4.2 Comparison to the literature
Much of the existing literature surrounding gabapentinoids focuses on the efficacy (35-37), increased prescribing trends and misuse (1-4, 6, 12, 13, 17, 18, 38) rather than on interventions to support deprescribing or clinical guideline recommendations. Whilst these drugs do work well for the conditions they have been approved for, a common theme emerging from more recent studies is a concern for the dramatic increase in gabapentinoid misuse and associated harms, as well as limited understanding of the use and efficacy of gabapentinoids in treating off-label conditions. (1-4, 6-8, 12, 13, 17, 18, 38) As awareness of these issues increase, deprescribing plays an important role in the clinical management of patients, and clinicians should not avoid deprescribing when the harms of the drug outweigh the benefits, particularly in at risk population groups. Existing evidence has found the most common ‘high-risk’ gabapentinoid misusers are more likely to be young males, often unemployed, concomitantly taking opioids, benzodiazepines, alcohol or illicit drugs and were likely to have been prescribed a gabapentinoid despite having history of a substance use disorder. (12, 18) Previous or current opioid abuse is the factor most commonly associated with higher-than-maximum-dose pregabalin prescriptions, and is well documented in studies of various settings, such as substance use disorder clinics, prison systems, and psychiatric wards. (18, 39) Finally, other reviews that have been conducted in areas of similar high-risk drug classes evaluating the effectiveness of deprescribing interventions have also encountered clinical heterogeneity and thus limited any conclusions from being made. (22, 40, 41) Studies have also concluded patients partaking in polypharmacy, particularly older patients, can also be classed as high-risk users due to oversedation contributing to an increased risk of falls. (42) Recently released guidelines from National Institute for Health and Care Excellence (NICE) in the UK detail the safe prescribing and withdrawal management of medications associated with dependence, including gabapentinoids, however do not provide an intervention to directly facilitate the safe tapering or ceasing of medication. (43)