TY - JOUR
AU - M. S. Ellis
AU - K . Y. Xu
AU - V. S. Tardelli
AU - T. M. Fidalgo
AU - M. E. Buttram
AU - R. A. Grucza
A1 - 
AB - IMPORTANCE: Gabapentin prescriptions have drastically increased in the US due to off-label prescribing in settings such as opioid use disorder (OUD) treatment to manage a range of comorbid conditions and withdrawal symptoms, despite a lack of evidence. OBJECTIVE: To assess the purpose and associated risks of off-label gabapentin use in OUD treatment. DESIGN, SETTING, AND PARTICIPANTS: This retrospective recurrent-event case-control study with a crossover design used administrative claims data from MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Individuals aged 12 to 64 years with an OUD diagnosis and filling buprenorphine prescriptions were included in the primary analysis conducted from July 1, 2022, through June 1, 2023. Unit of observation was the person-day. EXPOSURES: Days covered by filled gabapentin prescriptions. MAIN OUTCOMES AND MEASURES: Primary outcomes were receipt of gabapentin in the 90 days after initiation of buprenorphine treatment and drug-related poisoning. Drug-related poisonings were defined using codes from International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. RESULTS: A total of 109 407 patients were included in the analysis (mean [SD] age, 34.0 [11.2] years; 60 112 [54.9%] male). Among the 29 967 patients with Medicaid coverage, 299 (1.0%) were Hispanic, 1330 (4.4%) were non-Hispanic Black, 23 112 (77.1%) were non-Hispanic White, and 3399 (11.3%) were other. Gabapentin was significantly less likely to be prescribed to Black or Hispanic patients, and more likely to be prescribed to female patients, those with co-occurring substance use or mood disorders, and those with comorbid physical conditions such as neuropathic pain. Nearly one-third of persons who received gabapentin (4336 [31.1%]) had at least 1 drug-related poisoning after initiating buprenorphine treatment, compared with 13 856 (14.5%) among persons who did not receive gabapentin. Adjusted analyses showed that days of gabapentin use were not associated with hospitalization for drug-related poisoning (odds ratio, 0.98 [95% CI, 0.85-1.13]). Drug-related poisoning risks did not vary based on dosage. CONCLUSIONS AND RELEVANCE: Gabapentin is prescribed in the context of a myriad of comorbid conditions. Even though persons receiving gabapentin are more likely to have admissions for drug-related poisoning, these data suggest that gabapentin is not associated with an increased risk of drug-related poisoning alongside buprenorphine in adjusted analyses. More data on the safety profile of gabapentin in OUD settings are needed.
AD - Department of Psychiatry, Washington University in St Louis, School of Medicine, St Louis, Missouri.; Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.; Translational Addictions Research Laboratory, Centre for Addictions and Mental Health, University of Toronto, Toronto, Ontario, Canada.; Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville.; Department of Family and Community Medicine, St Louis University, St Louis, Missouri.; Department of Health and Outcomes Research, St Louis University, St Louis, Missouri.
AN - 37672238
BT - JAMA Psychiatry
C5 - Opioids & Substance Use
CP - 12
DA - Dec 1
DO - 10.1001/jamapsychiatry.2023.3145
DP - NLM
IS - 12
JF - JAMA Psychiatry
LA - eng
N2 - IMPORTANCE: Gabapentin prescriptions have drastically increased in the US due to off-label prescribing in settings such as opioid use disorder (OUD) treatment to manage a range of comorbid conditions and withdrawal symptoms, despite a lack of evidence. OBJECTIVE: To assess the purpose and associated risks of off-label gabapentin use in OUD treatment. DESIGN, SETTING, AND PARTICIPANTS: This retrospective recurrent-event case-control study with a crossover design used administrative claims data from MarketScan Commercial and Multi-State Medicaid databases from January 1, 2006, to December 31, 2016. Individuals aged 12 to 64 years with an OUD diagnosis and filling buprenorphine prescriptions were included in the primary analysis conducted from July 1, 2022, through June 1, 2023. Unit of observation was the person-day. EXPOSURES: Days covered by filled gabapentin prescriptions. MAIN OUTCOMES AND MEASURES: Primary outcomes were receipt of gabapentin in the 90 days after initiation of buprenorphine treatment and drug-related poisoning. Drug-related poisonings were defined using codes from International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. RESULTS: A total of 109 407 patients were included in the analysis (mean [SD] age, 34.0 [11.2] years; 60 112 [54.9%] male). Among the 29 967 patients with Medicaid coverage, 299 (1.0%) were Hispanic, 1330 (4.4%) were non-Hispanic Black, 23 112 (77.1%) were non-Hispanic White, and 3399 (11.3%) were other. Gabapentin was significantly less likely to be prescribed to Black or Hispanic patients, and more likely to be prescribed to female patients, those with co-occurring substance use or mood disorders, and those with comorbid physical conditions such as neuropathic pain. Nearly one-third of persons who received gabapentin (4336 [31.1%]) had at least 1 drug-related poisoning after initiating buprenorphine treatment, compared with 13 856 (14.5%) among persons who did not receive gabapentin. Adjusted analyses showed that days of gabapentin use were not associated with hospitalization for drug-related poisoning (odds ratio, 0.98 [95% CI, 0.85-1.13]). Drug-related poisoning risks did not vary based on dosage. CONCLUSIONS AND RELEVANCE: Gabapentin is prescribed in the context of a myriad of comorbid conditions. Even though persons receiving gabapentin are more likely to have admissions for drug-related poisoning, these data suggest that gabapentin is not associated with an increased risk of drug-related poisoning alongside buprenorphine in adjusted analyses. More data on the safety profile of gabapentin in OUD settings are needed.
PY - 2023
SN - 2168-622X (Print); 2168-622x
SP - 1269
EP - 1276+
ST - Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder
T1 - Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder
T2 - JAMA Psychiatry
TI - Gabapentin Use Among Individuals Initiating Buprenorphine Treatment for Opioid Use Disorder
U1 - Opioids & Substance Use
U3 - 10.1001/jamapsychiatry.2023.3145
VL - 80
VO - 2168-622X (Print); 2168-622x
Y1 - 2023
ER -