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Prevalence of and Factors Associated with Gabapentinoid Use and Misuse Among Texas Medicaid Recipients.
Clin Drug Investig. 2021 Mar; 41(3):245-253.CD

Abstract

BACKGROUND AND OBJECTIVES

Gabapentin and pregabalin have been considered relatively safe opioid-sparing adjuncts for pain management. However, rising prescribing trends, presence of gabapentinoids in opioid-related overdoses, and the growing body of evidence regarding gabapentinoid misuse and abuse, have caused gabapentinoids to emerge as a drug class of public health concern. This study aimed to assess the prevalence of, and factors associated with gabapentinoid use and misuse.

METHODS

This retrospective study of Texas Medicaid data from 1/1/2012 to 30/8/2016 included patients aged 18-63 years at index date, with ≥ 1 gabapentinoid prescription, and continuously enrolled 6 months pre-index and 12 months post-index. Gabapentinoid misuse was defined as ≥ 3 claims exceeding daily doses of 3600 mg for gabapentin and 600 mg for pregabalin. Age, gender, concurrent opioid use, neuropathic pain diagnoses and gabapentinoid type were independent variables. Descriptive and inferential statistics were used.

RESULTS

Of included subjects (N = 39,000), 0.2% (N = 81) met study criteria for gabapentinoid misuse. Overall, the majority (76.4%) of gabapentinoid users were aged 41-63 years with a mean ± SD age of 48.2 ± 10.7 years. Those patients meeting the study criteria for gabapentinoid misuse were significantly younger (45.1 ± 11.0 vs 48.2 ± 10.7, p = 0.0084). Majority of the study sample was female (68.1%). However, a significantly higher proportion of males met the study criteria for gabapentinoid misuse compared to females (0.3% vs 0.2%, p = 0.0079). Approximately one-half (51.9%) of the study sample had neuropathic pain, and gabapentinoid misuse was significantly higher in neuropathic pain patients compared to those without neuropathic pain (0.3% vs 0.1%, p = 0.0078). Over three-quarters (77.4%) of patients were using gabapentin; however, gabapentinoid misuse was significantly higher among pregabalin users (0.4% vs 0.2%, p = 0.0003). Approximately 20% (17.3%) of gabapentinoid users had ≥ 90 days of concurrent opioid use. However, there was no significant difference in gabapentinoid misuse among patients with concurrent opioid use compared to patients without (0.3% vs 0.2%, p = 0.1440). Factors significantly associated with misuse included: male sex (odds ratio [OR] 0.486; 95% confidence interval [CI] 0.313-0.756; p = 0.0013); neuropathic pain (OR 2.065; 95% CI 1.289-3.308; p = 0.0026); and pregabalin versus gabapentin use (OR 2.337, 95% CI 1.492-3.661; p = 0.0002). Concurrent opioid use was not significantly associated with gabapentinoid misuse (OR 1.542, 95% CI 0.920-2.586; p = 0.1006).

CONCLUSION

Prevalence of gabapentinoid misuse was low (0.2%) among Texas Medicaid recipients. Younger age, male gender, neuropathic pain diagnosis and pregabalin use were significantly associated with higher levels of gabapentinoid misuse.

Authors+Show Affiliations

Division of Health Outcomes, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA. eaibiloye@utexas.edu.Division of Health Outcomes, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.Division of Health Outcomes, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.Division of Health Outcomes, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, San Antonio, Texas, USA. University Health System, San Antonio, Texas, USA.Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts, USA. Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33580482

