{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:17:35Z","timestamp":1790727455926,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"2","funder":[{"DOI":"10.13039\/100009931","name":"Michigan Department of Health and Human Services","doi-asserted-by":"publisher","award":["E20180672-00 Michigan DHHS - MA-2018 Master Agreem"],"award-info":[{"award-number":["E20180672-00 Michigan DHHS - MA-2018 Master Agreem"]}],"id":[{"id":"10.13039\/100009931","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["E20182818-00"],"award-info":[{"award-number":["E20182818-00"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["MA-2018"],"award-info":[{"award-number":["MA-2018"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Administration","doi-asserted-by":"crossref","award":["SAMHSA: E20180568-00 MA-2018 Master Agreement Prog"],"award-info":[{"award-number":["SAMHSA: E20180568-00 MA-2018 Master Agreement Prog"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["RO1 DA042859"],"award-info":[{"award-number":["RO1 DA042859"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"NIAMS","doi-asserted-by":"crossref","award":["P50 AR070600"],"award-info":[{"award-number":["P50 AR070600"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2023,6,14]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Gabapentin is commonly prescribed as an off-label adjunct to opioids because of its safer risk profile. Recent evidence has shown an increased risk of mortality when coprescribed with opioids. Therefore, we aimed to evaluate whether the addition of off-label gabapentin in patients with chronic opioid use is associated with a reduction in opioid dosage.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective cohort study of patients with chronic opioid use with a new off-label gabapentin prescription (2010\u20132019). Our primary outcome of interest was a reduction in opioid dosage measured via oral morphine equivalents (OME) per day after the addition of a new off-label gabapentin prescription.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In our cohort of 172,607 patients, a new off-label gabapentin prescription was associated with a decrease in opioid dosage in 67,016 patients (38.8%) (median OME\/day reduction:13.8), with no change in opioid dosage in 24,468 patients (14.2%), and an increase in opioid dosage in 81,123 patients (47.0%) (median OME\/day increase: 14.3). A history of substance\/alcohol use disorders was associated with a decrease in opioid dosage after the addition of a new off-label gabapentin (aOR 1.20, 95%\u2009CI 1.16 to 1.23). A history of pain disorders was associated with a decrease in opioid dosage after the initiation of a new gabapentin prescription including arthritis (aOR 1.12, 95%\u2009CI 1.09 to 1.15), back pain (aOR 1.10, 95%\u2009CI 1.07 to 1.12), and other pain conditions (aOR 1.08, 95%\u2009CI 1.06 to 1.10).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this study of patients with chronic opioid use, an off-label gabapentin prescription did not reduce opioid dosage in the majority of patients. The coprescribing of these medications should be critically evaluated to ensure optimal patient safety.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2023-104613","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T01:15:16Z","timestamp":1687914916000},"page":"88-93","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Cohort study of new off-label gabapentin prescribing in chronic opioid users"],"prefix":"10.1136","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7586-6306","authenticated-orcid":false,"given":"Jessica I","family":"Billig","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-5953","authenticated-orcid":false,"given":"Mark C","family":"Bicket","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Yazdanfar","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhya","family":"Gunaseelan","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika D","family":"Sears","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad M","family":"Brummett","sequence":"additional","affiliation":[{"name":"Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F","family":"Waljee","sequence":"additional","affiliation":[{"name":"Univ Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,27]]},"reference":[{"key":"2025101111115536000_49.2.88.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1704633"},{"key":"2025101111115536000_49.2.88.2","unstructured":"U.S. Food and Drug Administration . Neurontin (Gabapentin). Available: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2011\/020235s036,020882s022,021129s022lbl.pdf [Accessed Jun 2021]."},{"key":"2025101111115536000_49.2.88.3","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1001\/jamainternmed.2019.0086","article-title":"A clinical overview of off-label use of Gabapentinoid drugs","volume":"179","author":"Goodman","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2025101111115536000_49.2.88.4","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamainternmed.2017.7856","article-title":"Gabapentinoid use in the United States 2002 through 2015","volume":"178","author":"Johansen","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2025101111115536000_49.2.88.