Pregabalin and gabapentin in non-opioid poisoning deaths.

Post-mortem findings of gabapentinoids have often been connected to drug abuse and especially opioid use. We aimed to investigate whether gabapentinoids have been implicated in the cause of death without the presence of opioids. In a three-year study period from 2016 to 2018, a total of 907 Finnish post-mortem cases positive for pregabalin or gabapentin were found. In nearly half of the pregabalin cases and in a third of the gabapentin cases, the blood concentration was above the typical therapeutic range of the drug. Of the cases in which pregabalin was detected, in 35% the drug was implicated in a fatal poisoning with or without other drugs or alcohol. For gabapentin, the percentage was 22%. In most of the fatal gabapentinoid poisonings, opioids or other central nervous system depressants were additionally detected in relevant concentrations. There were eight non-opioid gabapentinoid poisonings, in which no relevant other drugs were detected. Many of these cases were unintentional poisonings with a relatively high gabapentinoid concentration in the blood. In all but one, the manner of death was accidental, or the intent was undetermined. This study confirmed the previous findings that gabapentinoids are mostly implicated in fatal poisoning together with opioids. Half of the non-opioid cases were related to drug abuse but in the other half the death was presumably caused by overuse of a prescribed drug or suicide. While the use of gabapentinoids is a well-known problem among people who use drugs, it is important to note other groups of users who may be at risk of overdose by gabapentinoids.

Trends in gabapentin and baclofen exposures reported to U.S. poison centers.

Context: Prescriptions for nonopioid pharmacological therapies such as gabapentin and baclofen have been increasing. While gabapentin and baclofen are less likely than opioids to result in fatal overdose, they are each associated with dependence, misuse and adverse effects.Objective: The objective of this study is to evaluate and describe trends in adult exposures to gabapentin and baclofen reported to U.S. Poison Centers.Methods: This was a retrospective review of data collected by U.S. Poison Centers and entered in the National Poison Data System. We identified all cases of exposures to gabapentin (2013-2017) and baclofen (2014-2017) in patients aged 18 years and over. We then analyzed demographics, common co-ingestions, medical outcomes, and geographic distribution.Results: During the five-year period (2013-2017), there were 74,175 gabapentin exposures. All gabapentin exposures increased by 72.3%; isolated exposures increased by 67.1%; and isolated abuse/misuse exposures increased by 119.9%. During the four-year period (2014-2017), there were 15,397 baclofen exposures. All baclofen exposures increased by 36.2%; isolated exposures increased by 35.0%; and isolated abuse/misuse exposures increased by 31.7%. Co-ingestions of sedatives and opioids were common for both medications. Admissions to a health care facility were required in 16.7% of isolated gabapentin exposures, and 52.1% of isolated baclofen exposures. Intentional suspected suicide attempts with isolated gabapentin exposures increased by 80.5% over a five-year period; and increased by 43% for isolated baclofen exposures over a four-year period. All states saw increases in gabapentin exposures and most states saw increases in baclofen exposures, gabapentin misuse/abuse, and baclofen misuse/abuse.Conclusion: Gabapentin and baclofen misuse, toxicity, use in suicide attempts, and associated healthcare utilization among adults in the United States have significantly increased since 2013. Careful consideration and risk-benefit analysis should be employed when prescribing these medications.

Management of overdoses of loperamide, gabapentin, and modafinil: a literature review.

Introduction: The current emphasis on combatting the opioid epidemic in the United States and across the globe is well warranted, but rates and variations of other drugs and substances of abuse may be inadvertently increasing as well. These drugs and substances deserve equal attention in the literature to equip healthcare practitioners with the knowledge to provide optimal care in overdose patients. Areas covered: This evaluation includes loperamide, gabapentin, and modafinil and was accomplished through a comprehensive literature review of PubMed, MEDLINE, SCOPUS, ProQuest Central, ProQuest Dissertations, and CINAHL. The results of forty-four pieces of literature are included in this evaluation. The objective of this review is to provide a repository of standard and emerging treatment modalities for loperamide, gabapentin and modafinil for the emergency medicine team. Expert opinion: Loperamide, gabapentin, and modafinil are becoming drugs of abuse, and as such, should be on the radar of healthcare providers. Recognizing their unique toxicity profiles is imperative in providing optimal resuscitative care.

