Gabapentin Co-Prescriptions Increase as Opioid Therapy Declines: Report

Overprescribing of gabapentin and opioid combinations could cause respiratory depression, which can lead to serious injuries and death.

A new study warns that while the number of long-term opioid prescriptions has dropped over the past 20 years, gabapentin and opioid co-prescribing has increased, raising concerns about overuse and respiratory depression risks.

Published in the Journal of the American Medical Association (JAMA) on April 8, the study found long-term opioid prescriptions declined by 24%, while co-prescribing of opioids and gabapentin rose to nearly 60%.

Gabapentin Risks

Gabapentinoids, including gabapentin and pregabalin, are anticonvulsant drugs approved by the U.S. Food and Drug Administration (FDA) to treat nerve pain and seizures. They are sold under brand names Neurontin and Lyrica.

Doctors often prescribe these medications “off-label” for anxiety, alcohol withdrawal, fibromyalgia, sciatica, shingles and hot flashes. However, there are widespread concerns about overuse and abuse, which may cause serious side effects.

Previous research has warned that gabapentin use is rising across the U.S., while a European study found that drugs like Lyrica and Neurontin may be contributing to a growing abuse epidemic. Experts suggest this trend may be partly driven by some states allowing nurse practitioners and physician assistants to prescribe gabapentin.

Gabapentin Co-Prescribing Study

For the new study, researchers from the University of Michigan School of Public Health, Ann Arbor, analyzed data from the IQVIA Longitudinal Prescription Database from 2015 through 2023. Led by Dr. Thuy D. Nguyen, the team looked at data from 92% of prescriptions from U.S. retail pharmacies.

The study found signs of progress in addressing the opioid epidemic, with long-term prescriptions for narcotic painkillers, defined as 90 days or more, declining from 5.6 million in 2015 to 4.2 million in 2023, a 24% decrease. However, the findings also show a concerning trend, as co-prescribing of opioids and gabapentin increased from 47% in 2015 to 59% in 2023.

The team identified this trend as disturbing, given recent warnings linking concurrent opioid and gabapentin use to an increased risk of respiratory depression. Also known as hypoventilation, the condition occurs when the body has excess carbon dioxide and low oxygen levels, which can lead to fatigue, confusion and death.

Long-term opioid prescriptions are typically given to patients dealing with chronic pain, but also carry the risk of misuse, overdose and addiction. Those are similar concerns researchers have regarding gabapentin use.

Researchers called for improved guidelines for managing chronic pain to ensure patients can safely take gabapentin when needed, without increasing their risk of abuse and addiction.

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