 2015;248:172–80.

    Article  CAS  PubMed  Google Scholar 

  25. Abrahamsson T, Berge J, Ojehagen A, Hakansson A. Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment-A nation-wide register-based open cohort study. Drug Alcohol Depend. 2017;174:58–64.

    Article  CAS  PubMed  Google Scholar 

  26. Frauger E, Pochard L, Boucherie Q, Giocanti A, Chevallier C, Daveluy A, et al. Surveillance system on drug abuse: interest of the French national OPPIDUM program of French addictovigilance network [in French]. Therapie. 2017;72(4):491–501.

    Article  PubMed  Google Scholar 

  27. McNamara S, Stokes S, Kilduff R, Shine A. Pregabalin abuse amongst opioid substitution treatment patients. Ir Med J. 2015;108(10):309–10.

    CAS  PubMed  Google Scholar 

  28. Hakkinen M, Vuori E, Kalso E, Gergov M, Ojanpera I. Profiles of pregabalin and gabapentin abuse by postmortem toxicology. Forensic Sci Int. 2014;241:1–6.

    Article  CAS  PubMed  Google Scholar 

  29. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual report of the american association of poison control centers’ national poison data system (NPDS). Clin Toxicol (Phila). 2007;45(8):815–917.

    Article  Google Scholar 

  30. Litovitz TL, Klein-Schwartz W, White S, Cobaugh DJ, Youniss J, Omslaer JC, et al. 2000 Annual report of the american association of poison control centers toxic exposure surveillance system. Am J Emerg Med. 2001;19(5):337–95.

    Article  CAS  PubMed  Google Scholar 

  31. Wood DM, Berry DJ, Glover G, Eastwood J, Dargan PI. Significant pregabalin toxicity managed with supportive care alone. J Med Toxicol. 2010;6(4):435–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Nixon AC, Doak MW, Crozier H, Crooks DP, Waring WS. Patterns of antiepileptic drug overdose differ between men and women: admissions to the Edinburgh Poisons Unit, 2000–2007. QJM. 2009;102(1):51–6.

    Article  CAS  PubMed  Google Scholar 

  33. Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2016 registrations. 2017. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations. Accessed 1 Sept 2017.

  34. Health Research Board. National Drug-Related Deaths Index, 2004 to 2014 data. 2014. Available at: http://www.hrb.ie/uploads/tx_hrbpublications/National_Drug-Related_Deaths_Index_2004_to_2014_data_01.pdf. Accessed 18 Dec 2017.

  35. Schjerning O, Rosenzweig M, Pottegard A, Damkier P, Nielsen J. Abuse potential of pregabalin: a systematic review. CNS Drugs. 2016;30(1):9–25.

    Article  CAS  PubMed  Google Scholar 

  36. Wilens T, Zulauf C, Ryland D, Carrellas N, Catalina-Wellington I. Prescription medication misuse among opioid dependent patients seeking inpatient detoxification. Am J Addict. 2015;24(2):173–7.

    Article  PubMed  Google Scholar 

  37. Grosshans M, Lemenager T, Vollmert C, Kaemmerer N, Schreiner R, Mutschler J, et al. Pregabalin abuse among opiate addicted patients. Eur J Clin Pharmacol. 2013;69(12):2021–5.

    Article  CAS  PubMed  Google Scholar 

  38. Schjerning O, Pottegard A, Damkier P, Rosenzweig M, Nielsen J. Use of pregabalin: a nationwide pharmacoepidemiological drug utilization study with focus on abuse potential. Pharmacopsychiatry. 2016;49(4):155–61.

    Article  CAS  PubMed  Google Scholar 

  39. Health and Social Care Information Centre. Prescription Cost Analysis England 2012-Prescription items dispensed in the community in England and listed alphabetically within chemical entity by therapeutic class. 2013. Available at: https://digital.nhs.uk/catalogue/PUB10610. Accessed 1 Sept 2017.

  40. Savica R, Beghi E, Mazzaglia G, Innocenti F, Brignoli O, Cricelli C, et al. Prescribing patterns of antiepileptic drugs in Italy: a nationwide population-based study in the years 2000–2005. Eur J Neurol. 2007;14(12):1317–21.

    Article  CAS  PubMed  Google Scholar 

  41. US FDA. Statistical review and evaluation-Antiepileptic drugs and suicidality. 2008. Available at: https://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4372b1-01-FDA.pdf. Accessed 1 Sept 2017.

  42. EMCDDA-Europol 2009 Annual Report on the implementation of Council Decision 2005/387/JHA; Annex 2 – New psychoactive substances reported to the EMCDDA and Europol for the first time in 2009 under the terms of Council. Available at: http://www.emcdda.europa.eu/html.cfm/index33227EN.html. Accessed 1 Sept 2017.

  43. Health and Social Care Board. Advice for prescribers on the risk of the misuse of pregabalin and gabapentin. 2015. Available at: http://niformulary.hscni.net/Formulary/Adult/PDF/PregabalinAndGabapentinRiskOfMisuseAdviceHSCBWebVersion.pdf. Accessed 1 Sept 2017.

  44. Home Office and the Health Service Executive. A consultation on proposals to schedule pregabalin and gabapentin under the Misuse of Drugs Regulations 2001. 2017. Available at: https://www.gov.uk/government/consultations/pregabalin-and-gabapentin-proposal-to-schedule-under-the-misuse-of-drugs-regulations-2001. Accessed 1 Sept 2017.

  45. World Health Organization. Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment. 2017. Available at: https://www.whocc.no/filearchive/publications/2017_guidelines_web.pdf. Accessed 1 Nov 2017.

