Drug Details Matter

This week I want to share two articles about drugs and the studies on how they affect patients. The first article is about the effects of taking gabapentinoids. The second article examines risk factors in long-term opioid use. Below you’ll find these articles and my thoughts on their implications.

Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.

Pregabalin Linked to Suicidal Behavior, Overdose

New research shows that taking gabapentinoids, specifically pregabalin (LYRICA), increases the user’s risk for suicidal behavior, accidental overdoses, serious injuries and car accidents. While many of the studies are small and evidence is mixed, even with these known concerns prescriptions have increased dramatically in recent years as LYRICA is often viewed as an effective alternative to opioids. Based on these new studies it is becoming clearer that might not be the case.

Mark’s Thoughts:
With all the discussion about generics finally being available for LYRICA, I wanted to reiterate (again) that it’s not just about cost but also about appropriate utilization. Here’s something else to consider: “This very large trial provides important information that pregabalin—but not gabapentin—increased the risk of a range of adverse outcomes, including suicide thinking and completed suicide, head injuries, and road traffic accidents. The risk was ‘dose-related’ which is to say the more one takes, the more likely such outcomes were, and young people aged 15 to 24 seem particularly susceptible.” If you go to LYRICA’s website, this issue is very clearly shown (in bold) on the home page – “LYRICA and LYRICA CR may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.” One in 500 seems like a small number…unless you’re the “one.” The symptoms of these mood changes include (but I’m sure are not limited to) “new or worsening depression, anxiety, restlessness, trouble sleeping, panic attacks, anger, irritability, agitation, aggression, dangerous impulses or violence, or extreme increases in activity or talking.” Every single medication has a (sometimes long) list of potential side effects. Regardless of the drug, you should read that list. Every time. If the potential (or real) risks exceed the benefits, you need to find something else.

Study Links Injured Workers’ Initial Opioid Prescriptions, Long-Term Use, (Subscription Required)

Based on a study that looked at injuries reported to the Tennessee Bureau of Workers’ Compensation from March 2013 to December 2015, the strongest risk factor of long-term opioid use is the number of day’s supply initially prescribed. Initial opioid prescription of as little as five to nine days are associated with an increased possibility of an individual using opioids long-term, even when they were previously opioid-free.

Mark’s Thoughts:
Day supply of Rx opioids (5-9 days) is the most predictable predictor of long-term Rx opioid use per a study done by the TN Department of Health. That’s why focusing very clearly on that first opioid script is so important to ensure (1) it is the most clinically appropriate method for pain relief (2) if so, the least day supply/number of pills possible to move the patient towards a return to function. What society has found out over the past decade is that for many, zero opioids are necessary. Whatever the method, thoughtful consideration (and not rote status quo) is required. The Tennessee study found that 45 percent (that’s a large number) of the 128,885 injured workers received Rx opioids in the 90 days after injury. Eighty percent of those had not received any opioids within 60 days prior to the injury (what they classified as “opioid free”). Four percent of those “opioid free” ended up taking opioids for 45 days or more during the 90 days after the injury. Obviously, four is a low number…unless you’re part of the “four.” The article mentioned other studies, from WCRI to the University of Arkansas, that corroborated those conclusions. So it’s about finding the balance of “Appropriate, Not Zero, Opioids.”

To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-august-12-mark-rxprofessor-pew/.

Until Next Week,