Classification for gabapentin
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Classification and Misuse of Gabapentin: A Comprehensive Overview
Gabapentin Reclassification as a Controlled Substance
UK Reclassification Efforts
Gabapentin, along with pregabalin, has been reclassified as a class C controlled substance in the United Kingdom. This change, effective from April 2019, was driven by a significant increase in deaths associated with the misuse of these medications1 2 6. The reclassification aims to curb misuse and addiction by imposing stricter prescribing regulations, including the requirement for a physical prescriber signature for each prescription1.
International Concerns and Recommendations
The need for international classification of gabapentin as a controlled substance has been highlighted due to its rising misuse and associated fatalities. Various countries, including the United States, Germany, and Finland, have reported cases of gabapentin misuse, emphasizing the global nature of this issue4. The reclassification efforts in the UK serve as a model for other nations considering similar measures to prevent misuse and enhance patient safety1 2 6.
Gabapentin Misuse and Abuse
Prevalence and Motivations
Gabapentin misuse is a growing concern, with prevalence rates reported to be 1% in the general population, 40-65% among individuals with prescriptions, and 15-22% within populations of people who abuse opioids4. The motivations behind gabapentin misuse include recreational use, self-medication, and intentional self-harm. Misuse often occurs in combination with other substances such as opioids, benzodiazepines, and alcohol, particularly among individuals with a history of substance abuse4 7 8.
Effects and Risk Factors
Gabapentin misuse can produce subjective experiences similar to those of opioids, benzodiazepines, and psychedelics, even at doses within clinical recommendations4. The risk factors for misuse include a history of drug abuse and the availability of gabapentin as a non-controlled substance in many regions, which facilitates its diversion and non-medical use4 7.
Therapeutic Uses and Benefits
Treatment of Neuropathic Pain and Epilepsy
Gabapentin is primarily used for managing neuropathic pain and epilepsy. It has shown significant benefits in reducing pain and improving quality of life in patients with these conditions3. For instance, in children with severe dystonia, gabapentin significantly improved motor function and activities of daily living, highlighting its therapeutic potential beyond its primary indications3.
Off-Label Uses in Psychiatric and Substance Use Disorders
Gabapentin is also prescribed off-label for various psychiatric disorders and substance use disorders. It has demonstrated effectiveness in treating anxiety disorders, such as preoperative anxiety and social phobia, and in managing acute alcohol withdrawal syndrome by reducing cravings and improving abstinence rates5. However, its efficacy as a monotherapy for psychiatric conditions remains inconclusive, and more extensive clinical trials are needed to validate its use in these areas5.
Conclusion
The reclassification of gabapentin as a controlled substance in the UK underscores the growing concerns about its misuse and associated risks. While gabapentin offers significant therapeutic benefits for neuropathic pain, epilepsy, and certain psychiatric conditions, its potential for abuse necessitates stricter regulatory measures. International efforts to classify gabapentin as a controlled substance could help mitigate misuse and enhance patient safety globally.
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Most relevant research papers on this topic
Need for international classification of gabapentin as a controlled substance
International classification of gabapentin as a controlled substance is needed to address the increased risk of death associated with its misuse.
Rigorous JournalUK government to reclassify pregabalin and gabapentin after rise in deaths
Pregabalin and gabapentin could be reclassified as class C controlled substances after an increase in deaths linked to their use, following safety warnings and concerns about misuse and addiction.
Very Rigorous JournalGabapentin can significantly improve dystonia severity and quality of life in children.
Gabapentin significantly improves dystonia severity and daily living activities in children with severe dystonia, enhancing their quality of life.
Observational StudyGabapentin misuse, abuse and diversion: a systematic review.
Gabapentin misuse is prevalent globally, with substance abuse populations at a higher risk for misuse/abuse, primarily for recreational purposes and self-medication.
Systematic ReviewRigorous Journal
Highly CitedUse of Gabapentin in the Treatment of Substance Use and Psychiatric Disorders: A Systematic Review
Gabapentin shows potential in treating anxiety disorders and alcohol dependence, but more clinical trials are needed to confirm its effectiveness and safety.
Systematic ReviewPregabalin and gabapentin become controlled drugs to cut deaths from misuse
Pregabalin and gabapentin will become controlled drugs in the UK from next April to reduce deaths from their misuse, the government said.
Rigorous JournalA Call for Caution in Prescribing Gabapentin to Individuals With Concurrent Polysubstance Abuse: A Case Report.
Increased surveillance is needed for prescribing gabapentin to individuals with long-term polysubstance abuse, as it may lead to new onset dependence.
Case ReportAbuse and diversion of gabapentin among nonmedical prescription opioid users in Appalachian Kentucky.
Nonmedical prescription opioid users in Appalachian Kentucky are abusing and diversion gabapentin, potentially substituting it for other licit and illicit drugs.
Highly CitedA Clinical Overview of Off-label Use of Gabapentinoid Drugs.
Off-label use of gabapentinoids for pain is widespread, but clinicians should be aware of limited evidence and inform patients that potential benefits are uncertain for most off-label uses.
Literature ReviewRigorous JournalHighly CitedGabapentin for chronic neuropathic pain in adults.
Gabapentin at 1200 mg daily or greater provides moderate to substantial pain relief for adults with chronic neuropathic pain conditions like postherpetic neuralgia and painful diabetic neuropathy.
Systematic ReviewVery Rigorous JournalHighly Cited