Gabapentinoids Used as Recreational Drugs

Gabapentinoids Used as Recreational Drugs

A couple of "sister drugs" are relatively recent players in the recreational drug scene, and they both might bear a closer look by those involved in addiction treatment.

Recent studies confirm that both gabapentin and pregabalin, two popular gabapentinoids, are associated with a significant increase in unhealthy incidents, from overdose to suicide, due to an increase in recreational use.

Pregabalin, brand name Lyrica, is the newer of the two, and has been nicknamed "Bud" by recreational users because it makes them feel like they're drunk on Budweiser or some other alcoholic beverage. It is intended primarily to treat nerve and muscle pain, including fibromyalgia, as well as anxiety disorders.

Gabapentin, brand names Neurontin, Gralise, Neuraptine and others, is the older of the two, and intended primarily to treat neuropathic pain and epileptic seizures.

Distinct misuse potential

The increasing abuse of gabapentinoids was detailed in a recent UK study published in CNS Drugs:

"The gabapentinoids pregabalin and gabapentin were originally developed as anticonvulsants and are now increasingly and widely prescribed for a range of clinical conditions. Recently, however, both drugs have been reported as possessing a distinct potential for misuse. Although gabapentinoids at therapeutic dosages may present with a low addictive liability potential, misusers may ingest these molecules in order to achieve euphoric and dissociative effects similar to those of traditional recreational drugs."
The "key points" from the study are the conclusions that "misusers may ingest these molecules in order to achieve euphoric/dissociative effects," and both drugs "possess an addictive liability."

Adverse outcomes soar

An Oxford University research study has linked gabapentinoids with increased risks in several categories:

  • 26 percent higher for suicidal behavior and death
  • 24 percent higher for unintentional overdose
  • 22 percent higher for accidental injuries
  • 13 percent higher for traffic accidents
  • 4 percent higher for violent crimes and other offenses

When abused or misused on their own, pregabalin was by far the worst of the two. Gabapentin was safer on its own, but its use as an adjunct to opioid abuse raised it into the "deadly" category.

Dr. Derek K. Tracy of Queen Mary's Hospital, London, told Reuters News that the study provides important information about how pregabalin - but not gabapentin - increases the risk of a range of adverse outcomes. Importantly, the risk also is dose-related - the more one takes, the higher the risk. He added that young people, aged 15 to 24, are particularly susceptible.

He added that it's clear that some people are becoming dependent ("addicted") to gabapentinoids, "though we still lack good information on exactly how common that is, or which groups of people might be more vulnerable to this."

Prescriptions soaring

Gabapentinoid prescriptions have soared in recent years. A recent study reported that gabapentinoids were among the 15 top-selling medications in the world. This may be because they've been viewed as relatively effective with a low incidence of side effects. "But as we accumulated more information over time, it has become clear that this is not the case," Tracy explained, "and most recently there has been a countering drive to try to reduce their usage as their harm profile came more to the fore."

It should be noted that studies of gabapentinoids as potentially dangerous recreational drugs are not a new thing. As long as 10 years ago, abuses and dangers were being noted for gabapentin, pregabalin and even clonazepam (Klonopin), a benzodiazepine used to control seizures. These are all used in combination with primary drugs such as opioids by polydrug users. Another study over a decade ago found that online pharmacies were a primary source of gabapentinoids, and there already were dozens of websites advocating recreational uses for gabapentinoids.

Polydrug dangers

A research study published recently in JAMA found that during the first three months of combining opioids with benzodiazepines, the risk of opioid overdose soars five times the risk of just taking opioids. From then to roughly six months of such polydrug use the risk is double. After that it tapers down to the same as taking an opioid alone. It's estimated that combining opioids with gabapentin carries similar risks.

Another study found that combining gabapentinoids with alcohol also raised the risk of severe illness and death by a large percentage.

The JAMA study also found that the greater the number of doctors treating a patient, the greater the risk of overdose. Obviously, in such cases there's apparently a lack of communication between prescribing doctors. Since it's the role of prescribing physicians to closely examine their patients' inclination for drug misuse, such communications are vital.

For those of us specializing in treatment, our detailed drug histories help reveal potentially dangerous polydrug abuses. Knowing that a patient arriving for opioid treatment has been combining with gabapentin can significantly affect withdrawal and recovery. It now appears certain that we must inform patients about the potential hazards of gabapentinoids especially when combined with other substances.

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