The inevitable dark side of these “preferable to opioids” medications is becoming harder to ignore:
Gabapentinoid abuse may rise as the prescribing and use of opioids decreases, but the biggest concern may come when these agents are combined with other prescribed medications or illicit street drugs.
Gabapentinoid use has been associated with an amplification of a “high” feeling when used in combination with opioids. Therefore, the use of gabapentinoids in a population already receiving opioids may lead to a greater risk of abuse for both substances.
Gabapentin and pregabalin may be used more safely as alternatives after a patient has been rehabilitated off of opioids or before they start using them in the first place.
So now we’ll have to choose between only 1 of 3 options: opioids or benzodiazepines or gabapentoids, but no combination.
Again and again, a medication is deemed “harmful” for us because *other* people are abusing it for “fun”; people who are *not* pain patients.
Because gabapentin has a higher potential for abuse in patients with a history of SUD and patients concurrently taking opioids, it is prudent to be cautious when prescribing gabapentin or pregabalin in this population.
There are a few precautions healthcare providers can take to identify possible abuse.
Prescribers can monitor patients for
- changes in mood,
- frequent requests for early refills, and
- requests for rapid increases in doses.
They can also include gabapentinoids in urine monitoring to ascertain whether their patient is actually taking the prescribed medications.
Pharmacists can watch for patients taking multiple doses and/or and receiving prescriptions from multiple prescribers, and counsel patients.
Another sign to watch for is frequent early refill requests and asking to pay out of pocket instead of billing insurance.
Reporting gabapentin to prescription drug monitoring programs may be useful in identifying patients who may be abusing or diverting gabapentin.
By increasing awareness of abuse potential and reporting to prescription monitoring programs, healthcare providers may help to prevent and/or reduce overall abuse of gabapentinoids.