Opioids Are Not the Only Pain Medications That Can Be Abused
This article, in a slightly edited form, first appeared on Pain News Network on December 7, 2019.
Contrary to popular opinion, opioids don’t cause substance abuse. Opioids certainly may be abused, but it is human biology itself that drives drug abuse.
We often get the message that any pain treatment would be better than using opioids. However, even non-opioids prescribed for pain can contribute to overdoses and suicides. The same genetic and environmental factors that cause opioid abuse can induce abuse of other drugs, too.
A New Wave of Drugs to Abuse
The number of opioid prescriptions has decreased due to public demand and political pressure. According to a study from the IQVIA Institute for Human Data Science titled, “Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023,” in 2018, there was a 17 percent decrease in the number of opioids prescribed.
We may have expected that to translate into fewer drug abuse problems. Instead, we have seen an increase in overdoses, hospitalizations, and suicides caused by non-opioids including gabapentin, methamphetamines, and muscle relaxants.
Less access to prescription opioids has driven some people in disabling pain to seek illegal alternative medications to manage their pain. That has led to a wave of use, and abuse, of drugs that doctors have not prescribed.
Between 2016 and 2017, the Centers for Disease Control (CDC) reported a nearly 47% increase in fentanyl-related deaths. Overdoses related to methamphetamine and cocaine have surged. According to Stateline, approximately “14,000 cocaine users and 10,000 meth users died in the United States in 2017, an increase of more than a third compared with 2016 and triple the number of deaths in 2012.” Deaths involving heroin have also spiked since 2010, according to the CDC.
Gabapentin and Baclofen
Prescription drugs, too, have fueled the negative statistics. Doctors have felt forced to taper or discontinue prescribed opioids. In an attempt to find alternatives for pain management, they have increased the number of gabapentin and baclofen prescriptions.
Medical Xpress reports that a new study published in Clinical Toxicology, “Trends in gabapentin and baclofen exposures reported to U.S. poison centers,” finds that use of non-opioid medications gabapentin and baclofen “shows ‘worrying’ increases in related suicide attempts and hospital admissions in US adults since 2013, coinciding with a decrease in opioid prescriptions.” The study analyzed more than 90,000 cases of exposure to gabapentin and baclofen, and discovered “large increases in misuse and toxicity—with isolated abuse instances of using gabapentin (from 2013 to 2017) rising by 119.9 percent, and baclofen (2014-2017) [rising by] 31.7 percent.”
Newsweek also commented on the “Trends in gabapentin and baclofen exposures reported to U.S. poison centers” study. The article pointed out, “Over the period the drugs were studied, suicides [sic] attempts after people took gabapentin rose by 80.5 percent, and by 43 percent for baclofen.”
Gabapentin is one of the most commonly prescribed drugs in the United States. It is prescribed for epilepsy, hot flashes, migraines, nerve damage, and more. It is also used to treat the symptoms of drug and alcohol detoxification, and to treat pain for patients at higher risk of addiction to opioids. Baclofen is a muscle relaxant that has also been substituted for opioids. Other non-opioid drugs are being increasingly prescribed as well.
Non-opioids have a role to play in pain management, but it is just as important to understand their potential dangers as it is to understand the risks of opioids. Kimberly Reynolds of the University of Pittsburgh, who led the study, hopes the information provided by her research will help doctors and patients “make decisions regarding the role of these medications in their pain management based upon an evidence-informed risk-benefit analysis.”
All Medications Have Risks
While we need effective alternatives to opioids, it is important to know that alternatives to opioids also have risks. That is unavoidable, because all medications carry potential benefits and consequences.
To decide whether a medication is appropriate for an individual, it is critical to determine whether the potential benefit outweighs potential harm. Gabapentin and baclofen are not bad drugs, but they are not harmless replacements for opioids, either.
No pain medication, whether it is an opioid or non-opioid, is right for everyone under all circumstances. The next time a physician or nurse practitioner suggests replacing an opioid with gabapentin, baclofen, or another medication, it would be appropriate to ask for a comparison of the risks and benefits to be fully informed.
Talking with your healthcare provider about your preference for a particular medication does not make you a drug seeker. It helps you become an informed patient.
Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.
You can find him on Twitter: @LynnRWebsterMD.
Dr. Webster,
Thank you again for your insight and posting of this new, most important message. My husband has been on Baclofen for many years, and both of us has been on Gabapentin off and on over many years as well. Given that I started on Opioids in 1992, with a continued rise in strength until I reached a point with both, the long-acting and short-acting opioids, that I was on the maximum the doctors feel they can give me. (Which I claim is not) In spite of the fact that I would fare much better on double the Oxycontin I’m on for long-acting, the mere mention of this to any of my doctors causes hyperventilation on their part. LOL Therefore, I’ve learned to just ‘make do’ and be undermedicated, being on that same RX regimen daily for well over two decades now with no changes. Instead of raising my Oxy dose, my doctors have tried adding other medications for pain that aren’t in the Opioid family, like Mobic specifically for Arthritis pain, which is now riddling my original area of pain. These added medications I’ve been prescribed, do help some with additional pain relief, but not as much as one would certainly wish for. I truly believe, If I presented today to a new doctor who had no idea that I was on anything, would really believe that I’m on nothing, given my daily pain levels averaging out at 7-9 on the “Pain Scale” while on the medications I currently take. But, I’m sure I sound like a ‘broken record’ with some of my other previous comments. Thank you for everything you do for Chronic Pain Patients far and wide Dr. Webster. You are our beacon of shining light in this insane Opioid fog we’re all living within now. I recently purchased your book and am most excited to get the time to start reading it! I’m sure it will be stellar! As always, my highest regards, Connie Martin
The utter stupidity of our government never ceases to amaze me. They actually think they are doctors now prescribing for a nation. Shows the utter disregard for the people they are suppose to SERVE, rather they think they know it all about everything. A doctor has spent so much time in education and service to their patients, and then here comes a force from Washington to tell them how to do their job. It appalls me to think these are the people in charge. We should rise against the government and remind them of their real jobs, to serve us and not their selves and friends so that they may make vast fortunes and live above everyone else. It is a travesty that people are killing themselves just to get out of constant pain, when all they need is the medicine that really works for the pain.
