Abuse and Misuse of Pregabalin and Gabapentin

Abstract

Background

Gabapentinoid (pregabalin and gabapentin) abuse is increasingly being reported.

Objective

To assess the extent of gabapentinoid abuse, characteristics of typical abusers, patterns of abuse, and potential harms in order to bring this trend to providers’ attention.

Methods

A systematic review of MEDLINE, Cochrane Library, ClinicalTrials.gov, and US FDA data, indexed through 28 July 2016, utilizing the following searches: pregabalin OR gabapentin OR gabapentinoid AND one of the following: abuse, misuse, overdose, or substance-related disorders[MESH], was conducted. Additional studies were identified through review of references. English-language epidemiological studies, clinical studies, and case reports/series of gabapentinoid abuse/misuse/overdose were included. The authors reached consensus regarding study inclusion after full-text review. The body of literature was assessed for bias qualitatively.

Results

Fifty-nine studies were included in this systematic review (24 epidemiological, three clinical abuse liability, 16 abuse/misuse/dependence case reports/series, 17 acute overdose case reports/series—one included both an epidemiological study and case series and was included in both counts). Analysis of these studies indicates increasing numbers of patients are self-administering higher than recommended doses to achieve euphoric highs. In the general population, a 1.6% prevalence of gabapentinoid abuse was observed, whereas prevalence ranged from 3% to 68% among opioid abusers. An international adverse event database identified 11,940 reports of gabapentinoid abuse from 2004–2015, with >75% reported since 2012. Risk factors include a history of substance abuse, particularly opioids, and psychiatric co-morbidities. While effects of excessively high doses are generally non-lethal, gabapentinoids are increasingly being identified in post-mortem toxicology analyses.

Conclusion

Evidence suggests gabapentinoids possess potential for abuse, particularly in individuals with a history of opioid abuse, and reports of such abuse are increasingly being documented. Prescribers should be aware of high-risk populations and monitor for signs of abuse.

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Correspondence to Kirk E. Evoy.

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The authors did not receive any funding for this study.

Conflict of interest

Steven Saklad declares the following: Employee of The University of Texas at Austin College of Pharmacy. Appointed to the Texas Department of State Health Services, San Antonio State Hospital and the UT Health Science Center San Antonio School of Medicine. Speakers bureau for Otsuka/Lundbeck. Consultant for NCS Pearson, and Takeda. Speaker for several professional organizations. Board of Directors for the College of Psychiatric and Neurologic Pharmacists Foundation. Business Development Council for the College of Psychiatric and Neurologic Pharmacists. Expert witness on both defendant and plaintiff sides. No direct stock ownership in pharmaceutical corporations. Kirk Evoy and Megan Morrison report no conflicts of interest.

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Evoy, K.E., Morrison, M.D. & Saklad, S.R. Abuse and Misuse of Pregabalin and Gabapentin. Drugs 77, 403–426 (2017). https://doi.org/10.1007/s40265-017-0700-x

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Keywords

  • Gabapentin
  • Pregabalin
  • Abuse Liability
  • Poison Center
  • Urine Drug Screen