Introduction Gabapentin is commonly prescribed as an off-label adjunct to opioids because of its safer risk profile. Recent evidence has shown an increased risk of mortality when coprescribed with opioids. Therefore, we aimed to evaluate whether the addition of off-label gabapentin in patients with chronic opioid use is associated with a reduction in opioid dosage.
Methods We performed a retrospective cohort study of patients with chronic opioid use with a new off-label gabapentin prescription (2010–2019). Our primary outcome of interest was a reduction in opioid dosage measured via oral morphine equivalents (OME) per day after the addition of a new off-label gabapentin prescription.
Results In our cohort of 172,607 patients, a new off-label gabapentin prescription was associated with a decrease in opioid dosage in 67,016 patients (38.8%) (median OME/day reduction:13.8), with no change in opioid dosage in 24,468 patients (14.2%), and an increase in opioid dosage in 81,123 patients (47.0%) (median OME/day increase: 14.3). A history of substance/alcohol use disorders was associated with a decrease in opioid dosage after the addition of a new off-label gabapentin (aOR 1.20, 95% CI 1.16 to 1.23). A history of pain disorders was associated with a decrease in opioid dosage after the initiation of a new gabapentin prescription including arthritis (aOR 1.12, 95% CI 1.09 to 1.15), back pain (aOR 1.10, 95% CI 1.07 to 1.12), and other pain conditions (aOR 1.08, 95% CI 1.06 to 1.10).
Conclusions In this study of patients with chronic opioid use, an off-label gabapentin prescription did not reduce opioid dosage in the majority of patients. The coprescribing of these medications should be critically evaluated to ensure optimal patient safety.
- Analgesics, Opioid
- Opioid-Related Disorders
- Pain Management
Data availability statement
Data may be obtained from a third party and are not publicly available. Data are available from Optum’s Clinformatics Data Mart Database.
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Contributors JB: study design, data analysis, manuscript writing and editor, guarantor. MCB: study design, manuscript editing. MY: data collection, data analysis, manuscript editing. VG: data collection, data analysis, manuscript editing. EDS: study design, manuscript editing. CMB: study design, manuscript editing. JFW: study design, data analysis, manuscript writing and editing.
Funding Investigators were supported by National Institute on Drug Abuse (RO1 DA042859), NIAMS (P50 AR070600), the Michigan Department of Health and Human Services (E20180672-00 Michigan DHHS - MA-2018 Master Agreement Program) as well as the Substance Abuse and Mental Health Administration (SAMHSA: E20180568-00 MA-2018 Master Agreement Program) and the Centers for Disease Control and Prevention (E20182818-00 MA-2018 Master Agreement Program). Dr. Brummett is a consultant for Heron Therapeutics (San Diego, CA).
Competing interests CMB is a consultant for Heron Therapeutics (San Diego, California, USA).
Provenance and peer review Not commissioned; externally peer reviewed.
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