Thread by @DrSuziNielsen

At the #CPDD22 mini-symposium on #gabapentin talks about considerable research highlighting potential for SUD treatment but also high rates of identification in overdose. Prescribing continues to increase yet diversion appears to trend down after regulatory changes 1/

2/ anecdotal reports of #gabapentin enhancing opioid effects and reducing withdrawal. Motivation for use is a mix of non-medical use with other substances and therapeutic motivations e.g. to self manage pain/withdrawal

3/ increases in gapabentin increase in a linear manner compared with low/stable pregabalin prescribing (interesting this is reversed in Australia) - it is commonly being prescribed off label for substance use treatment

4/ non-medical use commonly with other opioids, especially with opioid agonist treatment and in those without housing or with chronic pain. Co-use with methadone or bup mixed between prescribed as part of treatment and non-prescription use. Is it because OAT doses are too low?

5/ my thoughts, as always, it's complex. Medical and nonmedical reasons overlap with considerable self medication for therapeutic use but also recreational use for the positive feelings when combined with opioids. Matthew Ellis: Risks & benefits need to be better understood

6/ questions remain as to whether gabapentin use is resulting from underdosing methadone and buprenorphine and if restricting its use will lead to other bad outcomes..

7/ Joshua Black shows gapabentin prescribing increases as opioids and benzos drop, and gapabentin use independently associated with mortality with opioids

8/ US poison centre exposures are also increasing as opioid analgesic and benzo poisonings decrease though numbers still relatively low for gabapentin; deaths as a single substance only 5% of total cases, almost all oral use

9/ US general population surveys asking about use in a way not directed by your healthcare provider.. prevalence <1%, compared to around three times as much for benzos and 5x for opioids

10/ death certificate mentions ..15th most frequently mentioned drug (1848 deaths, or 3%), with 98% of cases involving other substances