Trends in gabapentin and baclofen exposures reported to U.S. poison centers

Abstract

Context: Prescriptions for nonopioid pharmacological therapies such as gabapentin and baclofen have been increasing. While gabapentin and baclofen are less likely than opioids to result in fatal overdose, they are each associated with dependence, misuse and adverse effects.Objective: The objective of this study is to evaluate and describe trends in adult exposures to gabapentin and baclofen reported to U.S. Poison Centers.Methods: This was a retrospective review of data collected by U.S. Poison Centers and entered in the National Poison Data System. We identified all cases of exposures to gabapentin (2013-2017) and baclofen (2014-2017) in patients aged 18 years and over. We then analyzed demographics, common co-ingestions, medical outcomes, and geographic distribution.Results: During the five-year period (2013-2017), there were 74,175 gabapentin exposures. All gabapentin exposures increased by 72.3%; isolated exposures increased by 67.1%; and isolated abuse/misuse exposures increased by 119.9%. During the four-year period (2014-2017), there were 15,397 baclofen exposures. All baclofen exposures increased by 36.2%; isolated exposures increased by 35.0%; and isolated abuse/misuse exposures increased by 31.7%. Co-ingestions of sedatives and opioids were common for both medications. Admissions to a health care facility were required in 16.7% of isolated gabapentin exposures, and 52.1% of isolated baclofen exposures. Intentional suspected suicide attempts with isolated gabapentin exposures increased by 80.5% over a five-year period; and increased by 43% for isolated baclofen exposures over a four-year period. All states saw increases in gabapentin exposures and most states saw increases in baclofen exposures, gabapentin misuse/abuse, and baclofen misuse/abuse.Conclusion: Gabapentin and baclofen misuse, toxicity, use in suicide attempts, and associated healthcare utilization among adults in the United States have significantly increased since 2013. Careful consideration and risk-benefit analysis should be employed when prescribing these medications.

Keywords: AAPCC; Baclofen; U.S. Poison Centers; drug misuse; drug overdose; gabapentin.