States starting to respond to gabapentin abuse
Thursday, August 03, 2017
Several states around the country have started to respond to a yet another growing problem: gabapentin abuse.
Over the past several years, a series of reports and studies have confirmed that patients are using high doses of gabapentin for recreational purposes. The same types of drug-seeking behaviors, euphoria and even withdrawal symptoms are exhibited that have traditionally been associated with controlled substances.
Gabapentin is not a federally controlled substance — yet. States, however, are not waiting and are enacting legislation to raise awareness of the problem in hopes of curbing overprescribing and diversion for nonmedical purposes.
Ohio, for example, began requiring pharmacies to report prescription sales of gabapentin through the Ohio Automated Rx Reporting System (OARRS).
The legislation, however, only requires "reporting" but does not mandate that doctors or pharmacists check the system prior to prescribing or dispensing of gabapentin. Rather, "Pharmacists and prescribers are expected to use professional judgment to determine the need to request an OARRS report prior to dispensing, prescribing or personally furnishing gabapentin."
Kentucky has taken it a little bit further in that they have reclassified gabapentin to be a Schedule V controlled substance. This change requires prescribers to have an active DEA license to prescribe gabapentin. Additionally, the rescheduling will prevent samples from being distributed, limit the number of refills and prevent physician assistants in Kentucky from prescribing it.
"I can see where using it in addition to other illicit drugs, especially opioids, can lead to overdoses just simply due to the fact that gabapentin will increase or enhance the high or euphoria that you get from an opioid," Sgt. Tod Young of the Warren County Drug Task Force in Kentucky said in a Daily News article.
Massachusetts has begun requiring the reporting of gabapentin prescription products to the state's Prescription Monitoring Program (PMP) as of Aug. 1. Such reporting must occur on a daily basis along with the reporting of other federally controlled substances.
Additionally, pharmacies will need to be able to collect a valid ID from patients picking up prescriptions for gabapentin by Aug. 1, 2018. Pharmacies able to comply with this requirement sooner are strongly urged by the Board of Pharmacy to do so.
States are making these changes because gabapentin prescribing appears to be on the rise. For example, an IMS report indicated that there were about 57 million prescriptions written for gabapentin in 2015 in the U.S. This is a 42 percent increase from just four years earlier. Another report noted that gabapentin-related visits to the emergency room increased fivefold from 2008 to 2011.
While it is encouraging to see us address this growing problem, observing the efforts to try and curb the problems with gabapentin addiction and abuse can be both saddening and frustrating as well. It is disappointing to see what appears to be an ever-widening problem with substance abuse going on in our nation.
Addiction is out of control. There were 62,000 overdose deaths in the U.S. in 2016, and reports suggest that the first six months of 2017 have gotten even worse.
Pharmacists like myself have watched as politicians, public health and pharmacy organizations have desperately sought to slow down our substance abuse problem through legislation.
Opana ER, the long-acting opioid by Endo, is now being withdrawn from the market due to extensive evidence of abuse and under pressure from the FDA. We've seen drug-schedule changes to prescription analgesics like hydrocodone and tramadol. We have expanded prescription monitoring programs (PMP) across the country.
But it feels like we are simply rearranging the deck chairs on a sinking ship. The problem keeps getting worse.
Pharmacists nevertheless must remain vigilant in our efforts to ensure the medication we dispense is being used for a legitimate medical purpose. And now we're looking more closely at gabapentin.
Early refill patterns, the use of multiple prescribers and pharmacies, and combinations of gabapentin with opioids or benzodiazepines may be warning signs of addiction. A word of caution and compassion from a trusted pharmacist may be the first step in a patient's road to recovery.
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