Gabapentin prescriptions rising among opioid users for pain relief

Gabapentin is widely prescribed off-label to treat pain. However, there are concerns about the proliferation of medical and non-medical use, and the potential increased risk of overdose death associated with concurrent opioid use. Despite these considerations, prescription gabapentin use among people who use unregulated drugs is uncharacterised in Canada. Therefore, we investigated trends and factors associated with being prescribed gabapentin for pain among community-recruited people who use opioids. Data were derived from three prospective cohort studies of people who use unregulated drugs in Vancouver, Canada, restricted to periods of opioid use (i.e., unregulated use, non-medical use, and/or opioid agonist treatment). We characterised factors associated with reporting gabapentin for pain between 2014 and 2020 using multivariable generalised estimating equations. Trends in self-reported prescription (2014-2020) and non-medical (2016-2024) gabapentin use were explored. Between 2014 and 2020, we included 10,999 observations from 2039 participants who had a baseline median age of 38 years and were 62.4% male and 57.5% White. Gabapentin prescriptions for pain were reported by 255 (12.5%) participants. Observations reporting a neuropathic pain diagnosis had 3.54 times the adjusted odds (95% CI 2.81, 4.46) of being prescribed gabapentin. From 2014 to 2020, the prevalence of gabapentin prescriptions rose from 5.4% to 7.8%. Non-medical gabapentin use remained low. Among people who use opioids, we observed an increase in gabapentin prescriptions for pain between 2014 and 2020. Gabapentin prescriptions were strongly associated with reporting a neuropathic pain diagnosis. Rates of non-medical gabapentin use were substantially lower than rates reported internationally.