‘Low risk’ pain pill caught up in drug epidemic
The story line sounds familiar: A popular pain drug becomes a new way to get high as prescribing by doctors soars.
But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments.
The drug, called gabapentin, is one of the most prescribed medications in the US, ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients.
Those same forces are changing the drugs that Americans abuse, according to experts.
“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.
While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications.
The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said commissioner Scott Gottlieb.
“One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”
Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.
People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.
Medical journal articles estimate that between 15 and 25 percent of opioid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks.
Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to US poison control centers show a stark rise in abuse and overdoses.
The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority.
In some parts of the US, the rise in gabapentin abuse has led to new restrictions and surveillance.
Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.
Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases.
Still, there is little consensus about the next steps, or even the scope of the problem.
Michael Polydefkis, a neurologist at John Hopkins University who primarily treats seniors for nerve pain, says he has never seen patients deliberately misuse gabapentin.
And given recent restrictions on opioids by hospitals, insurers and government authorities, many physicians are wary of limiting any other medicines that can help treat pain. The Centers for Disease Control and Prevention’s prescribing guidelines endorse gabapentin as a good choice for nerve pain.
But there are questions about how much is being prescribed for proven uses. Historically, the vast majority of prescriptions have been for uses not OK’d by the FDA as safe or effective.
“This drug was kind of unusual in that it was prescribed as a kind of miracle pill that could be used for anything,” said Dr Joseph Ross, a researcher at Yale University’s school of medicine.
In a recent Journal of the American Medical Association, he called for new studies of gabapentin’s real-world use.
While doctors can prescribe drugs for any use, drug makers can only market their products for uses approved by the FDA.