Gabapentin and Opioid Prescribing Trends among Adolescents Undergoing Common Procedures: A National Retrospective Cohort Study.

BACKGROUND

Adolescents who fill an opioid prescription for surgery are at increased risk of adverse outcomes, including persistent opioid use, addiction, or overdose. Limited evidence suggests clinicians may increasingly prescribe gabapentin as an opioid-sparing strategy, although gabapentin is increasingly associated with adverse outcomes. The authors examined perioperative gabapentin and opioid prescribing trends over time.

METHODS

Using a national private insurance claims database, the authors identified a cohort of gabapentin and opioid-naive adolescents 11 to 21 yr old who underwent seven procedures that are either common or associated with postoperative persistent opioid use between 2012 and 2022. The authors quantified initial gabapentin and opioid prescriptions, refills within 60 days, and number of days and pills dispensed and used multivariable logistic regression analysis to assess the association between gabapentin dispensing and opioid refills.

RESULTS

Of 181,225 gabapentin and opioid-naive adolescents, 32.1% (n = 58,139) filled a new prescription for one or both. Specifically, 1.1% (n = 662) filled a gabapentin prescription, 96.7% (n = 56,210) filled an opioid prescription, and 2.2% (n = 1,267) filled both. Initial gabapentin prescriptions included a mean ± SD supply of 22.0 ± 15.0 days, 55.3% contained an initial daily dose 600 mg or greater, and 36.5% obtained one or more refills. Opioid-only prescriptions declined during the study period, while gabapentin prescriptions with and without opioid increased. Adolescents who filled both opioid and gabapentin versus opioid-only prescriptions had a 14% (95% CI, 11.0 to 16.8%) adjusted probability difference with regard to obtaining an opioid refill (40.7% vs. 21.6%).

CONCLUSIONS

Gabapentin dispensing increased over time, and more than one third of adolescents were dispensed a refill prescription. Coprescription with opioids did not appear to be associated with decreased opioid quantity in the initial prescription or decreased likelihood of obtaining a refill opioid prescription after undergoing a study procedure. In addition, opioids were often prescribed when they were unlikely to be needed for postoperative pain management.