Gabapentin-related Deaths: Patterns of Abuse and Postmortem Levels.

Gabapentin, a GABA analogue, is a nonopioid prescribed for seizure control and neuralgic pain. Its abuse for recreational purposes has been increasing in recent years as the number of prescriptions also increases. In our series, we review 104 cases of decedents who tested positive for gabapentin in postmortem blood samples and an additional 53 nonfatal cases of motor vehicle drivers suspected of driving under the influence. In 47.1% of the fatality cases, gabapentin was directly involved in death. Most gabapentin fatalities had several other intoxicants present (opioids, over-the-counter medications, antianxiety, and antidepressant medications). In cases in which gabapentin was determined to be a cause of death, the blood concentrations ranged from 1.1 to 134.0 mg/L. Persons who died of a gabapentin-related drug death were prescribed the drug legitimately 91.4% of the time, with 84.2% of those also having a known prior history of abuse or misuse of prescription medications.

The Utility of a Prescription Monitoring Program in Death Investigation: The Virginia Experience.

The Virginia Prescription Monitoring Program (VPMP) has been in effect since 2002, providing reports for prescribers, pharmacists, and other stakeholders in the growing opioid epidemic. The Office of the Chief Medical Examiner is one such stakeholder and has found great efficacy in the program in investigating suspected drug-related deaths. This review examines the origins of the VPMP, its benefits, and limitations for use during death investigation.

A brief analysis of suicide methods and trends in Virginia from 2003 to 2012.

BACKGROUND: The objective is to analyze and compare Virginia suicide data from 2003 to 2012 to US suicide data. METHODS: Suicide trends by method, age, gender, and race were obtained from Virginia's Office of the Chief Medical Examiner's annual reports. RESULTS: Similar to US suicide rates, suicide rates in Virginia increased between 2003 and 2012 from 10.9/100,000 people to 12.9/100,000 people. The most common methods were firearm, asphyxia, and intentional drug overdose, respectively. The increase in asphyxia (r = 0.77, P ≤ 0.01) and decrease in CO poisoning (r = -0.89, P ≤ 0.01) were significant. Unlike national trends, intentional drug overdoses decreased (r = -0.55, P = 0.10). Handgun suicides increased (r = 0.61, P = 0.06) and are the most common method of firearm suicide. Hanging was the most common method of asphyxia. Helium suicides also increased (r = 0.75, P = 0.05). Middle age females and males comprise the largest percentage of suicide. Unlike national data, the increase in middle age male suicides occurred only in the 55-64-year-old age group (r = 0.79, P ≤ 0.01) and decreased in the 35-44-year-old age group (r = -0.60, P = 0.07) and 10-14-year-old age group (r = -0.73, P = 0.02). Suicide in all female age ranges remained stable. Caucasians represent the highest percentage of suicide. CONCLUSION: There has been a rise in suicide in Virginia and suicide rates and trends have closely resembled the national average albeit some differences. Suicide prevention needs to be enhanced.