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Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland.
Br J Anaesth. 2020 08; 125(2):159-167.BJ

Abstract

BACKGROUND

Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ∼7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006-2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs.

METHODS

National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases.

RESULTS

From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 'recurrent users' (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08-2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription.

CONCLUSIONS

Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication.

Authors+Show Affiliations

School of Nursing & Midwifery, Robert Gordon University, Aberdeen, UK.Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.NHS Tayside Directorate of Public Health, King's Cross, Dundee, UK.NHS Tayside Directorate of Public Health, King's Cross, Dundee, UK.Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.Dundee Epidemiology and Biostatistics Unit, Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK. Electronic address: l.a.colvin@dundee.ac.uk.Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32571568

Citation

Torrance, Nicola, et al. "Trends in Gabapentinoid Prescribing, Co-prescribing of Opioids and Benzodiazepines, and Associated Deaths in Scotland." British Journal of Anaesthesia, vol. 125, no. 2, 2020, pp. 159-167.
Torrance N, Veluchamy A, Zhou Y, et al. Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. Br J Anaesth. 2020;125(2):159-167.
Torrance, N., Veluchamy, A., Zhou, Y., Fletcher, E. H., Moir, E., Hebert, H. L., Donnan, P. T., Watson, J., Colvin, L. A., & Smith, B. H. (2020). Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. British Journal of Anaesthesia, 125(2), 159-167. https://doi.org/10.1016/j.bja.2020.05.017
Torrance N, et al. Trends in Gabapentinoid Prescribing, Co-prescribing of Opioids and Benzodiazepines, and Associated Deaths in Scotland. Br J Anaesth. 2020;125(2):159-167. PubMed PMID: 32571568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland. AU - Torrance,Nicola, AU - Veluchamy,Abirami, AU - Zhou,Yiling, AU - Fletcher,Emma H, AU - Moir,Eilidh, AU - Hebert,Harry L, AU - Donnan,Peter T, AU - Watson,Jennifer, AU - Colvin,Lesley A, AU - Smith,Blair H, Y1 - 2020/06/19/ PY - 2020/02/19/received PY - 2020/05/01/revised PY - 2020/05/02/accepted PY - 2020/6/24/pubmed PY - 2020/8/18/medline PY - 2020/6/24/entrez KW - benzodiazepine KW - drug diversion KW - drug-related death KW - gabapentinoid KW - mortality KW - opioid KW - prescribing KW - social deprivation SP - 159 EP - 167 JF - British journal of anaesthesia JO - Br J Anaesth VL - 125 IS - 2 N2 - BACKGROUND: Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ∼7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006-2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs. METHODS: National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases. RESULTS: From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 'recurrent users' (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08-2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription. CONCLUSIONS: Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/32571568/Trends_in_gabapentinoid_prescribing_co_prescribing_of_opioids_and_benzodiazepines_and_associated_deaths_in_Scotland_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(20)30373-1 DB - PRIME DP - Unbound Medicine ER -