Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract
Gabapentin is a popular drug used for seizure disorders, postherpetic neuralgia, and many off-label indications. Several reports have emerged stating that gabapentin provides euphoric and dissociative properties and is often combined to potentiate the effect of other substances of abuse. It works by binding to voltage-gated calcium channels and decreasing neuronal excitability, although its mechanism for euphoria is not fully understood.

Recent literature supports the abuse potential of gabapentin. It has been shown to have similar patterns of abuse to other controlled substances including high daily does, use of a substantial proportion of drug supply by a small portion of users, and elevated rates of abuse in patients using both gabapentin and opioids. Concomitant use of gabapentin and opioids may increase the risk of harm and health-service utilization for respiratory depression. The combination is also associated with a significantly increased odds of opioid-related death.

There is a need for a call to action regarding the status of gabapentin in order to decrease the misuse, abuse, and potential patient harm associated with its use.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Identify the pharmacokinetic and pharmacodynamic properties that drive the misuse of gabapentin.
• Describe various ways that gabapentin misuse has presented in medicine
• Recognize the process needed to reclassify a drug as a controlled substance

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.. The assigned universal program number(s) is JA4008223-0000-23-075-H01-P .  This knowledge-based activity provides 1  contact hours of continuing pharmacy education credit.

Suggested Additional Reading:

1. Bonnet U, Scherbaum N. How addictive are gabapentin and pregabalin? A systematic review. Eur Neuropsychopharmacol. 2017;27(12):1185-1215. doi:10.1016/j.euroneuro.2017.08.430
2. Center for Drug Evaluation and Research. "Serious Breathing Difficulties with Gabapentin and Pregabalin." U.S. Food and Drug Administration. FDA, 19 Dec. 2019. Web. 02 Sept. 2020. Drug Overdose Deaths. (2020, March 19). Retrieved September 22, 2020, from https://www.cdc.gov/drugoverdose/data/statedeaths.html.
3. Drugs of Abuse: A DEA Resource Guide.; 2020.
4. Evoy KE, Morrison MD, Saklad SR. Abuse and Misuse of Pregabalin and Gabapentin. Drugs. 2017;77(4):403-426. doi:10.1007/s40265-017-0700-x
5. Gomes T, Juurlink DN, Antoniou T, Mamdani M, Paterson JM, Brink W Van Den. Gabapentin, opioids , and the risk of opioid- related death : A population-based nested case – control study. Published online 2017:1-13
6. Kimberly Reynolds, Robert Kaufman, Amanda Korenoski, Laura Fennimore, Joshua Shulman & Michael Lynch (2019): Trends in gabapentin and baclofen exposures reported to U.S. poison centers, Clinical Toxicology, DOI: 10.1080/15563650.2019.1687902
7. Neurontin [package insert]. New York, NY: Parke-Davis; 2011
8. Peckham AM, Evoy KE, Covvey JR, Ochs L, Fairman KA, Sclar DA. Predictors of Gabapentin Overuse With or Without Concomitant Opioids in a Commercially Insured U.S. Population. Pharmacotherapy. 2018;38(4):436-443. doi:10.1002/phar.2096
9. Peckham AM, Fairman KA, Sclar DA. All-Cause and Drug-Related Medical Events Associated with Overuse of Gabapentin and/or Opioid Medications: A Retrospective Cohort Analysis of a Commercially Insured US Population. Drug Saf. 2018;41(2):213-228. doi:10.1007/s40264-017-0595-1
10. Peckham AM, Fairman KA, Sclar DA. Prevalence of Gabapentin Abuse: Comparison with Agents with Known Abuse Potential in a Commercially Insured US Population. Clin Drug Investig. 2017;37(8):763-773. doi:10.1007/s40261-017-0530-3
11. "QuarterWatch™ (includes Data from Quarter 3, 2018) Focus on Three Psychoactive Drugs: Gabapentin, Pregabalin, and Pimavanserin." Institute For Safe Medication Practices. 27 Mar. 2019. Web. 02 Sept. 2020.
12. Schifano F. Misuse and abuse of pregabalin and gabapentin: cause for concern?. CNS Drugs. 2014;28(6):491-496. doi:10.1007/s40263-014-0164-4
13. Slavova, Svetla, et al. "Prevalence of gabapentin in drug overdose postmortem toxicology testing results." Drug and alcohol dependence 186 (2018): 80-85.
14. Smith, Rachel V., Jennifer R. Havens, and Sharon L. Walsh. "Gabapentin misuse, abuse and diversion: a systematic review." Addiction 111.7 (2016): 1160-1174.
15. Vickers-Smith R, Sun J, Charnigo RJ, Lofwall MR, Walsh SL, Havens JR. Gabapentin drug misuse signals: A pharmacovigilance assessment using the FDA adverse event reporting system. Drug Alcohol Depend. 2020;206(June 2019):107709. doi:10.1016/j.drugalcdep.2019.107709