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Update from the CDC: Gabapentin involvement in overdose deaths

Gabapentin likely contributed to 5% of deaths from overdose with any substance in 2019 to 2020, according to a new study. 

Gabapentin, an anticonvulsant, is the seventh-most prescribed drug in the US, with 69 million prescriptions written in 2019, according to the authors of the study, Christine Mattson (from the Division of Overdose Prevention at the Centers for Disease Control and Prevention [CDC]), Farnaz Chowdhury, and Thomas Gibson. Gabapentin is generally safe when used by itself but can be risky when combined with other drugs, especially opioids, where it can potentiate respiratory depression.

To understand the role of gabapentin in overdoses, the authors drew on data from the State Unintentional Drug Overdose Reporting System (SUDORS), analyzing data from 2019 to 2020 in 23 states and the District of Columbia. During that period, there were 62,652 overdose deaths, of which 58,362 had documented toxicology results. Of these, gabapentin was found in 9.7%. Gabapentin was judged to contribute to overdose death in 52.3% of those deaths—or 5.0% of the total deaths from overdose.

Individuals who died from a gabapentin-related overdose were most likely to be non-Hispanic white (83%), between the ages of 35 and 54 years (52%), with men and women equally affected. Deaths hit a peak in the second quarter of 2020, but remained high through the rest of the study period. About 90% of deaths co-involved an opioid, either illicit (approximately 70%) or prescription (approximately 35%). Involvement of illicitly manufactured fentanyls rose from about 50% at the start of the study period to almost 70% by the end of it.

Because gabapentin testing is not uniformly performed in overdose cases, “overdose deaths involving gabapentin or with gabapentin detected are likely underestimated,” the authors noted. “Despite the lack of uniform testing, gabapentin detection and involvement in overdose deaths increased during 2019–2020. These findings highlight the dangers of polysubstance use, particularly co-use of gabapentin and illicit opioids. Persons who use illicit opioids with gabapentin should be educated about the increased risk for respiratory depression and death.”

Mattson CL, Chowdhury F, Gilson TP. Notes from the field: Trends in gabapentin detection and involvement in drug overdose deaths — 23 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep 2022;71:664–666.