Pregabalin and the Risk for Opioid-Related Death: A Nested Case–Control Study

Gomes, Tara; Greaves, Simón; Brink, Wim van den; Antoniou, Tony; Mamdani, Muhammad; Paterson, J. Michael; Martins, Diana; Juurlink, David N.

doi:10.7326/m18-1136

Cited by 130 publications

(124 citation statements)

References 5 publications

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“…Gabapentin, which is commonly used, only decreased subjective pain . Recent reports raise the concern that using GABAergic medication within 120 days of surgery was associated with an increased risk of opioid‐related death in chronic opioid users . These findings warrant caution when prescribing postoperative opioids and further emphasizes the need to limit their use.…”

Section: Discussionmentioning

confidence: 99%

“…28 Recent reports raise the concern that using GABAergic medication within 120 days of surgery was associated with an increased risk of opioid-related death in chronic opioid users. 29,30 These findings warrant caution when prescribing postoperative opioids and further emphasizes the need to limit their use. Steroids have also been shown to be a promising component of multimodal analgesia, most likely through anti-inflammatory effects.…”

Section: Reducing Opioid Usementioning

confidence: 99%

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Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Dang

Duffy

et al. 2019

The Laryngoscope

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Objectives In otolaryngology, postoperative pain management lacks evidence‐based guidelines. We designed a prospective, multiphasic study aimed to develop evidence‐based guidelines for postoperative pain management within our institution. In this first phase of our project, we investigated opioid prescription and consumption as well as pain trends for common otolaryngologic procedures. Methods Patients (n = 161) who underwent procedures between July 2018 and February 2019 were surveyed on their postoperative opioid usage and pain from day of discharge to first clinic visit. Opioid prescriptions were converted to standardized units of morphine milligram equivalents (MME). The procedures selected for analysis were parathyroidectomy/thyroidectomy, parotidectomy, sialendoscopy, and transoral robotic surgery resection (TORS). Results In total, 19,748 MME were prescribed: 8,588 MME (43.5%) were used, leaving 11,159 MME (56.5%) unused. TORS average MME used: 221 ± 227; total MME unused: 38%. Sialendoscopy average MME used: 31 ± 46; total MME unused: 67%. Parathyroidectomy/thyroidectomy average MME used: 30 ± 37; total MME unused: 66%. Parotidectomy average MME used: 43 ± 53; total MME unused: 65%. Male gender, smoking (current and former), and psychiatric medication use were positive predictors of opioid consumption in postoperative patients (P < 0.001). Conclusion At our institution, over 50% of prescribed postoperative opioids went unused. This was most pronounced for nonmucosal surgeries. Postoperative pain management should account for this to minimize unnecessary opioid prescriptions. Based on our findings and review of current literature, we are in the process of developing prescribing recommendations to be implemented within our institution. Level of Evidence 2 Laryngoscope, 130:659–665, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Reducing Opioid Usementioning

confidence: 99%

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Dang

Duffy

et al. 2019

The Laryngoscope

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“…There have also been reports that gabapentin may be combined with other drugs that are easily abused, such as opioids, in order to enhance the "opioid high," leading to drug-induced depression and death [30,31]. Two recent studies conducted among the general population in Canada showed concomitant prescription of gabapentinoids and opioids was associated with increased odds of opioid-related deaths [32,33].…”

Section: Discussionmentioning

confidence: 99%

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

et al. 2020

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Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant pre-scription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12-1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03-1.27), and hospitalization (HR 1.33, 95% CI 1.31-1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16-1.28) and hospitalization (HR 1.37, 95% CI 1.33-1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95-1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients. cancer, whether patients had at least one pain-related hospitalization and the number of hospitalizations in 2010 [6,8].

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“…Current initiatives implemented in the US health systems to reduce gabapentinoid use include prior authorization and step therapy for pregabalin, mandatory reporting of gabapentin use to prescription drug monitoring programs in some states (e.g., Massachusetts, Ohio, and Virginia), and classifying gabapentin as a Schedule V Controlled Substance with prescribing quantity limits (Kentucky) [17,18]. However, definitions for high-risk gabapentinoid use vary [19][20][21]. While gabapentinoids are promoted as a key constituent of multimodal analgesia to reduce the opioid dosages in perioperative and other acute pain settings [22], our findings underscore the importance of safety evaluations of gabapentinoids and concomitant use of opioids/benzodiazepines and gabapentinoids in the US ambulatory care settings, especially among the largest proportion of gabapentinoid prescribers, primary care physicians.…”

Section: Discussionmentioning

confidence: 99%

Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016

Zhou

Bhattacharjee

Kwoh

et al. 2019

JCM

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Increasing gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; P trend < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the gabapentinoids. Most (96.6%) of the gabapentinoid visits did not have an approved indication for gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, gabapentinoid use increased substantially, commonly prescribed by primary care physicians.

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Pregabalin and the Risk for Opioid-Related Death: A Nested Case–Control Study

Cited by 130 publications

References 5 publications

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Postoperative opioid‐prescribing practices in otolaryngology: A multiphasic study

Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016

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