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Gabapentinoid use in prisons.

Dear Editor:

Gabapentinoids (gabapentin and pregabalin) are widely used in neurology, psychiatry and family medicine and gabapentinoid abuse is increasingly being reported (Schifano, 2014). The drug abuse rates may be higher among prisons compared to normal population (Amau-Peiro et al., 2012). We reviewed past medical records of our patients, in an attempt to determine the rates of gabapentinoid use among prisons.

The prisons are recorded by the same social security code in the automation system of our hospital. All medical records with this code were found and revised from the system. The demographics (age, gender etc.), medical history including neurological complaints, drug use such as gabapentinoids, neurological and radiologic examination, and electroencephalography (EEG) and electromyography (EMG) studies of the patients were recorded.

A total of 83 male patients were admitted to our department between January 2012 and July 2014. The most common complaint was seizure (28.9%) followed by peripheral nerveous system (25.3%) and polyneuropathic ones (18.1%). Totally 25 patients were using drugs such as pregabalin or gabapentin (15 and 10, respectively). Pregabalin was prescribed to only 6 of 15 patients by our neurology (n=4) and neurosurgery clinics (n=2). Other prisons claimed that pregabalin and gabapentin were started by another hospital (n=9, n= 10, respectively). Three of the patients receiving gabapentine stated drug dependency. Sixteen patients requested pregabalin due to their neuropathic pain. A total of 41 (49.4%) prisons applied to the neurology clinic with the request of a gabapentinoid prescription.

The request of pregabalin prescription of 5 prisons with the complaints of loss of strength in the left hand and numbness in the fingers (on the left side in four out five patients) was interesting, since they applied after a convict had been prescribed pregabalin for the treatment of severe pain following surgery for left unlar neuropathy.

Objective signs and symptoms (clinical or radiological evidence or EMG or EEG findings) consistent with the admission complaint were detected in 43 out of eightythree (51.8%) inmates, while this rate was 53.7% in patients on gabapentinoid or who request a gabapentinoid prescription.

The use of gabapentinoids including mainly pregabalin, is significantly higher among prisons. Our findings suggest that the rate of gabapentinoid abuse is far beyond that of the previous reports and gabapentinoids are the most commonly abused drugs among prisons. It is important to increase the awareness about gabapentinoid abuse among inmates. Unfortunately, gabapentinoids have been prescribed to inmates in our clinic, before this awareness. Bicknell (2013) recommends the discontinuation of this medicine in inmates, in case of a suspicion about neuropathic pain or a history of drug abuse. More than half of our patients had objective evidences of neuropathic pain and epilepsy. We suggest a detailed assessment of the history of drug abuse, before prescribing gabapentinoids to inmates and gradual discontinuation of the medicine in case of a suspicion of abuse, even in the presence of objective evidences.

REFERENCES

Arnau-Peiro, F., Garcia-Guerrero, J., Herrero-Matias, A., Castellano-Cervera, J. C., Vera-Remartinez, E. J., Jorge-Vidal, V., Iranzo-Tatay, C. (2012). [Description of the psychiatric unit in prisons in the autonomous community of Valencia]. Revista Espahola de Sanidad Penitenciaria, 14(2), 50-60.

Bicknell, M. (2013). The pain of pregabalin prescribing in prisons. The British Journal of General Practice, 63(613), 405. doi: 10.3399/bjgpl3X670615.

Schifano, F. (2014). Misuse and abuse of pregabalin and gabapentin: cause for concern? CNS Drugs, 28(6), 491-496. doi: 10.1007/s40263-014-0164-4.

Semiha KURT, Durdane AKSOY, Betul CEVIK & Orhan SUMBUL

Gaziosmanpasa University

Faculty of Medicine

Department of Neurology

Tokat, Turkey

Address all correspondence to:

Semiha Kurt M. D.

Gaziosmanpasa University, Faculty of Medicine, Department of

Neurology, Tokat, Turkey

Tel: +90(356) 2125746 Ext:1260,

Fax: +90(356) 2133179; E-mail: gsemihakurt@hotmail.com
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Title Annotation:rate of use of gabapentinoid in prisons
Author:Kurt, Semiha; Aksoy, Durdane; Cevik, Betul; Sumbul, Orhan
Publication:Journal of Alcohol & Drug Education
Article Type:Letter to the editor
Date:Apr 1, 2015
Words:620
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