Trending gabapentin exposures in Kentucky after legislation requiring use of the state prescription drug monitoring program for all opioid prescriptions.

OBJECTIVE: Gabapentin is a gamma-aminobutyric acid (GABA) analog approved by the Food and Drug Administration (FDA) for partial seizures and post-herpetic neuralgia. Due to its wide therapeutic window and minimal adverse effects, it is frequently prescribed for additional off-label uses. The purpose of this study was to characterize the number, exposure reason, medical outcomes, and disposition of gabapentin exposures reported to one regional poison control center (PCC). METHODS: A retrospective cross-sectional review of exposures reported to one regional PCC was performed from January 1, 2012 to December 31, 2015. The primary outcomes were the number of gabapentin-only exposures and multi-agent exposures including gabapentin reported. Exposure reason, medical outcome, and disposition were identified for each exposure. RESULTS: There were 424 gabapentin-only exposures during the study period. The number of exposures increased each year, from 39 in 2012 to 160 in 2015. There were 1321 multi-agent exposures that included gabapentin. These exposures increased from 165 in 2012 to 440 in 2015. Comparatively, total human exposures reported to the regional PCC decreased during the study period. The majority of gabapentin-only and multi-agent exposures was intentional versus unintentional. Nine patients (2%) had a major medical outcome and three patients (1%) died in the gabapentin-only group. Comparatively, 76 patients (6%) had a major medical outcome and 12 patients (1%) died in the multi-agent group. Almost half of the multi-agent exposures required admission to the intensive care unit (ICU). CONCLUSIONS: Both gabapentin-only and multi-agent exposures increased significantly from 2012 to 2015, with the majority of cases intentional ingestion, specifically suspected suicide. The increased number of gabapentin exposures coincided with Kentucky's implementation of prescription opioid reform legislation. Providers are encouraged to call their local PCC, regardless of exposure type, to effectively monitor and evaluate exposure trends.

Establishment of a comprehensive drug overdose fatality surveillance system in Kentucky to inform drug overdose prevention policies, interventions and best practices.

BACKGROUND: According to the National Center for Health Statistics, Kentucky had the third highest drug overdose fatality rate in the nation in 2015 at 29.9 drug overdose fatalities per 100 000 population. OBJECTIVE: The elevated drug overdose fatality rate necessitated the development and implementation of a comprehensive multisource drug overdose fatality surveillance system (DOFSS). METHODS: DOFSS stakeholder work group members and data sources were identified, and memorandums of understanding were established. The following data sources were used to establish DOFSS: (1) death certificates; (2) autopsy reports; (3) toxicology result reports; (4) coroner reports; and (5) Kentucky All Schedule Prescription Electronic Reporting (KASPER) (prescription drug monitoring programme) data. Drug overdose poisonings were defined using Injury Surveillance Workgroup 7 definitions. Analyses were performed to investigate possible drug overdose-related health disparities for disabled drug overdose decedents and to characterise gabapentin in drug overdose deaths. RESULTS: DOFSS identified 2106 drug overdose poisoning fatalities in Kentucky for 2013-2014. Identification of specific drugs involved in drug overdose deaths increased from 75.8% using a single data source to 97.5% using multiple data sources. Disabled drug overdose decedents were significantly more likely to have an active prescription for drugs identified in their system compared with the non-disabled drug overdose decedents. Toxicology data showed increased gabapentin involvement in drug overdose deaths from 2.9% in 2013 to 17% in 2014. Alprazolam was found most often in combination with gabapentin (41%), along with various other benzodiazepines and prescription opioids. CONCLUSIONS: A comprehensive multisource DOFSS improved drug overdose fatality surveillance by increasing completeness of data and data quality. DOFSS is a model that can be considered by other states to enhance their efforts in tracking drug overdose fatalities, identifying new and emerging trends, and informing policies and best practices, to address and reduce drug overdoses.