Citation

Ibiloye, Elizabeth A., et al. "Prevalence of and Factors Associated With Gabapentinoid Use and Misuse Among Texas Medicaid Recipients." Clinical Drug Investigation, vol. 41, no. 3, 2021, pp. 245-253.
Ibiloye EA, Barner JC, Lawson KA, et al. Prevalence of and Factors Associated with Gabapentinoid Use and Misuse Among Texas Medicaid Recipients. Clin Drug Investig. 2021;41(3):245-253.
Ibiloye, E. A., Barner, J. C., Lawson, K. A., Rascati, K. L., Evoy, K. E., & Peckham, A. M. (2021). Prevalence of and Factors Associated with Gabapentinoid Use and Misuse Among Texas Medicaid Recipients. Clinical Drug Investigation, 41(3), 245-253. https://doi.org/10.1007/s40261-021-01009-6
Ibiloye EA, et al. Prevalence of and Factors Associated With Gabapentinoid Use and Misuse Among Texas Medicaid Recipients. Clin Drug Investig. 2021;41(3):245-253. PubMed PMID: 33580482.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of and Factors Associated with Gabapentinoid Use and Misuse Among Texas Medicaid Recipients. AU - Ibiloye,Elizabeth A, AU - Barner,Jamie C, AU - Lawson,Kenneth A, AU - Rascati,Karen L, AU - Evoy,Kirk E, AU - Peckham,Alyssa M, Y1 - 2021/02/12/ PY - 2021/01/27/accepted PY - 2021/2/14/pubmed PY - 2021/5/5/medline PY - 2021/2/13/entrez SP - 245 EP - 253 JF - Clinical drug investigation JO - Clin Drug Investig VL - 41 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Gabapentin and pregabalin have been considered relatively safe opioid-sparing adjuncts for pain management. However, rising prescribing trends, presence of gabapentinoids in opioid-related overdoses, and the growing body of evidence regarding gabapentinoid misuse and abuse, have caused gabapentinoids to emerge as a drug class of public health concern. This study aimed to assess the prevalence of, and factors associated with gabapentinoid use and misuse. METHODS: This retrospective study of Texas Medicaid data from 1/1/2012 to 30/8/2016 included patients aged 18-63 years at index date, with ≥ 1 gabapentinoid prescription, and continuously enrolled 6 months pre-index and 12 months post-index. Gabapentinoid misuse was defined as ≥ 3 claims exceeding daily doses of 3600 mg for gabapentin and 600 mg for pregabalin. Age, gender, concurrent opioid use, neuropathic pain diagnoses and gabapentinoid type were independent variables. Descriptive and inferential statistics were used. RESULTS: Of included subjects (N = 39,000), 0.2% (N = 81) met study criteria for gabapentinoid misuse. Overall, the majority (76.4%) of gabapentinoid users were aged 41-63 years with a mean ± SD age of 48.2 ± 10.7 years. Those patients meeting the study criteria for gabapentinoid misuse were significantly younger (45.1 ± 11.0 vs 48.2 ± 10.7, p = 0.0084). Majority of the study sample was female (68.1%). However, a significantly higher proportion of males met the study criteria for gabapentinoid misuse compared to females (0.3% vs 0.2%, p = 0.0079). Approximately one-half (51.9%) of the study sample had neuropathic pain, and gabapentinoid misuse was significantly higher in neuropathic pain patients compared to those without neuropathic pain (0.3% vs 0.1%, p = 0.0078). Over three-quarters (77.4%) of patients were using gabapentin; however, gabapentinoid misuse was significantly higher among pregabalin users (0.4% vs 0.2%, p = 0.0003). Approximately 20% (17.3%) of gabapentinoid users had ≥ 90 days of concurrent opioid use. However, there was no significant difference in gabapentinoid misuse among patients with concurrent opioid use compared to patients without (0.3% vs 0.2%, p = 0.1440). Factors significantly associated with misuse included: male sex (odds ratio [OR] 0.486; 95% confidence interval [CI] 0.313-0.756; p = 0.0013); neuropathic pain (OR 2.065; 95% CI 1.289-3.308; p = 0.0026); and pregabalin versus gabapentin use (OR 2.337, 95% CI 1.492-3.661; p = 0.0002). Concurrent opioid use was not significantly associated with gabapentinoid misuse (OR 1.542, 95% CI 0.920-2.586; p = 0.1006). CONCLUSION: Prevalence of gabapentinoid misuse was low (0.2%) among Texas Medicaid recipients. Younger age, male gender, neuropathic pain diagnosis and pregabalin use were significantly associated with higher levels of gabapentinoid misuse. SN - 1179-1918 UR - https://www.unboundmedicine.com/medline/citation/33580482/Prevalence_of_and_Factors_Associated_with_Gabapentinoid_Use_and_Misuse_Among_Texas_Medicaid_Recipients_ L2 - https://dx.doi.org/10.1007/s40261-021-01009-6 DB - PRIME DP - Unbound Medicine ER -