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

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More from @DrSuziNielsen

Jun 12
Really important study being presented by Staci Gruber at #CPDD22 which longitudinally assesses a whole range of functioning in cannabis naive ppl before and following use of medical cannabis (now 3 years of follow up funded) 1/
2/ most interested in use for pain, detailed info collected on cannabinoid use..including developing the cannacount metric to measure cannabinoid use
Most are using CBD dominant products, which include a range of other minor cannabinoids including CBG and CBC
Read 4 tweets
Jun 12
David Ledgerwood talks about a pharmacist delivered contingency management in people with HIV who smoke - and of course I am super excited to see #pharmacists deliver these interventions #cpdd22 1/
2/ can pharmacists be trained to deliver contingency management for smoking cessation?
3/ yes! Of course they can. Pharmacists do really well in terms of delivering contingency management, especially discussing smoking and praising efforts and being generally skilful in smoking cessation
Read 4 tweets
Nov 16, 2021
"Won't giving people #naloxone increase their drug use?" I get this question almost every time I deliver training to healthcare professionals. Superstar student @WaiChungTse1 led this systematic review to examine this common concern 1/ (FREE to download)
authors.elsevier.com/c/1e5JG_LkIBSl…
2/ So what did we do? We looked for studies where substance use and overdose was measured before and after naloxone provision. We found no evidence that take-home naloxone leads to increased substance use or overdose. 1 study found reduced ED attendances following naloxone supply
3/ So if you are providing naloxone, or thinking about it, this might be reassuring. If you train pharmacists, doctors, first responders etc and they have concern.. please feel free to share this work with them! @PSA_National @RACGP @ijdrugpolicy
authors.elsevier.com/c/1e5JG_LkIBSl…
Read 4 tweets
Nov 10, 2021
Last session for me today at @APSAD40 on prescription opioids, treatment, and prescription drug monitoring programs. First up - a mini-symposium with @PPrathivadi , @LouisaPicco and @Sarah_Haines_ .. lets see if I can pull out a few key findings 1/
2/ First up @PPrathivadi talking about GPs use of PDMP, benefits for informing prescribing but challenges with reluctance to use technology - also check out this super commentary with @Sarah_Haines_ in the @AusJPrimHealth on evaluation considerations
publish.csiro.au/py/PY20296
3/ Next is @LouisaPicco talking about implementation of prescription monitoring with #pharmacists. Alerts seem to really drive responses (over other clinical risk factors).. are automatic alerts replacing clinical judgement? Conclusion: PDMP should not replace clinical decisions
Read 8 tweets
Nov 10, 2021
Last afternoon of #APSAD40! It is a joy to chair this session on #overdose - lots of key learnings and great work in the prevention space. Here are a couple of highlights from the session 1/
2/ Louisa Durrant (NUM at Melaleuca, @qldhealthnews) spoke about lessons learned supplying take-home naloxone in the opioid treatment program in QLD. Despite many having experienced an overdose, few had access to naloxone before the pilot, and consumers valued being offered THN.
3/ Dr Eleanor Black presented on the ONE study, a pilot study looking at ED delivery of #naloxone - a key opportunity to offer naloxone to people at risk of overdose. Most (not all) staff through they should offer #naloxone, with common misconception of naloxone increased OD risk
Read 11 tweets
Nov 9, 2021
What's new in take-home #naloxone in Australia? 1/ Ange Matheson from @NSWHealth explains the NSW model which allows a whole range of workers and non-medical services across the NSW (e.g. those working NGOs without pharmacists or doctors on staff) to supply naloxone #APSAD40
2/ Tegan Nuckey from Queensland (QuIHN) talks about their #naloxone program, adapted from the WA model.. now funded until 2023 (but no recurrent funding). Hopefully a national program will be funded by then! No cost, script, no ID - addressing key barriers.
3/ Robin Greaves (Tasmania) presented on the Tasmanian gov program where poisons regulations were changed to allow supply by NPS workers as part of their pilot. With limited funding, the pilot focused on people who use heroin, now ongoing funding provides FREE naloxone from NSPs
Read 4 tweets

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