Gabapentinoid: The most dangerous class of drugs for pain relief?
The gabapentinoid prescription class of drugs, developed for seizures and commonly prescribed for chronic nerve pain is causing alarm worldwide as a new drug that's being abused. The matter is grave in India as well as many reports of unwanted side effects and a tendency to become addicted are coming to the fore.
What are gabapentinoids?
Gabapentinoids are an anti-seizure class of drug that is also prescribed for nerve pain. It has been available since 1993. Most common versions of this are gabapentin or pregabalin.
A quick review of literature indicated that the first peer-reviewed report of any gabapentinoid-linked death was published in 2011 in the Journal of Forensic Sciences, and that was an intentional suicide by overdose.
Since its introduction, gabapentinoids have been very popular and widely used as an adjuvant, an add-on drug that boosts the effects of other drugs, especially to help control partial seizures in adults. However, in the quarter century since its initial approval, off-label uses have exploded. It’s been prescribed to treat multiple physical conditions with neurological origins, from restless leg syndrome to nerve pain to acute and post-herpetic pain associated with shingles. It’s also prescribed for multiple psychiatric conditions, such as anxiety disorder, bipolar disorder, attention deficit disorder, and is even prescribed, somewhat ironically, in addiction treatment to reduce cravings and withdrawal symptoms.
Like almost all FDA-approved medications, when prescribed responsibly and taken as prescribed, gabapentinoids can offer great relief to those with these conditions. However, we all know that we live in a world in which not every patient takes medications as prescribed.
So, what's the danger?
Well, when used recreationally in this way, gabapentinoids are often taken in doses that are much greater than its typical legitimate therapeutic dose. Some users report taking up to 5,000 milligrams at once, which is nearly 2.5 times the usual prescribed daily dose of 1,800 mg. At those high doses, gabapentinoids, like many other anti-seizure medications, may produce exaggerated adverse effects, including, counterintuitively, seizures.
In this respect, this issue with gabapentinoids seem to represent a bit of a perfect storm. First, gabapentinoids are prescribed for pain, and since no health professional wants to see a patient in pain, this may foster a bit of leniency when it comes to prescribing practices and quantity limits for this drug.
Second, gabapentinoids are often prescribed off-label, so this may foster a bit of an “anything goes” and “let’s try it and see if it works” feeling among prescribers and their patients, encouraging experimentation with doses and dosing frequency.
Third, gabapentinoids are not a controlled substance, and thus, since the usual guidelines and restrictions for prescribing and dispensing large quantities of such substances don’t apply to gabapentinoids, this may foster less oversight of their use and fewer warnings for potential abuse.
Fourth, gabapentinoids are not an opioid and this may foster a relative, and false, sense of safety about their use and reduce concerns about its potential for abuse
Finally, since gabapentinoids are often prescribed in large quantities, are relatively inexpensive and widely available for both its prescribed use as well as for experimentation for abuse.
Recreational gabapentinoid abuse (with or without a prescription) needs to be on the radar of orthopaedists and neurologists due to their potential for producing not only additive adverse effects, but also serious drug-drug interactions with medications we commonly use during dental procedures, such as for conscious-sedation or the treatment of post-operative pain. Even when used for legitimate reasons, gabapentinoids taken in combination with opioids increase the risk of respiratory depression and death.
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Medical Review: This article is written by Dr Nishtha Mittal (Senior Health Content Editor at Zanskar Health) and has been medically reviewed by the medical team at Zanskar Health. This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.