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More Patients are Misusing Common Alternatives to Prescription Opioids, Study Finds

New research finds that two pain killers branded as safe alternatives to opioids can actually be life-threatening. Learn when and how to prescribe them.

The incidence of suicide attempts and hospital admissions in adults taking the non-opioid mediations gabapentin and baclofen has been on the rise since 2013, according to a comprehensive analysis. The alarming trend coincides with a decline in opioid prescriptions in the US. After opioid prescriptions between 2010 and 2012, the Centers for Disease Control and Prevention called on prescribers to limit their use. However, because gabapentin and baclofen are viewed as safer alternatives for pain management, prescriptions increased by the millions, and consequently, so did their misuse.

What Did the Study Find?

“We are seeing a worrying increase in harmful exposures to gabapentin and baclofen in US adults over recent years, which may be an unintended consequence of the move away from opioid prescriptions for pain management,” lead study author Kimberly Reynolds, MS, DNP, of the University of Pittsburgh, said.

For the study published in Clinical Toxicology, researchers at the University of Pittsburgh examined more than 90,000 cases of exposure to the two medications. They noted substantial increases in misuse and toxicity. Isolated abuse instances of using gabapentin rose by 119.9% from 2013 to 2017, and baclofen by 31.7% from 2014 to 2017. The data collected from exposures reported to poison centers showed that all states had seen increases in gabapentin exposures. Researchers also observed increases in baclofen exposures, gabapentin misuse/abuse, and baclofen misuse/abuse in most states. The overwhelming majority of intentional exposures were suicide attempts, Dr. Reynolds says.

What Does the Study Mean for Providers?

“Patients who are prescribed gabapentin and/or baclofen [are] more likely to be treated for mood disorders and pain as they are comorbid conditions,” Dr. Reynolds says. “The prevalence of these exposures demonstrates the need to identify risk factors associated with suicide and misuse when prescribing these medications.” She adds that when prescribing these medications, providers should use validated tools to screen for substance use disorders, mood disorders, and suicidal ideation. And if appropriate, non-pharmacological therapy is an option for chronic pain patients, per CDC recommendations.

Choosing to Prescribe Gabapentin or Baclofen

First, providers should discuss the risk-benefit of using gabapentin and baclofen with patients. An important point to stress: potential mood changes, says Yili Huang, DO, director of the Pain Management Center at Northwell Health’s Phelps Hospital in Sleepy Hollow, New York. “I tell patients that … if they feel that they are experiencing mood changes while on medication to give me a call,” Dr. Huang says. “Even if the patients don’t have a history of anxiety or depression, I tell them to be watchful for strange thoughts or mood changes. If this happens, we will switch the medication or reduce the dosage.” Dr. Huang also advises starting with a low dose and gradually increasing it. “We want to dose the medication to provide pain relief but not sedation or other side effects so that the patient can tolerate it,” he explains.

Even with these precautions, providers need more research on these drugs, Dr. Reynolds says. “Building a better understanding of the risks carried by these non-opioid medications is necessary so that providers and patients can make better-informed decisions about their role in pain management,” she explains. “It could also lead to introducing new public health measures.”

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