PM&R News   •   April 2018

Another one bites the dust! Opioid related deaths are increasing substantially throughout the United States.  A lot of resources are being put into studying this increase and how to improve pain control without opioids. Gabapentin has been a common drug used to treat pain while trying to decrease opioid burden due to its’ safe side effect profile. A recent study, took a look at the co-use of gabapentin while on opioids and the risk of opioid related overdose.  The study looked at individuals who died of an opioid related cause and compared them to 4 controls. They evaluated for gabapentin use in the 120 days preceding the death to determine if an association existed. The analysis found co-gabapentin and opioid use was associated with a nearly 60% increase in the odds of opioid related death. This was not seen in co-use of opioids and NSAIDs. Due to this study and others showing similar trends, Kentucky has now made gabapentin a controlled substance and other states are likely to follow.  A drug that we once thought had a minimal side effect profile and thought to help with opioid tapers, actually carries a substantial risk. Furthermore, gabapentin has had increasing street value as pills near $1.00 a piece. Physicians should exercise caution before prescribing gabapentin and determine the risks and benefits for your particular patient.