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Gabapentin and pregabalin are commonly prescribed medications for the treatment of seizure disorders, neuropathic pain (eg, postherpetic neuralgia), fibromyalgia, anxiety, post-traumatic stress disorder, and restless leg syndrome. Gabapentinoids are commonly ingested in self-harm attempts and often misused for their sedative and euphoric To assess quarterly trends in gabapentin-involved overdose deaths of unintentional or undetermined intent during 2019–2020, CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS) in 23 states and the District of Columbia.** A recent report from the US Centers for Disease Control and Prevention (CDC) found that between 2019 and 2020, coroners and medical examiners detected gabapentin in 5687, or almost 10%, of the 58 362 overdose deaths in 23 states and the District of Columbia that had available toxicology results. Therefore, overdose deaths due to opioids alone or due to the combined sedating effects of opioids and gabapentin would be identified in this database. These data are used regularly to study opioid overdose deaths in Ontario [4,21–23]. A gabapentin overdose is rare, but it is possible. The likelihood of an overdose increases when you abuse gabapentin with other drugs like opioids and alcohol. If you or someone you know is experiencing a gabapentin overdose, seek medical help immediately. Despite higher opioid-involved overdose death rates overall (Hedegaard et al., 2022), men have typically had lower rates of overdoses deaths involving opioids and gabapentinoids/Z-drugs than women. This disparity disappeared in 2020, further evidence of the fentanyl crisis explaining trends in these deaths given the fentanyl crisis’s Because gabapentin and opioids are both commonly prescribed for pain, the likelihood of co-prescription is high. However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental opioid-related death in patients receiving opioids. Only 19 deaths involving gabapentin were identified as possible suicides during the five-year study period, but there were thousands of gabapentin-related calls each year coded as attempted suicides — including over 10,000 calls in 2017 alone. 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. Postmortem toxicology tests detected gabapentin in almost 1 in 10 US overdose deaths between 2019 and 2020. In about half of the cases, a medical examiner or coroner ruled the drug was a cause of the death, according to a report from the CDC’s Division of Overdose Prevention. Within the last two decades, drug-related overdose deaths have quadrupled in the United States. 1-4 In 2019 alone, these overdoses accounted for over 70,000 deaths―more than half of which involved an opioid. 1, 2 Concomitant utilization of CNS depressants such as benzodiazepines with opioids is a known risk factor for respiratory depression Most gabapentin-involved overdose deaths, 83.2%, occurred among non-Hispanic White persons. More than half of gabapentin-involved deaths, 52.2%, occurred among persons aged 35 to 54 years. Gabapentin-involved overdose deaths occurred with nearly equal frequency among men and women. With the increase in opioid misuse and overdose-related deaths nationwide, health care providers are encouraged to find a nonopioid analgesic. Application of gabapentin for treatment is not without side-effects, especially in patients with an undiagnosed psychiatric disorder or who are at risk of suicidality. The first death with gabapentin detected occurred in 2004, and with pregabalin in 2006. The number of deaths following gabapentinoid use has increased (Figure 1A): 8.9% of all NPSAD reports in 2014 detected a gabapentinoid, rising to 32.3% in 2020. In our series, we review 104 cases of decedents who tested positive for gabapentin in postmortem blood samples and an additional 53 nonfatal cases of motor vehicle drivers suspected of driving under the influence. In 47.1% of the fatality cases, gabapentin was directly involved in death. Gabapentin was found at very high frequency in accidental mixed drug fatalities. Gabapentin concentrations were generally within the normal therapeutic range (2-20 μg/mL). It is unknown whether a synergistic effect with opioids may contribute to central respiratory depression. The State Unintentional Drug Overdose Reporting System statistics from 23 states and the District of Columbia now indicate that GBP may be playing a larger role in overdose deaths in the United States. About 10% of all instances with test results available, or 5687 overdose deaths between 2019 and 2020, had toxicology tests that revealed GBP use. Gabapentin detection and involvement in overdose deaths increased during 2019 and 2020, according to a study published in the CDC's Morbidity and Mortality Weekly Report. Signs and Symptoms of Gabapentin Overdose. A gabapentin overdose can be dangerous or even deadly. Some factors can increase the risk of a fatal overdose, such as taking several substances at once. Gabapentin overdose symptoms can include: Drowsiness; Movement difficulties; Dizziness; Nausea or vomiting; Rapid heartbeat; Low blood pressure Illicit opioid-involved deaths accounted for 56.8% of overdose deaths with gabapentin detected in the first quarter of 2019 and 69.2% in the last quarter of 2020; this increase was largely driven by illicitly manufactured fentanyl and fentanyl analogs.
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