Gabapentin increasingly involved in drug overdose deaths

A new U.S. Centers for Disease Control and Prevention (CDC) report has found increasing detection of gabapentin in drug overdose deaths. Gabapentin, approved as an anticonvulsant medication in Canada, and as an anticonvulsant and postherpetic neuralgia treatment in the U.S., is also commonly used off-label to treat neuropathic pain. Prescribing of gabapentin has been steadily increasing in recent years, with 69 million prescriptions dispensed in the U.S. in 2019—making it the seventh most commonly prescribed medication nationally. On its own, gabapentin is generally considered safe and is seldom associated with overdose. However, when used with other central nervous system depressants (e.g., opioids), the risk for respiratory depression is increased, potentially resulting in death. Read: How to help patients with neuropathic pain Gabapentin has been misused to potentiate the effects of illicit opioids. Gabapentin exposures associated with intentional abuse, misuse or unknown exposures reported to U.S. poison centers increased by 104% from 2013 to 2017. However, less is known about the role of gabapentin in fatal overdoses. To examine this issue, the CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS) in 23 states and the District of Columbia during 2019-20. SUDORS requires jurisdictions to abstract data from death certificates and medical examiner or coroner reports, including postmortem toxicology results, which identify detected drugs and those determined to cause death. Main findings: Among 58,362 deaths with documented toxicology results, 5,687 (9.7%) had gabapentin detected on postmortem toxicology. Gabapentin-involved deaths occurred in 2,975 of 5,687 deceased persons (52.3%) with a positive gabapentin test result. Most gabapentin-involved overdose deaths occurred among non-Hispanic white people (83.2%) and people 35 to 54 years of age (52.2%). Gabapentin-involved overdose deaths occurred with approximately equal frequency among men (49.7%) and women (50.3%). During the second quarter of 2020, the number of deaths reported with gabapentin detected (959) was approximately double that of the first quarter of 2019 (449). Illicit opioid-involved deaths accounted for 56.8% of overdose deaths with gabapentin detected in the first quarter of 2019 and 69.2% in the last quarter of 2020; this increase was largely driven by illicitly manufactured fentanyl and fentanyl analogs. The percentage of deaths that involved a prescription opioid declined from 41.9% of deaths with gabapentin detected in the first quarter of 2019 to 33.0% during the last quarter of 2020. The percentage of deaths with gabapentin detected that involved a stimulant (in the absence of opioid co-involvement) was low and largely stable during 2019-20, ranging from 6% to 9%. The authors conclude that during 2019-20, gabapentin detection and involvement in fatal drug overdoses increased. This increase appeared to follow the rising trend in overall overdose deaths during the COVID-19 pandemic. Nearly 90% of drug overdose deaths in which gabapentin was detected also involved an opioid, particularly illicitly manufactured fentanyl. Read: SSRIs and oxycodone combination increases overdose risk The authors note that gabapentin is not uniformly reported in postmortem toxicology tests or included on death certificates in the U.S.; therefore, the above statistics likely underestimate the number of overdose deaths involving gabapentin or with gabapentin detected. Despite the lack of uniform testing and reporting, gabapentin detection and involvement in overdose deaths increased during 2019–2020. These findings highlight the dangers of polysubstance use, particularly co-use of gabapentin and illicit opioids. Persons who use illicit opioids with gabapentin should be educated about the increased risk for respiratory depression and death. Reference 1. Mattson CL, Chowdhury F, Gilson TP. Notes from the field: trends in gabapentin detection and involvement in drug overdose deaths — 23 States and the District of Columbia, 2019–2020. MMWR 2022;71(19):664-6. https://www.cdc.gov/mmwr/volumes/71/wr/mm7119a3.htm (accessed July 5, 2022).

Gabapentin increasingly involved in drug overdose deaths

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