June 22, 2022

Gabapentin-Involved Overdose Deaths on the Rise

The Centers for Disease Control and Prevention (CDC) recently published a new Morbidity and Mortality Report, noting an increasing trend of gabapentin overdoses.

Gabapentin is an anticonvulsant medication FDA-approved to treat pain resulting from shingles or diabetes, as well as certain epileptic conditions. Gabapentin has seen off-label use for the treatment of neuropathic pain, as well as certain non-neuropathic pain, particularly as opioid utilization has decreased.

Gabapentin prescribing has steadily increased in recent years, and in 2019, 69 million gabapentin prescriptions were dispensed in the United States, making it the seventh most commonly prescribed medication nationally.

While gabapentin is not frequently associated with overdose on its own, it is a controlled substance and when used with other central nervous system depressants such as opioids, there is risk for respiratory depression, potentially resulting in death.

Data indicate gabapentin exposures associated with intentional abuse, misuse, or unknown exposures reported to U.S. poison centers increased by 104% from 2013 to 2017. To assess quarterly trends in gabapentin-involved overdose deaths of unintentional or undetermined intent during 2019–2020, the CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS) in 23 states and the District of Columbia.

Data on 62,652 overdose deaths that occurred during 2019–2020 found that among 58,362 deaths with documented toxicology results, a total of 5,687 (9.7%) had gabapentin detected on postmortem toxicology. Gabapentin-involved deaths occurred in 2,975 of 5,687 decedents (52.3%) with a positive gabapentin test result.

Most gabapentin-involved overdose deaths occurred among non-Hispanic White persons (83.2%) and persons aged 35–54 years (52.2%). Gabapentin-involved overdose deaths occurred with approximately equal frequency among men (49.7%) and women (50.3%).

During the second quarter of 2020, the number of deaths reported with gabapentin detected (959) approximately doubled compared with the first quarter of 2019 (449). In the fourth quarter of 2020, 801 deaths with gabapentin detected occurred. Among deaths where gabapentin was detected, 49.4% were gabapentin-involved during the first quarter of 2019. This percentage increased to 55.1% during the fourth quarter of 2020.

The percentage of opioid-involved deaths with gabapentin detected remained consistently high, ranging from 85% to 90%. Illicit opioid-involved deaths accounted for 56.8% of overdose deaths with gabapentin detected in the first quarter of 2019 and 69.2% in the last quarter of 2020. This increase was largely driven by illicitly manufactured fentanyl and fentanyl analogs.

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