Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland.

BACKGROUND: Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ∼7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006-2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs. METHODS: National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases. RESULTS: From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 'recurrent users' (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08-2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription. CONCLUSIONS: Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication.

Hidden GBV: Women and substance use.

Gender based violence (GBV) is disproportionately higher in women who use substances. This vulnerable population are also at a disadvantage when it comes to accessing harm reduction services. Between May and October 2021 there were 77 cases discussed at Multi-Agency Risk Assessment Conferences (MARAC) in Dundee. The majority of these cases (62) had substance misuse as a risk factor. It is at these meetings that the vulnerability of women comes to the fore and issues of violence are highlighted. During this time period, 44 cases involved the victim being strangled/choked or suffocated and 43 cases had weapons as a risk factor. 56 of the cases included children. The issue of GBV or Intimate Partner Violence (IPV) is often hidden, especially in and by those affected by substance use. Women experiencing GBV require specialist support, often across different services to address different needs. How well violence against women is understood in relationships that are affected by drugs is difficult to determine. In many instances it isn't until a MARAC meeting, or similar crisis point is met, that the extent of the abuse is highlighted. What services can provide singularly is limited in many of these cases but joint-working and innovative practices, such as the Hub model and the Gendered Services Project in Dundee, strive to change the landscape of service delivery.