Gabapentin increasingly linked to overdose deaths: CDC report

USA: Gabapentin was detected in almost 1 in 10 US overdose deaths between 2019 and 2020, according to a report from the CDC's Division of Overdose Prevention. The report further stated that the medical examiner or coroner ruled the drug was a cause of death in about half of the cases. 

Gabapentin was approved by the US Food and Drug Administration (FDA) for the treatment of seizures and pain associated with shingles. The prescription rate doubled from about 13 to 27 per 1000 insurance beneficiaries between 2009 and 2016 due to the growing off-label prescribing of gabapentin for nerve pain and other conditions. As a matter of fact, gabapentin had become the seventh most prescribed drug in the US by 2019. 

Sometimes, gabapentin is used to amplify the effects of illicit opioids. The FDA issued a warning in late 2019 that gabapentin may cause serious breathing difficulties when used with drugs that depress the central nervous system, such as anti-anxiety medications, opioids, and antidepressants. 

Now, the report from the State Unintentional Drug Overdose Reporting System from 23 states and the District of Columbia indicates that the role of gabapentin in the US overdose deaths may be growing. Overall, toxicology tests revealed gabapentin's role in 5687 overdose deaths between 2019 and 2020—about 10% of all cases with test results available. Overdose deaths in which gabapentin was detected doubled from 449 in the first quarter of 2019 to 959 in the second quarter of 2020.

The proportion of these cases that medical examiners ruled was caused by the drug increased from 50% in early 2019 to 55% by late 2020. About 90% of these cases also involved opioids, primarily illicitly manufactured fentanyl. About 83% of deaths caused by gabapentin occurred among White adults aged 35 to 54 years.

"Persons who use illicit opioids with gabapentin should be educated about the increased risk for respiratory depression and death," the authors wrote. 

Reference:

Kuehn BM. Gabapentin Increasingly Implicated in Overdose Deaths. JAMA. 2022;327(24):2387. doi:10.1001/jama.2022.10100