Peckham Alyssa M, Evoy Kirk E, Covvey Jordan R, Ochs Leslie, Fairman Kathleen A, Sclar David A
Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, Glendale, Arizona.
College of Pharmacy, The University of Texas at Austin, San Antonio, Texas.
Pharmacotherapy. 2018 Apr;38(4):436-443. doi: 10.1002/phar.2096. Epub 2018 Mar 28.
Research suggests the medical consequences of gabapentin overuse depend on whether gabapentin is abused alone or with opioids to potentiate an opioid "high." The objective of this study was to assess predictors of gabapentin overuse with or without concomitant opioids.
Data were obtained from the Truven Health MarketScan Commercial Claims and Encounters database for 2013 through 2015. Eligibility criteria were gabapentin utilization, with or without opioids, for 120 days or longer throughout a 12-month observation period. Cohort identification was based on patterns of overuse exceeding thresholds of 3600 mg of gabapentin and/or 50 morphine-mg equivalents of opioids; sustained overuse was defined as three or more quarters exceeding threshold. Diagnostic predictors were measured in the 6 months pretreatment in inpatient (IP) or emergency department (ED) settings. Indications were measured in IP, ED, or ambulatory settings. Logistic regression analyses adjusted for age, sex, indication, use of benzodiazepine or z-hypnotics (i.e., zaleplon, zolpidem, eszopiclone) during gabapentin treatment, pretreatment ED/IP use, and pretreatment diagnoses of anxiety or depression.
Criteria for sustained overuse were met by 2.0% of 44,148 patients treated with gabapentin without opioids and by 11.7% of 15,335 patients treated with concomitant gabapentin-opioid. The top three predictors of sustained overuse for gabapentin-only patients were insomnia (7.0%), euphoria (4.5%), and bipolar disorder (4.5%), and were detoxification (35.6%), altered mental status (26.3%), and addiction (21.6%) for gabapentin-opioid patients. In adjusted analyses, concomitant opioid use multiplied the odds of sustained misuse by 6.32 (95% confidence interval [CI] = 5.80-6.89) and the interaction of addiction with opioid use by 1.88 (95% CI = 1.32-2.66). Among gabapentin-only patients, sustained misuse was predicted by a history of anxiety (odds ratio = 1.56, 95% CI = 1.02-2.38) but not by a history of addiction.
The likelihood of gabapentin overuse alone is low but significantly increases with concomitant opioid use, especially when coupled with a history of addiction. History of addiction does not appear to increase risk of gabapentin misuse among those with gabapentin alone.
研究表明，加巴喷丁过度使用的医学后果取决于其是单独滥用还是与阿片类药物一起使用以增强阿片类药物的“快感”。本研究的目的是评估加巴喷丁单独或与阿片类药物同时过度使用的预测因素。
数据来自2013年至2015年的Truven Health MarketScan商业索赔和会诊数据库。纳入标准为在12个月的观察期内，加巴喷丁使用120天或更长时间，无论是否使用阿片类药物。队列识别基于加巴喷丁超过3600毫克和/或阿片类药物50毫克吗啡当量的过度使用模式；持续过度使用定义为超过阈值的三个或更多季度。在住院（IP）或急诊科（ED）环境中，在预处理的6个月内测量诊断预测因素。在IP、ED或门诊环境中测量适应症。逻辑回归分析对年龄、性别、适应症、加巴喷丁治疗期间使用苯二氮卓类药物或z-催眠药（即扎来普隆、唑吡坦、艾司佐匹克隆）、预处理时的ED/IP使用情况以及焦虑或抑郁的预处理诊断进行了调整。
44148例仅使用加巴喷丁的患者中有2.0%符合持续过度使用标准，15335例同时使用加巴喷丁和阿片类药物的患者中有11.7%符合该标准。仅使用加巴喷丁患者持续过度使用的前三位预测因素是失眠（7.0%）、欣快感（4.5%）和双相情感障碍（4.5%），而同时使用加巴喷丁和阿片类药物的患者是戒毒（35.6%）、精神状态改变（26.3%）和成瘾（21.6%）。在调整分析中，同时使用阿片类药物使持续滥用的几率增加了6.32倍（95%置信区间[CI]=5.80-6.89），成瘾与阿片类药物使用的相互作用增加了1.88倍（95%CI=1.32-2.66）。在仅使用加巴喷丁的患者中，焦虑史可预测持续滥用（比值比=1.56，95%CI=1.02-2.38），而成瘾史则不能。
单独使用加巴喷丁过度使用的可能性较低，但与阿片类药物同时使用时显著增加，尤其是伴有成瘾史时。成瘾史似乎不会增加仅使用加巴喷丁患者滥用加巴喷丁的风险。
