Randomized, placebo-controlled pilot trial of gabapentin during an outpatient, buprenorphine-assisted detoxification procedure.

Abstract

This pilot study examined the efficacy of the N-type calcium channel blocker gabapentin to improve outcomes during a brief detoxification protocol with buprenorphine. Treatment-seeking opioid-dependent individuals were enrolled in a 5-wk, double blind, placebo-controlled trial examining the effects of gabapentin during a 10-day outpatient detoxification from buprenorphine. Participants were inducted onto buprenorphine sublingual tablets during week 1, were randomized and inducted onto gabapentin or placebo during week 2, underwent a 10-day buprenorphine taper during weeks 3–4 and then were tapered off gabapentin/placebo during week 5. Assessments included thrice-weekly opioid withdrawal scales, vitals, and urine drug screens. Twenty-four individuals (13 male, 17 Caucasian, 3 African American, 4 Latino, mean age 29.7 yrs) participated in the detoxification portion of the study (gabapentin, N=11; placebo, N=13). Baseline characteristics did not differ significantly between groups. Self-reported and observer-rated opioid withdrawal ratings were relatively low and did not differ between groups during the buprenorphine taper. Urine results showed a drug x time interaction, such that the probability of opioid-positive urines significantly decreased over time in the gabapentin versus placebo groups during weeks 3–4 (OR=0.73, p=0.004). These results suggest that gabapentin reduces opioid use during a 10-day buprenorphine detoxification procedure.

A Decade of Gabapentinoid Misuse: An Analysis of the European Medicines Agency’s ‘Suspected Adverse Drug Reactions’ Database

“…Gabapentin is approved to treat epilepsy and neuropathic pain disorders [4,34], with off-label use of the molecule including restless legs syndrome, migraine, vasomotor symptoms of menopause, and alcohol and substance dependence [2,[35][36][37][38]. There are anecdotal reports of its misuse [39], particularly in cocaine users and prison settings [40,41].…”

Psychoactive medications and disengagement from office based opioid treatment (obot) with buprenorphine

“…This finding may reflect that many of these medications are sedatives and anxiolytics and may increase the short-term tolerability of the buprenorphine induction and stabilization (Gold, 1993; Kleber et al, 1980; Kowalczyk et al, 2015; Salehi et al, 2011; Sanders et al, 2013; Washton and Resnick, 1982). However, in exploratory analyses assessing each emerging PAM separately, both gabapentin and clonidine appeared to be associated with shorter time to disengagement.…”

“…However, these psychoactive medications, especially gabapentin and clonidine, may be co-prescribed with buprenorphine to manage co-occurring psychiatric or sleep disorders and help maintain patients in recovery. While some psychoactive medications have been shown to increase the short-term (<12 weeks) tolerability of the opioid agonist induction or detoxification taper (Gold, 1993; Kleber et al, 1980; Kowalczyk et al, 2015; Salehi et al, 2011; Sanders et al, 2013; Washton and Resnick, 1982), their association with more long-term treatment outcomes have not been documented. Given the reports of misuse of gabapentin, clonidine and promethazine among patients on methadone and chronic opioids, as well as the emerging case reports for patients on buprenorphine, we hypothesized that these psychoactive medications would be associated with early disengagement from buprenorphine treatment.…”

Present and Future Pharmacological Treatments for Opioid Addiction

“…These medications do not act directly on GABA receptors or transporters [125] but modulate the α2-delta subunit of calcium channels, preventing the release of neurotransmitters like glutamate [126]. Both medications prevent opioid tolerance and dependence and reduce withdrawal symptoms in humans and preclinical models [127][128][129].…”