Guidance on Dangerous Medications

This week I want to share two articles about news surrounding different types of drugs. The first article is about a new study that is examining opioid use for people with acute spinal pain. The second article is about the new classification of Gabapentin and Pregabalin to a Class C controlled substance in the United Kingdom. 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.

World-first opioid trial on acute spinal pain

Opioid benefit versus harm is a huge point of discussion and research all over the globe. Currently, the Sydney School of Public Health is conducting research about the effects of opioids on pain relief for patients with acute spinal pain. The main reason this study is different than others regarding opioids is that it is not comparing opioids to other pain medication. Instead, it is comparing opioids to its amount of effectiveness in patients with acute spinal pain. The results will be beneficial to doctors to help decide if and when to prescribe opioids.

Mark’s Thoughts:
This could be very helpful research from Australia. “What the OPAL study will do is provide quality evidence to help doctors decide whether opioids should be used in acute spinal pain. We will provide a definitive answer and rigorous evidence to inform patients whether opioids are beneficial if they experience a new episode of spinal pain.” Note they don’t say opioids should never be prescribed, or that they should always be prescribed, but a strategic decision needs to be made for each individual. The study will be double-blinded (where neither the patients or physicians know who gets what) and random—the gold standard for clinical studies. There is no ETA for the study to be finished, but this kind of study will be a very useful input to everyone on the role of opioids in acute pain management. I doubt the findings will be that opioids never have a role. But I also doubt the findings will be that opioids are the choice. Finding the balance—appropriate use—is a worthy goal for which we should strive.

Prescription drugs pregabalin and gabapentin have been reclassified—but it won’t stop problem use

Two common prescription drugs—Gabapentin and Pregabalin—have been reclassified as class C controlled substances in the UK. These drugs are most often used to treat epilepsy, anxiety, peripheral and neuropathic pain and are known to produce feelings of euphoria, calmness and relaxation. However, these drugs can have serious side effects. And they are medications with increasing abuse and diversion. With this new classification of controlled substances, prescriptions will need to be handwritten and it will be illegal to supply or sell these drugs to others. One reason for the new classification is the increase of prescriptions for these drugs in the last 5 years (pregabalin by 350% and gabapentin by 150%).

Mark’s Thoughts:
The potential dangers of Gabapentin (Neurontin is the most commonly used namebrand) and Pregabalin (Lyrica is the most commonly used namebrand) continue to be increasingly recognized. Two states—Kentucky effective 7/1/17 and Michigan effective 1/1/19—classified all gabapentin products as Schedule V. Pregabalin is Schedule V while Gabapentin continues to to be unscheduled by the federal DEA. And now the UK has rescheduled both drugs to Class C controlled substances (essentially the equivalent of Schedule V). Why this attention? Because they are drugs that can be abused (“For example, using gabapentin and pregabalin with heroin can increase their euphoric effects”). How does this impact Work Comp? Lyrica is in almost all Top 10 lists of utilized drugs and in state drug formularies both drugs are typically listed as preferred/’Y’ options. If you’re using these drugs, or you’re managing someone with these drugs, read all of these articles to understand the risks and make wise treatment choices. As we desperately search for solution(s) to the opioid epidemic, our society is willing to try treatments that previously would have never been considered. But each potential solution needs to be evaluated for its own benefit v. risk profile. In the case of Lyrica and Neurontin, we may be swapping one set of dangerous drugs for another. Just because a medication is “safer” doesn’t mean it’s “safe.” Read the label. Understand the side effects. Identify the interactions. Compare the pros and cons. Evaluate the alternatives. Don’t rely solely on a physician or pharmacist or a TV commercial for your education. Do your homework. Do not put anything into your mouth that you don’t fully understand. If after your due diligence the medication makes sense for you, take it in full compliance with instructions but stay watchful.

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Until next week,