Doctors prescribe more Gabapentin, a potential drug for abuse

Payments to doctors by pharmaceutical companies could prompt them to prescribe more expensive and branded versions of pain medication, gabapentin, a team of researchers said in the July 8 issue of JAMA Internal Medicine, and the increasing use of this drug suggests that it can be abused.

"We found that the more money the doctors received from the sector, the more likely they were to prescribe gabapentin, but more research is needed to understand how much gabapentin is used for addiction," says Dr. Principal author Greg Rhee, Assistant Professor of Medicine. public health at UConn Health.

Gabapentin is a fairly old drug, normally prescribed to control seizures and treat nerve pain. But consumption of this drug has tripled in the United States between 2002 and 2015, and Rhee and colleagues wanted to understand why. It is chemically similar to chemical gamma-aminobutyric acid of the brain, called GABA. Gabapentin appears to act in a manner similar to GABA by calming overexcited brain cells, which is why it is sometimes used to treat epilepsy. The way it relieves nervous pain is less well understood. But since it does not interact dangerously with other drugs or cause euphoria when taken at therapeutic doses, it is frequently prescribed for chronic pain. And its use has increased: prescription gabapentin and its analogues have increased from 1.2% of US adults in 2002 to 3.9% of US adults in 2015.

Rhee and colleagues at Yale University questioned whether payments to doctors by the pharmaceutical industry could affect the prescription. They reviewed the Open Payments and Medicare Part D prescribing databases for 2014-2016. Both databases are available through the Centers for Medicare and Medicaid services. Open Payments is a national program that requires drug manufacturers to disclose payments to physicians. The Medicare Part D prescriber database shows all the prescriptions made to people in Medicare Part D plans, and is searchable by physician and drug.

Gabapentin manufacturers paid $ 11.5 million to doctors between 2014 and 2016, Rhee and colleagues found. Payments were made to approximately 14% of physicians who prescribed any type of gabapentin during those years, mainly pain relievers and general practitioners, most of whom were located in the south and east of the country.

The researchers found that doctors who received payments from the industry were more likely to prescribe a branded version of Gabapentin such as Lyrica, Gralise or Horizant. These brand name drugs cost several hundred dollars for a month 's supply, compared to less than $ 20 for a month' s supply of the generic. In addition to the cost, the increase in prescriptions is worrying because Gabapentin is at risk of being abused. Although it is not reported that it is intoxicating when used in accordance with the instructions, gabapentin's search on internet sites about the drug experience such as erowid shows that taking it in larger amounts can cause a long lasting effect. Some long-term users who have taken gabapentin in therapeutic doses for legitimate medical reasons have also reported addiction. Rhee and her colleagues are concerned that the number of prescriptions tripled over the past 15 years indicates that Gabapentin is being diverted for recreational purposes, but more research is needed before to be able to determine.