* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Gabapentenoid Abuse - Indiana Pharmacists Alliance
Drug design wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Drug discovery wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Neuropsychopharmacology wikipedia , lookup
Pharmacognosy wikipedia , lookup
Neuropharmacology wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Prescription costs wikipedia , lookup
Drug interaction wikipedia , lookup
Prescription drug prices in the United States wikipedia , lookup
Polysubstance dependence wikipedia , lookup
Gabapentinoid Abuse: An Alarming Trend Kirk Evoy, PharmD PGY2 Ambulatory Care Resident St. Joseph Regional Medical Center The speaker has no actual or potential conflicts of interest to disclose The Current Issue Gabapentin(GBP) and pregabalin(PRG) abuse on the rise • PRG scripts ↑350% and GBP ↑150% in UK from 2007-2012 • 2010 list of new recreational psychoactive substances • Warning added to European PRG labeling • Growing black market • Increased reports of related fatalities Papazisis G, et al. Int J Clin Pharmacol Ther 2014. [Epub ahead of print] Schifano F. CNS Drugs 2014.;28:491-496 Spence D. BMJ 2013;347:f6747. Abuse Potential • Zacny et al. – 75 or 150 mg PRG +/- oxycodone in 16 non-drugabusing volunteers – No abuse liability with or without oxycodone • Pfizer study – 450 mg PRG dose in 15 recreational drug users – “Good drug effect”, “liking”, “high” Zacny et al. Pharacol Biochem Behav 2012;100:560-565. Papazisis G, et al. Int J Clin Pharmacol Ther 2014. [Epub ahead of print] ≈ 30 mg diazepam Perceived Effects of High Doses Both sedative and dissociative/psychedelic properties • High/stoned • Euphoria • Improved sociability • Marijuana or benzodiazepine (BZD) like relaxation • Amphetamine like trip • Sedation • Amnesia • “Zombie-like” effects Papazisis G, et al. Int J Clin Pharmacol Ther 2014. [Epub ahead of print]. Schifano F. CNS Drugs 2014.;28:491-496. Spence D. BMJ 2013;347:f6747. Pattern of Abuse • Kapil et al. – Frequency of misuse of GBP, PRG, baclofen • Weekly: 13% • Between weekly and monthly: 50% • Monthly: 37% • Schifano et al. – – – – – Study of web reports from 108 websites Doses >>> recommended max Tolerance develops and wears off rapidly Multiple routes of administration PRG superior to GBP Papazisis G, et al. Int J Clin Pharmacol Ther 2014. [Epub ahead of print]. Schifano F, et al. Psychotherapy and Psychosomatics 2011.;80:118-122. Schifano F. CNS Drugs 2014;28:491-496. Gahr M et al. Eur J Clin Pharmacol 2013;69:1335-1342. Dependence and Withdrawal • Cravings, self-titration, drug-seeking suggest dependence • BZD or alcohol-like withdrawals – Alleviated rapidly with resumption of gabapentenoid – Not relieved with BZDs • Multiple reports of relapse shortly after detox Filipetto F, et al. JAOA 2010;110:605-607. [Author not listed]. J Clin Psychiatry 2007;68;3:483-484. Hellwig TR, et al. Am J Health-Syst Pharm 2010;67:910-912. See S, et al. Ann Pharmacother 2011;45:e31. Victorri-Vigneau C, et al. Pharmacopsychiatry 2007;40:43-44 Kruszewksi SP, et al. Journal of Psychiatric Practice 2009;15:314-319. Gahr M, et al. J Addict Med 2013;7:147-149. Overdose • Reported doses up to 7.2g PRG and 90g GBP • Rarely sole cause of death – Completed suicide with 45g GBP – Survived suicide attempt with 90g GBP • Contributor in polysubstance abuse fatalities – Additive CNS depressant effects • Poisoning usually delayed response Baird C, et al. Eur Addict Res 2014;20:115-118 Hakkinen M, et al. Forensic Science International 2014;241:1-6. Middleton O. J Forensic Sci 2011;56:1373-1375. Schauer SG, et al. Military Medicine2013;178:119. [Abstract]. Typical Abuser • • • • • Young males Low income H/O recreational drug abuse Concomitant opiate use Consume very high gabapentenoid doses Boden R, et al. Eur J Clin Pharmacol 2014:70;197-204. Schifano F. CNS Drugs 2014;28:491-496 Gahr M et al. Eur J Clin Pharmacol 2013;69:1335-1342. Extent of the Problem • Swedish and German national registries point toward significant increase in abuse since 2008 • Growing trend, but number of patients still small • UK ED visit rates (per 100,000 population) GBP Alcohol Opioids BZDs 2004 2011 2.7 230.5 67.7 58.2 4.9 232.5 178.6 136.6 Papazisis G, et al. Int J Clin Pharmacol Ther 2014. [Epub ahead of print] Schifano F. CNS Drugs 2014;28:491-496 Hakkinen M, et al. Forensic Science International 2014;241:1-6. Schwan S, et al. Eur J Clin Pharmacol 2010;66:947-953 Howland RH. Journal of Psychosocial Nursing 2014;52:12-15. Next Time You Verify a Gabapentinoid, Consider… • Drug-seeking behaviors • History of/risk factors for abuse • Judicious dose escalation and prescription quantities • Avoid abrupt discontinuation • Appropriateness of off-label uses, especially in treating addiction • Urine drug screens • Alert physicians of abuse potential • Continued post-marketing surveillance is crucial Papazisis G, et al. Int J Clin Pharmacol Ther 2014. [Epub ahead of print] Smith BH. British Jounral of General Practice 2012: DOI:10.3399/bjgp12X653516. [Author not listed]. Rev Prescrire2012;32:116-118. Questions?