Drug-Related Deaths – the Gabapentinoid Connection

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Statistics on drug-related deaths in Scotland during 2015 & 2016 were released recently (June 2018). Similar figures for England & Wales were published in August 2017. The North East of England had the highest rate of drug-related deaths in England & Wales in 2016 (77.4 deaths per million population).

Both sets of figures show a steep increase in the detection of gabapentinoids (gabapentin or pregabalin) at post-mortem.

Across Great Britain as a whole, opioids, alcohol, antidepressants, benzodiazepines, cocaine and paracetamol are still the drugs most commonly detected at post-mortem following drug-related death, but the gabapentinoids are catching up – potentially because of use to enhance the euphoric effects of opioids.

In October 2017, the MHRA warned healthcare professionals of a risk of severe respiratory depression with gabapentin – particularly, but not exclusively, when used in combination with opioids. Healthcare professionals were advised to:

  • be aware of the risk of CNS depression, including severe respiratory depression, with gabapentin
  • consider whether dose adjustments might be necessary in patients at higher risk of respiratory depression, including elderly people, patients with compromised respiratory function, respiratory or neurological disease, or renal impairment, and patients taking other CNS depressants

Public Health England published related advice on the risk of misuse of gabapentinoids in 2014.