Dr. Webster,
As always, your voice is a song above the screeches of the anti opioid zealots. Gabapentin is everywhere. I’ve been prescribed it for everything from Pyoderma Gangrenosum to recurrent headaches. I wish what you said here were true:
“Talking with your healthcare provider about your preference for a particular medication does not make you a drug seeker. It helps you become an informed patient.”
Unfortunately in this climate, the mere mention of pain medication labels you a drug seeker, and in my experience, not only will most doctors not talk about, but their entire attitude towards you changes. These are indeed dark times, and now with the psychobabble of ‘it’s all in your head’ gaining steam, I fear we in pain are seeing another oncoming wave in our own personal opioid crisis. When will it end? WHERE will it end? Prohibition?
Thank you a thousand times for your compassion and advocacy.
Megan
I’m a retired RN, MSN who has had chronic pain (fibromyalgia, osteoarthritis, bil. hip bursitis, degenerative disc disease, osteopenia, etc., etc.) for over 3 decades. I was placed on hydrocodone at the beginning of my pain complaints because OTC meds did nothing, zero, zip, nada. I’m not proud of this, but I used to (back in the day) be able to out-drink most men & still be able to function adequately (I always had a designated drive on these rare occasions). My doctor told me I had a high pain tolerance & a high tolerance to analgesics, which now makes me a “high risk” opioid patient. The deal is that I’ve never abused drugs & the only laws I’ve ever considered breaking are occasional speeding & parking issues (I worked Downtown Dallas & had to show up for the courthouse or trial prep. on time during high traffic hours). I’ve always taken my pain meds as prescribed, had the same doctor for 3 decades, & the same pharmacy. My husband of 45 yrs is the same way. We’re boring people who obey 99% of laws & rules. Now that we have a “pain mgmt” doctor, we’re both feeling as if we’re being placed in a manufactured adversarial role w/ our physicians. Our pain meds have been halved from 80 mg of Norco daily to 40 mg, w/ the promise that we’ll be taken down to 30 mg & eventually -0- mg. These are not patient-centered “goals”; they’re doctor-centered. Simply put, the docs don’t want to lose their licenses, their office computers & documents being confiscated by the IRS or DEA, & their lives destroyed because of a few resistant chronic pain patients.
In regard to your article, we cannot take NSAIDs due to chronic kidney disease. Period. We have to be judicious in taking Tylenol due to frequent elevated liver panels. We have to watch what drugs interfere w/ our diabetes, & what drugs interact w/ other drugs. The doctors don’t watch these things unless it relates to their specialty, & they don’t seem to care about us unless it’s dealing w/ their specialty. Our PCPs throughout the years (insurance has us changing about every few years now) are too busy in their practice to look at us holistically, so we feel like we’re on our own to solve our medication & even many medical issues. If I was not a nurse, we’d be up the proverbial creek. There have been 5 missed diagnoses (including melanoma, severe spinal stenosis & degenerative disc disease at multiple levels, thyroid nodules, etc.). We have to INSIST that the doctors run tests that above & beyond their routine labwork. That’s when they discovered that indeed we had real medical issues that needed immediate attention. We are very skeptical of the medical profession & we do not trust most physicians.
I just had my 2nd major spine surgery 4 wks ago, w/ a fusion at 2 levels & placement of hardware. The surgeon won’t prescribe anymore opioids, even though I’m about to go into physical therapy for months, & my pain doc is talking about lowering my opiods down to 30 mg/day max. So……the docs in their vast wisdom have me on 600 mg of gabapentin 3x/day w/ tizanidine (muscle relaxant) 4 mg 3x/day. I have to supplement w/ NSAIDS throughout the day & pray that my kidneys hold steady. My nephrologist says that naproxen is better for my kidneys if I feel I MUST take NSAIDs (he says this w/ a big frown on his face).
I know I’m not as bad off as I’ve seen & read about other patients w/ chronic pain & conditions, & my heart so goes out to them. If I never go below a 6-7 on a 10-pt pain scale, & max at 8-9 for about 5 hrs/day, then I know that others are barely hanging on by the skin of their teeth. I anticipate the suicide rates will continue to grow. We don’t yet have adequate stats on why someone kills themselves related to chronic pain (or acute pain being mismanaged), because they often don’t leave suicide notes stating what led them to such an end to a precious life. They should NEVER have to be forced to choose. Doctors & patients need to come together to solve these issues, & the government needs to step aside except in the cases of illicit drug use or cartels, etc. “If it ain’t broke, don’t fix it.”
Parents need to take responsibility for adequately storing their medications, children need to be taught the seriousness of taking medicines (or anything) that don’t belong to them (stealing), & each medication that does pertain to them needs to be closely monitored. Mental illness, including addictions, need to be handled more aggressively by doctors, family, & friends. Leave the rest of us alone. It’s our life, our doctors, & our families’ business, not the government’s.