An Examination of Concomitant Non-Medical Use of Gabapentin and Opioids.

项目摘要/摘要 加巴喷丁在神经学、精神病学和初级保健中被广泛用于治疗癫痫。 和神经痛，以及在阿片类药物使用障碍(OUD)治疗期间的标签外，以减轻戒断 症状，控制疼痛，并解决患者的焦虑。从2002年到2015年，加巴喷丁的处方增加了两倍， 近年来，与加巴喷丁有关的阿片类药物过量也有所增加。因此，从2017年开始， 根据国家管制物质法，多个州将加巴喷丁重新归类为附表五。2019年， 美国食品和药物管理局要求加巴喷丁的标签更改，其中包括潜在的警告 与阿片类药物一起使用时的呼吸抑制。记录非医疗用途的有限报告(NMU) 加巴喷丁，特别是在阿片类药物使用者和接受药物辅助治疗(MAT)的个人中 为了奥德。加巴喷丁是一种非医用药物，用于增强阿片类药物的兴奋作用，包括地塞米松 丁丙诺啡和美沙酮的药物，以及自我治疗乌德症状。除了这些简短的 有报道称，缺乏对加巴喷丁和阿片类药物伴发的NMU的系统研究。在 同时，研究记录了在治疗过程中对个体使用加巴喷丁的治疗益处。 治疗药物使用障碍。研究表明，每天服用加巴喷丁的个人报告说 戒断症状减轻和加巴喷丁与美沙酮联合治疗阿片类药物效果良好 解毒。鉴于越来越多的关于加巴喷丁NMU的报告，特别是NMU与阿片类药物和 MAT；处方加巴喷丁在治疗对象中的接受度；以及缺乏系统数据 检查伴随的加巴喷丁和阿片类药物的NMU，拟议的探索性R21研究试图 研究一下这一现象。这项研究将利用社会生态学理论驱动的设计来调查 伴随NMU的动机、性别和种族/民族差异，以及MAT和处方药的历史 加巴喷丁。将实现以下具体目标：1)评估人口、社会文化和 三个社会生态领域的心理社会特征(个人内部、人际关系和 影响伴随的加巴喷丁/阿片类药物的NMU；以及给药途径、模式 获得、结果(n=150)；2)决策的构建和民族志决策模型(EDM) 启动加巴喷丁/阿片类药物的伴随NMU(n=60)；3)联合检测加巴喷丁的NMU 包括动机、效果和后果(n=30)。样本将在以下地点收集 接受OUD治疗的个人，将包括大致相同数量的男性和女性，如 以及黑人、西班牙裔和白人。这项研究将把NIDA战略计划的目标1提前 确定加巴喷丁伴随NMU的环境、行为和社会原因及后果 和阿片类药物，它将为OUD治疗提供者和处方者提供信息，并帮助开发 预防和干预策略。本探索性研究在EDM方法论的运用上具有创新性。

Project Summary/Abstract Gabapentin is widely prescribed in neurology, psychiatry, and primary healthcare for the treatment of epilepsy and neuralgia, as well as off- label during treatment for opioid use disorder (OUD) to mitigate withdrawal symptoms, manage pain, and address patient anxiety. From 2002-2015, prescriptions for gabapentin tripled, and gabapentin-involved opioid overdoses have also increased in recent years. As a result, starting in 2017, multiple states reclassified gabapentin to Schedule V under state-controlled substances laws. In 2019, the Food and Drug Administration required labeling changes for gabapentin that included a warning of potential respiratory depression when used with opioids medications. Limited reports document non-medical use (NMU) of gabapentin, especially among opioid users and individuals receiving medication assisted treatment (MAT) for OUD. Gabapentin is non-medically used to potentiate the euphoric effects of opioids, including MAT medications buprenorphine and methadone, as well as to self-treat OUD symptoms. Aside from these brief reports, systematic studies examining the concomitant NMU of gabapentin and opioids are lacking. At the same time, research documents the therapeutic benefits of administering gabapentin to individuals in treatment for substance use disorder. Studies have shown that individuals receiving daily doses of gabapentin reported decreased symptoms of withdrawal and gabapentin works well in combination with methadone for opioid detoxification. Given the growing reports of NMU of gabapentin, especially NMU co-occurring with opioids and MAT; the accepted use of prescribed gabapentin among treatment clients; and the dearth of systematic data examining the concomitant NMU of gabapentin and opioids, the proposed exploratory R21 study seeks to examine this phenomenon. The study will utilize a social ecology theory-driven design to investigate motivations for concomitant NMU, gender and racial/ethnic differences, and histories of MAT and prescribed gabapentin. The following specific aims will be accomplished: 1) Assess demographic, sociocultural, and psychosocial characteristics across three social ecological domains (intrapersonal, interpersonal, and community) which influence concomitant NMU of gabapentin/opioids; and routes of administration, modes of acquisition, and consequences (n=150); 2) Construct and ethnographic decision model (EDM) of the decision to initiate concomitant NMU of gabapentin/opioids (n=60); and 3) Examine NMU of gabapentin in combination with MAT, including motivations, effects, and consequences (n=30). The sample will be collected among individuals entering treatment for OUD and will include approximately equal numbers of men and women, as well as, and Black, Hispanic, and white individuals. The study will advance Goal 1 of NIDA’s strategic plan by identifying environmental, behavioral, and social causes and consequences of concomitant NMU of gabapentin and opioids and it will be informative for OUD treatment providers and prescribers and aid in the development of prevention and intervention strategies. This exploratory study is innovative in its use of EDM methodology.