More money, more gabapentin

July 08, 2019

Pharmaceutical companies' payments to doctors may be influencing them to prescribe more expensive, brand-name versions of the pain drug gabapentin, a team of researchers report in the July 8 issue of JAMA Internal Medicine, and the increasing use of the drug suggests it may be being abused. 

"We found that the more physicians receive industry money, the more likely they were to prescribe gabapentin. But more research is needed to understand how much of that gabapentin goes to drug abuse," says lead author Greg Rhee, an assistant professor of medicine and public health at UConn Health. 

Gabapentin is a fairly old drug, normally prescribed to control seizures and treat nerve pain. But use of the drug has increased 3-fold in the US between 2002 and 2015, and Rhee and his colleagues wanted to understand why. It is chemically similar to the brain chemical gamma-aminobutyric acid, known as GABA. Gabapentin seems to work similarly to GABA by calming overexcited brain cells, which is why it is sometimes used to treat epilepsy. The way it relieves nerve pain is less well understood. But because it doesn't interact dangerously with other drugs nor cause euphoria when taken at therapeutic doses, it is frequently prescribed for chronic pain. And its use has been increasing: prescriptions of gabapentin and analogs of it rose from 1.2% of US adults in 2002 to 3.9% of US adults in 2015.

Rhee and colleagues from Yale University wondered whether payments from the pharmaceutical industry to doctors might be influencing prescribing. They looked at the Open Payments and Medicare Part D Prescriber databases for 2014-2016. Both databases are made available through the Centers for Medicare and Medicaid Services. Open Payments is a national program that obligates drug manufacturers to disclose payments made to physicians. Medicare Part D Prescriber database shows all the prescriptions made to people in Medicare Part D plans, and is searchable by doctor and by drug.

Gabapentin manufacturers paid physicians $11.5 million between 2014 and 2016, Rhee and his colleagues found. The payments went to about 14% of the doctors who prescribed any kind of gabapentin in those years, mostly pain doctors and general practitioners, most of whom were located in the southern and eastern parts of the country.

The researchers found that doctors who received payments from industry were more likely to prescribe a brand name version of gabapentin such as Lyrica, Gralise or Horizant. These brand name drugs cost several hundred dollars for a one month supply, compared to less than $20 for a one month supply of the generic. Besides cost, the rise in prescriptions is concerning because gabapentin has the potential to be abused. Although it is not reported to be intoxicating when used as directed, searching for gabapentin on drug experience websites such as erowid shows that taking it in larger quantities can cause a long lasting high. Some long-term users who took gabapentin at therapeutic doses for legitimate medical reasons also report it can be addictive. Rhee and his colleagues are concerned that the three-fold increase in prescriptions over the last decade and a half indicate some gabapentin is being diverted for recreational purposes, but caution that more research needs to be done before that can be determined.
-end-
This work was funded by the National Institutes of Health grant #T32AG019134.

University of Connecticut

Related Medicare Articles from Brightsurf:

Falling Medicare reimbursement rates for orthopaedic trauma
The amount Medicare reimburses for orthopaedic trauma surgery has fallen by nearly one-third over the past two decades, reports a study in the Journal of Orthopaedic Trauma.

Medicare coverage varies for transgender hormone therapies
A new study has shown substantial variability in access to guideline-recommended hormone therapies for older transgender individuals insured through Medicare.

Medicare changes may increase access to TAVR
The number of hospitals providing TAVR could double with changes to Medicare requirements.

Inequitable medicare reimbursements threaten care of most vulnerable
Hospitals, doctors and Medicare Advantage insurance plans that care for some of the most vulnerable patients are not reimbursed fairly by Medicare, according to recent findings in JAMA.

Medicare may overpay for many surgical procedures
For most surgical procedures, Medicare provides physicians a single bundled payment that covers both the procedure and related postoperative care over a period of up to 90 days.

Only 1 in 4 Medicare patients participate in cardiac rehabilitation
Only about 24% of Medicare patients who could receive outpatient cardiac rehabilitation participate in the program.

How common is food insecurity among Medicare enrollees? 
Nearly 1 in 10 Medicare enrollees age 65 and over and 4 in 10 enrollees younger than 65 with long-term disabilities experience food insecurity.

Medicare for All unlikely to cause surge in hospital use: Harvard study
Despite some analysts' claims that Medicare for All would cause a sharp increase in health care utilization, a new study finds the two biggest coverage expansions in US history -- Medicare and the ACA -- caused no net increase in hospital use.

Critical heart drug too pricey for some Medicare patients
An effective drug to treat chronic heart failure may cost too much for senior citizens with a standard Medicare Part D drug plan, said a study co-authored by a John A.

Research suggests strategy for more equitable Medicare reimbursement
Those who were enrolled in both Medicare and Medicaid were sicker, had more cognitive impairments and difficulty functioning, and needed more social support than those who were not enrolled in both government programs, Saint Louis University research found.

Read More: Medicare News and Medicare Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.