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)