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.
JAMA Psychiatry. 2023 Dec 1;80(12):1269-1276. doi: 10.1001/jamapsychiatry.2023.3145.
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.
重要性：由于在阿片类药物使用障碍 (OUD) 治疗等环境中进行了非适应证处方，以管理一系列合并症和戒断症状，美国的加巴喷丁处方数量大幅增加，尽管缺乏证据。 目的：评估 OUD 治疗中非适应证加巴喷丁使用的目的和相关风险。 设计、设置和参与者：这是一项具有交叉设计的回顾性复发性事件病例对照研究，使用了 MarketScan 商业和多州医疗补助数据库从 2006 年 1 月 1 日至 2016 年 12 月 31 日的行政索赔数据。纳入了年龄在 12 至 64 岁之间且 OUD 诊断和使用丁丙诺啡处方的个体，并于 2023 年 6 月 1 日进行了主要分析。观察单位为人天。 暴露：用加巴喷丁填充的处方覆盖的天数。 主要结果和测量：主要结果是在开始丁丙诺啡治疗后的 90 天内接受加巴喷丁治疗和与药物相关的中毒。使用国际疾病分类第 9 版和国际疾病分类、损伤和死因统计分类第 10 版中的代码定义与药物相关的中毒。 结果：共纳入 109407 名患者进行分析（平均[标准差]年龄为 34.0[11.2]岁；60112 [54.9%]为男性）。在有医疗补助覆盖的 29967 名患者中，299 名（1.0%）为西班牙裔，1330 名（4.4%）为非西班牙裔黑人，23112 名（77.1%）为非西班牙裔白人，3399 名（11.3%）为其他种族。加巴喷丁不太可能开给黑人和西班牙裔患者，而更可能开给女性患者、同时患有物质使用或情绪障碍的患者，以及患有神经病理性疼痛等合并躯体疾病的患者。与未接受加巴喷丁治疗的患者相比（13856 名[14.5%]），在开始丁丙诺啡治疗后，近三分之一（4336 名[31.1%]）接受加巴喷丁治疗的患者至少发生了 1 次与药物相关的中毒。调整分析显示，加巴喷丁的使用天数与药物相关中毒的住院治疗无关（比值比，0.98 [95%CI，0.85-1.13]）。药物相关中毒风险与剂量无关。 结论和相关性：加巴喷丁在许多合并症的情况下都有处方。尽管接受加巴喷丁治疗的患者更有可能因药物相关中毒而住院治疗，但这些数据表明，在调整分析中，加巴喷丁与丁丙诺啡联合使用并不会增加药物相关中毒的风险。需要更多关于加巴喷丁在 OUD 环境中安全性的信息。
JAMA Psychiatry. 2023-12-1
JAMA Netw Open. 2021-2-1
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