Conference Coverage

Beware nonopiate meds with high street value


 

EXPERT ANALYSIS FROM ACP INTERNAL MEDICINE

– Gabapentin heads the short list of prescription drugs other than opioids and benzodiazepines with substantial black-market abuse potential, according to Alexander Y. Walley, MD.

“At least in Massachusetts, where I see patients, these are the pills that people are using and trading on the street. Your part of the country might have others,” noted Dr. Walley, director of the addiction medicine fellowship program at Boston Medical Center.

Dr. Alexander Y. Walley a general internist at Boston University and director of the addiction medicine fellowship program at Boston Medical Center Bruce Jancin/MDedge News

Dr. Alexander Y. Walley

Topping the list are the gabapentinoids: gabapentin and pregabalin. These two are the subject of much of the latest research on prescription drug misuse. Other prescription drugs commonly used as street pills are promethazine, clonidine, stimulants for ADHD, and bupropion.

“I’m not telling you to never prescribe these medications – they are clinically indicated in certain cases and should certainly be used,” Dr. Walley said at the annual meeting of the American College of Physicians. “But now that you know that they might be misused, you should use safeguards.

“A lot of these medications – gabapentin is an example – are a problem primarily in people with other substance use disorders,” he added. “That’s really where I think you need to have the greatest caution.”

Gabapentinoids

Gabapentin and pregabalin are not addictive in the sense that it’s easy to get laboratory animals or healthy volunteers to self-administer them. However, gabapentinoid use disorder is extremely common among people with opioid use disorder, who report that the combination boosts the euphoric effects of opioids and reduces opioid withdrawal symptoms without causing side effects.

Indeed, a recent systematic review of 106 studies found that gabapentinoid use disorder was present in up to 26% of opioid users (Eur Neuropsychopharmacol. 2017 Dec;27[12]:1185-1215).

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