McNeilage Amy G, Browne Evan, Nielsen Suzanne, Ashton-James Claire E, Murnion Bridin
Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.
Eur J Pain. 2025 Oct;29(9):e70116. doi: 10.1002/ejp.70116.
The global rise in gabapentinoid prescriptions for chronic pain has been striking. However, this trend has been accompanied by growing concerns about misuse and dependence. This qualitative systematic review aimed to synthesise the perspectives of healthcare practitioners and other professionals on these emerging challenges.
Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) were searched to May 2025. Eligible studies used qualitative or mixed methods to explore professional views on gabapentinoid misuse or dependence. Studies focusing solely on patient perspectives or therapeutic use were excluded. Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Data were analysed using thematic synthesis, and confidence in the findings was evaluated using GRADE-CERQual.
After screening 1584 records, 19 original studies were included. Most were conducted in substance use treatment and law enforcement settings, where professionals frequently encounter vulnerable populations and more severe patterns of misuse than in general clinical care. Reported drivers of misuse included polydrug use, opioid substitution, psychological distress and poor access to non-pharmacological care. Signs of misuse included early refills, dose escalation and reluctance to taper. Professionals described ethical tensions in prescribing and dispensing and proposed harm reduction strategies, including prescriber education, regulatory reform, expanded treatment access and public awareness.
Gabapentinoid misuse is shaped by clinical, social and structural factors. Tackling these challenges requires systemic responses that go beyond individual prescribers. Lessons from opioid policy responses should inform balanced, compassionate and evidence-informed strategies to reduce harm and improve care.
This is the first systematic review to synthesise professional perspectives on gabapentinoid misuse and dependence, drawing on studies from Europe, North America, the Middle East and Africa. Integrating insights from healthcare, law enforcement and policy settings, it reveals the structural drivers behind rising misuse-including opioid regulation, socioeconomic hardship and limited access to alternatives-and highlights gaps in clinical guidance. The findings offer actionable, cross-sector strategies to support safer prescribing, informed policy and more effective harm reduction.
全球范围内，用于慢性疼痛的加巴喷丁类药物处方量显著增加。然而，这一趋势伴随着对药物滥用和药物依赖的日益担忧。本定性系统评价旨在综合医疗从业者和其他专业人士对这些新出现挑战的看法。
检索了六个数据库（MEDLINE、Scopus、Web of Science、CINAHL、EMBASE、PsycINFO），检索截至2025年5月。纳入的合格研究采用定性或混合方法，以探讨专业人士对加巴喷丁类药物滥用或依赖的看法。仅关注患者观点或治疗用途的研究被排除。使用批判性评价技能计划清单评估方法学质量。采用主题综合法分析数据，并使用GRADE-CERQual评估研究结果的可信度。
在筛选了1584条记录后，纳入了19项原创研究。大多数研究在物质使用治疗和执法环境中进行，与一般临床护理相比，专业人员在这些环境中经常接触到弱势群体以及更严重的滥用模式。报告的滥用驱动因素包括多药使用、阿片类药物替代、心理困扰以及难以获得非药物治疗。滥用迹象包括提前续方、剂量增加以及不愿减药。专业人员描述了处方和配药过程中的伦理困境，并提出了减少伤害的策略，包括对开处方者进行教育、监管改革、扩大治疗途径以及提高公众意识。
加巴喷丁类药物的滥用受到临床、社会和结构因素的影响。应对这些挑战需要系统性的应对措施，而不仅仅局限于个体开处方者。阿片类药物政策应对措施的经验教训应为减少伤害和改善护理的平衡、富有同情心且基于证据的策略提供参考。
这是第一项系统评价，综合了来自欧洲、北美、中东和非洲的研究中专业人士对加巴喷丁类药物滥用和依赖的看法。整合了医疗保健、执法和政策环境中的见解，揭示了滥用增加背后的结构性驱动因素，包括阿片类药物监管、社会经济困难以及难以获得替代药物，并突出了临床指南中的差距。研究结果提供了可采取行动的跨部门策略，以支持更安全的处方、明智的政策制定以及更有效的减少伤害措施。
