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What’s New in the Patient Safety World

June 2022

Gabapentin and Overdoses



Gabapentinoids have become widely used in pain management. In fact, they are among the top 20 most prescribed medications in the US. We used to consider them as relatively safe drugs, perhaps one of the factors contributing to their widespread use. But, over the past 5 years, there have been many reports that have raised red flags about gabapentinoids, particularly when they are used in conjunction with opioids.


Overdose deaths due to gabapentinoids alone are quite rare. However, gabapentinoids are being found in more and more fatal overdose cases. A new CDC report (Mattson 2022) has found that gabapentin-involved overdose deaths have increased in recent years. In almost 60,000 fatal overdoses analyzed, 9.7% had detectable gabapentin on toxicology testing, and 52.3% of those were labeled as “gabapentin-involved” deaths. Opioids, whether prescription or street drugs, were involved in 85-90% of cases. Illicit fentanyl has increased recently as a cause of these overdose deaths.


CDC says these findings highlight the dangers of polysubstance use, particularly co-use of gabapentin and illicit opioids. They recommend that persons who use illicit opioids with gabapentin should be educated about the increased risk for respiratory depression and death.



Some of our prior columns on safety issues with gabapentinoids:







Mattson CL, Chowdhury F, Gilson TP. Notes from the Field: Trends in gabapentin detection and involvement in drug overdose deaths — 23 states and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep 2022; 71: 664-666




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