  46. Finkelstein Y, Macdonald EM, Hollands S, Sivilotti ML, Hutson JR, Mamdani MM, et al. Repetition of intentional drug overdose: a population-based study. Clin Toxicol (Phila). 2016;54(7):585–9.

    Article  CAS  Google Scholar 

  47. de Groot MC, Schuerch M, de Vries F, Hesse U, Oliva B, Gil M, et al. Antiepileptic drug use in seven electronic health record databases in Europe: a methodologic comparison. Epilepsia. 2014;55(5):666–73.

    Article  PubMed  Google Scholar 

  48. Bazazi AR, Zelenev A, Fu JJ, Yee I, Kamarulzaman A, Altice FL. High prevalence of non-fatal overdose among people who inject drugs in Malaysia: correlates of overdose and implications for overdose prevention from a cross-sectional study. Int J Drug Policy. 2015;26(7):675–81.

    Article  PubMed  Google Scholar 

  49. Haw C, Hawton K, Casey D, Bale E, Shepherd A. Alcohol dependence, excessive drinking and deliberate self-harm: trends and patterns in Oxford, 1989–2002. Soc Psychiatry Psychiatr Epidemiol. 2005;40(12):964–71.

    Article  PubMed  Google Scholar 

  50. Sinclair JM, Gray A, Hawton K. Systematic review of resource utilization in the hospital management of deliberate self-harm. Psychol Med. 2006;36(12):1681–93.

    Article  PubMed  Google Scholar 

  51. Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol. 2017;27(12):1185–215.

    Article  CAS  PubMed  Google Scholar 

  52. Haw C, Casey D, Holmes J, Hawton K. Suicidal intent and method of self-harm: a large-scale study of self-harm patients presenting to a general hospital. Suicide Life Threat Behav. 2015;45(6):732–46.

    Article  PubMed  Google Scholar 

  53. Hori S, Kinoshita K. Clinical characteristics of patients who overdose on multiple psychotropic drugs in Tokyo. J Toxicol Sci. 2016;41(6):765–73.

    Article  CAS  PubMed  Google Scholar 

  54. Crombie IK, McLoone P. Does the availability of prescribed drugs affect rates of self poisoning? Br J Gen Pract. 1998;48(433):1505–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Gjelsvik B, Heyerdahl F, Hawton K. Prescribed medication availability and deliberate self-poisoning: a longitudinal study. J Clin Psychiatry. 2012;73(4):e548–54.

    Article  PubMed  Google Scholar 

  56. Tournier M, Grolleau A, Cougnard A, Molimard M, Verdoux H. Factors associated with choice of psychotropic drugs used for intentional drug overdose. Eur Arch Psychiatry Clin Neurosci. 2009;259(2):86–91.

    Article  PubMed  Google Scholar 

  57. Okumura Y, Nishi D. Risk of recurrent overdose associated with prescribing patterns of psychotropic medications after nonfatal overdose. Neuropsychiatr Dis Treat. 2017;13:653–65.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Zalsman G, Hawton K, Wasserman D, van Heeringen K, Arensman E, Sarchiapone M, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016;3(7):646–59.

    Article  PubMed  Google Scholar 

  59. Health Service Executive. Connecting for Life, Irelands National Strategy to Reduce Suicide 2015–2020. 2015. Available at: https://www.healthpromotion.ie/hp-files/docs/HME00945.pdf. Accessed 1 Sept 2017.

  60. World Health Organization. Practice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm. 2016. Available at: http://apps.who.int/iris/bitstream/10665/208895/1/9789241549578_eng.pdf. Accessed 1 Sept 2017.

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Acknowledgements

The authors would like to thank the DROs who work on the National Self-Harm Registry Ireland, collecting information on self-harm presentations to hospitals across Ireland.

Funding

This research was conducted as part of a Ph.D. that was jointly funded by the University of Manchester and the National Suicide Research Foundation, Cork, Ireland. The National Self-Harm Registry Ireland is funded by the Health Service Executive’s National Office for Suicide Prevention.

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Authors and Affiliations

  1. National Suicide Research Foundation, University College Cork, Room 4.28, Fourth Floor, Western Gateway Building, Western Road, Cork, Ireland

    Caroline Daly, Eve Griffin, Ivan J. Perry & Ella Arensman

  2. Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK

    Darren M. Ashcroft

  3. NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK

    Darren M. Ashcroft

  4. Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK

    Roger T. Webb

  5. School of Public Health, University College Cork, Cork, Ireland

    Ivan J. Perry & Ella Arensman

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  1. Caroline Daly
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  2. Eve Griffin
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  3. Darren M. Ashcroft
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  6. Ella Arensman
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Corresponding author

Correspondence to Caroline Daly.

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Conflict of interest

Ms. Caroline Daly, Dr Eve Griffin, Prof. Darren M. Ashcroft, Prof. Roger T. Webb, Prof Ivan J. Perry and Prof Ella Arensman have no conflicts of interest to declare.

Ethics Approval

The National Self-Harm Registry Ireland has received ethical approval from the National Research Ethics Committee of the Faculty of Public Health Medicine and the Clinical Research Ethics Committees of all 36 hospitals. The National Suicide Research Foundation is registered with the Data Protection Agency and complies with the Irish Data Protection Act of 1988 and the Irish Data Protection (Amendment) Act of 2003.

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Daly, C., Griffin, E., Ashcroft, D.M. et al. Intentional Drug Overdose Involving Pregabalin and Gabapentin: Findings from the National Self-Harm Registry Ireland, 2007–2015. Clin Drug Investig 38, 373–380 (2018). https://doi.org/10.1007/s40261-017-0616-y

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