Calls to poison control centers for gabapentin, baclofen increased in recent years
The increase in exposures to and misuse of these medications in the U.S. may represent an unintended consequence of recent reductions in opioid prescribing for pain management, study authors said.
Gabapentin and baclofen misuse, use in suicide attempts, and associated hospital admissions among U.S. adults have increased since 2013, a retrospective study found.
Researchers assessed trends in adult exposures to gabapentin and baclofen reported to U.S. poison control centers and entered in the National Poison Data System. They analyzed demographics, common co-ingestions, medical outcomes, and geographic distribution. The study analyzed exposures to the two drugs with or without co-exposure to other compounds. Isolated exposures were defined as those only involving gabapentin or baclofen. Results were published on Dec. 1 by Clinical Toxicology.
There were 74,175 gabapentin exposures from 2013 to 2017 (mean age, 44.6 years; 59.7% female). Gabapentin exposure increased by 72.3% overall during this period, while isolated exposures increased by 67.1% and isolated abuse/misuse exposures increased by 119.9%. There were 15,397 baclofen exposures from 2014 to 2017 (mean age, 39.9 years; 63.4% female). Baclofen exposure increased by 36.2% overall during this period, while isolated exposures increased by 35.0% and isolated abuse/misuse exposures increased by 31.7%.
Co-ingestions of sedatives and opioids were common for both medications. Admission to a health care facility was required in 16.7% of isolated gabapentin exposures and 52.2% of isolated baclofen exposures. Critical care unit admission was required in a majority of these cases (53.9% for gabapentin and 73.5% for baclofen). Intentional suspected suicide attempts with isolated gabapentin exposures increased by 80.5% over a five-year period and by 43.0% for isolated baclofen exposures over a four-year period. All states saw increases in gabapentin exposures, and most saw increases in baclofen exposures, gabapentin misuse/abuse, and baclofen misuse/abuse.
Among other limitations, the study relied on voluntarily reported exposure cases and may not represent the total incidence of national exposures, and confirmatory testing for the presence of gabapentin, baclofen, and/or additional co-ingestions was not consistently documented, the authors noted. Increased exposures to gabapentin and baclofen coincide with reductions in opioid prescribing and may represent an unintended consequence of the ongoing need for effective pain management and migration away from opioid use, they concluded.
“While the risks of opioids have been widely publicized, medication alternatives to opioids also carry risks that need to be better understood, described, and disseminated so that providers and patients can make decisions regarding the role of these medications in their pain management based upon an evidence-informed risk-benefit analysis,” the authors wrote.