Data from the State Unintentional Drug Overdose Reporting System suggest that gabapentin’s role in US overdose deaths may be growing. Overall, toxicology tests detected gabapentin in 10% of all cases with test results available. Overdose deaths in which gabapentin was detected doubled from 449 in the first quarter of 2019 to 959 in the second quarter of 2020. James W. Mold, MD, MPH

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Gabapentin Increasingly Implicated
in Overdose Deaths
Postmortem toxicology tests detected gabapentin in almost 1 in 10 US overdose deaths
between 2019 and 2020.In about half of the
cases, a medical examiner or coroner ruled
the drug was a cause of the death, according to a report from the CDC’s Division of
Overdose Prevention.
The US Food and Drug Administration
(FDA) approved gabapentin for treating seizures and pain associated with shingles. But
growing off-label prescribing of gabapentin for nerve pain and other conditions contributed to its prescription rate doubling
from about 13 to 27 per 1000 insurance beneficiaries between 2009 and 2016. In fact,
by 2019, gabapentin had become the
seventh most prescribed drug in the US.
Gabapentin is sometimes used to amplify the effects of illicit opioids. In late 2019,
the FDA warned that gabapentin might
cause serious breathing difficulties when
usedwith drugs that depress the central nervous system, such as opioids, antianxiety
medications, and antidepressants.
Now, data from the State Unintentional
Drug Overdose Reporting System from 23
states and the District of Columbia suggest
that gabapentin’s role inUS overdose deaths
may be growing.Overall, toxicology tests detected gabapentin in 5687 overdose deaths
between 2019 and 2020—about 10% of all
cases with test results available. Overdose
deaths in which gabapentin was detected
doubled from 449 in the first quarter of 2019
to 959 in the second quarter of 2020.
The proportion of these cases thatmedical examiners ruled were caused by the drug
increased from 50% in early 2019 to 55% by
late 2020. About 90% of these cases also involved opioids, primarily illicitly manufactured fentanyl. About 83% of deaths caused
by gabapentin occurred amongWhite adults
aged 35 to 54 years.
“Personswho use illicit opioidswith gabapentinshouldbeeducatedabouttheincreased
risk for respiratorydepressionanddeath,” the
authors wrote. − Bridget M. Kuehn, MSJ

Author/s:

Kuehn, B. M.