Peckham Alyssa M, Fairman Kathleen A, Sclar David A
Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA.
Clin Drug Investig. 2017 Aug;37(8):763-773. doi: 10.1007/s40261-017-0530-3.
Despite international calls to make gabapentin a controlled substance, studies of gabapentin use/abuse patterns are limited to small/high-risk samples and adverse event reports.
The aim of this study was to conduct a systematic assessment of the abuse potential/prevalence of gabapentin in a large sample.
Truven Health MarketScan Commercial Claims and Encounters database, years 2013-2015.
Patients with two or more claims for one or more abusable drugs and ≥12 months' continuous enrollment were sampled for Lorenz curve analysis. Prevalence analysis was limited to those with ≥120 days of therapy.
Abuse potential was measured as Lorenz-1 (consumption of drug supply by top 1% of users) of ≥15%. Dose thresholds were morphine milligram equivalent (MME) standards for opioids, and maximum labeled doses in milligrams (mg) for other drugs.
Lorenz-1 values were 37% opioids, 19% gabapentin, 15% pregabalin, 14% alprazolam, and 13% zolpidem. The top 1% gabapentin users filled prescriptions for a mean (median) 11,274 (9534) mg/day, more than three times the recommended maximum (3600 mg). Of these, one-quarter used or diverted ≥12,822 mg/day. The top 1% opioid and pregabalin users filled prescriptions for a mean (median) 180 (127) MMEs and 2474 (2219) mg/day, respectively. Of patients using opioids + gabapentin simultaneously, 24% had three or more claims exceeding the dose threshold within 12 months.
Established threshold criteria for gabapentinoid abuse are uncertain. Indications for gabapentinoid use (e.g. hot flashes, restless legs syndrome) were not measured.
Gabapentin use patterns are similar to those of other abusable medications. High daily doses pose safety and/or diversion concerns, and investigation of the medical consequences of gabapentin abuse is needed.
尽管国际上呼吁将加巴喷丁列为管制药物，但关于加巴喷丁使用/滥用模式的研究仅限于小样本/高风险样本以及不良事件报告。
本研究旨在对大样本中加巴喷丁的滥用潜力/流行情况进行系统评估。
Truven Health MarketScan商业索赔和就诊数据库，2013 - 2015年。
对一种或多种易滥用药物有两次或更多次索赔且连续参保≥12个月的患者被抽样用于洛伦兹曲线分析。患病率分析仅限于治疗时间≥120天的患者。
滥用潜力以洛伦兹-1（前1%使用者的药物供应量消耗）≥15%来衡量。剂量阈值对于阿片类药物是以吗啡毫克当量（MME）标准，对于其他药物是以毫克（mg）的最大标注剂量。
洛伦兹-1值分别为阿片类药物37%、加巴喷丁19%、普瑞巴林15%、阿普唑仑14%和唑吡坦13%。前1%的加巴喷丁使用者平均（中位数）每天开具的处方量为11,274（9534）mg，超过推荐最大量（3600 mg）的三倍多。其中，四分之一的使用者每天使用或挪用≥12,822 mg。前1%的阿片类药物和普瑞巴林使用者平均（中位数）每天开具的处方量分别为180（127）MME和2474（2219）mg。在同时使用阿片类药物和加巴喷丁的患者中，24%在12个月内有三次或更多次索赔超过剂量阈值。
加巴喷丁类药物滥用的既定阈值标准尚不确定。未对加巴喷丁类药物的使用指征（如潮热、不安腿综合征）进行测量。
加巴喷丁的使用模式与其他易滥用药物相似。高日剂量引发安全和/或挪用问题，需要对加巴喷丁滥用的医学后果进行调查。