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002396","article-title":"Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study","volume":"14","author":"Gomes","year":"2017","journal-title":"PLoS Med"},{"key":"2025101111115536000_49.2.88.6","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s40264-018-0671-1","article-title":"Authors' reply to: Tomoyuki Kawada's comment on: \"all-cause and drug-related medical events associated with Overuse of Gabapentin and\/or opioid medications: A retrospective cohort analysis of a commercially insured US population''","volume":"41","author":"Peckham","year":"2018","journal-title":"Drug Saf"},{"key":"2025101111115536000_49.2.88.7","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.japh.2021.04.020","article-title":"Opioid prescribing and health outcomes in opioid-naive patients: analysis of a statewide health information exchange","volume":"61","author":"Udayachalerm","year":"2021","journal-title":"Journal of the American Pharmacists Association"},{"key":"2025101111115536000_49.2.88.8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.31647","article-title":"Association of Gabapentinoids with the risk of opioid-related adverse events in surgical patients in the United States","volume":"3","author":"Bykov","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025101111115536000_49.2.88.9","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1111\/add.15189","article-title":"Dual-Trajectories of opioid and Gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: A retrospective cohort study","volume":"116","author":"Zhou","year":"2021","journal-title":"Addiction"},{"key":"2025101111115536000_49.2.88.10","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1093\/pm\/pnz317","article-title":"Opioid dose and benzodiazepine use among commercially insured individuals on chronic opioid therapy","volume":"21","author":"Kay","year":"2020","journal-title":"Pain Med"},{"key":"2025101111115536000_49.2.88.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2010.05.017"},{"key":"2025101111115536000_49.2.88.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.05.020"},{"key":"2025101111115536000_49.2.88.13","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2025101111115536000_49.2.88.14","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90133-8"},{"key":"2025101111115536000_49.2.88.15","unstructured":"Healthcare Cost Utilization Product. Agency for Healthcare Research and Quality . Beta clinical classifications software (CCS) for ICD-10-CM\/PCS; 2018."},{"key":"2025101111115536000_49.2.88.16","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in US adults","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA Surg"},{"key":"2025101111115536000_49.2.88.17","unstructured":"U.S. Food and Drug Administration . Drug approval package: Lyrica (Pregabalin). 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Available: https:\/\/www.fda.gov\/news-events\/fda-brief\/fda-brief-fda-requires-new-warnings-gabapentinoids-about-risk-respiratory-depression [Accessed 19 Jul 2021]."},{"key":"2025101111115536000_49.2.88.25","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.amepre.2020.09.007","article-title":"Trends in Co-prescribing of opioids and opioid Potentiators among U.S","volume":"60","author":"Rhee","year":"2021","journal-title":"American Journal of Preventive Medicine"},{"key":"2025101111115536000_49.2.88.26","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1007\/s11606-018-4752-8","article-title":"Medicare Formulary coverage and restrictions for opioid Potentiators from 2013 to 2017","volume":"34","author":"Vijay","year":"2019","journal-title":"J Gen Intern Med"},{"key":"2025101111115536000_49.2.88.27","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jval.2020.12.001","article-title":"Association between dual Trajectories of opioid and Gabapentinoid use and Healthcare expenditures among US Medicare beneficiaries","volume":"24","author":"Zhou","year":"2021","journal-title":"Value Health"},{"key":"2025101111115536000_49.2.88.28","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1007\/s40264-020-00985-6","article-title":"Current evidence on abuse and misuse of Gabapentinoids","volume":"43","author":"H\u00e4gg","year":"2020","journal-title":"Drug Saf"},{"key":"2025101111115536000_49.2.88.29","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.676224","article-title":"Non-medical use of prescription Gabapentinoids (Gabapentin and Pregabalin) in five European countries","volume":"12","author":"Fonseca","year":"2021","journal-title":"Front Psychiatry"},{"key":"2025101111115536000_49.2.88.30","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-013-1578-5"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2023-104613","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:12:07Z","timestamp":1760206327000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2023-104613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,27]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,5]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/rapm-2023-104613"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2023-104613","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,27]]}}}