Opioid alternatives ineffective and potentially harmful

Canadian medical professionals are trying to substitute alternative drugs for back pain in an effort to stem the opioid addiction crisis sweeping across North America; unfortunately, many of these alternative prescriptions, according to a study by the Canadian Medical Association Journal (CMAJ), are ineffective and risky.

In late June, the CMAJ published a study showing that gabapentinoids, like pregabalin and gabapentin, are not actually effective for lower back pain treatments, the reason for which they’re often prescribed. Not only that, the drugs were found to have dangerous side effects like drowsiness and sedation which pose risks for motor vehicle accidents, respiratory depression, falls among the elderly, and in some cases, death. Additionally, in 2016, Health Canada discovered that gabapentin is linked to a heightened risk of serious breathing problems.

Not classified as narcotics or monitored like opioids, gabapentinoids were originally sold under the name Neurotonin and Lyrica in Canada and were approved to treat epilepsy and neuropathic pain related to diabetes, spinal cord injuries, fibromyalgia, and shingles. When reports suggested that gabapentinoids could treat a wider array of ailments for which they weren’t initially approved, prescriptions rose dramatically. Treating a symptom with drugs that have not been approved for that specific purpose is called off-label prescribing, and has led to a significant increase in gabapentinoid usage across the nation.

“In light of the evidence, we should proceed with caution with using gabapentinoids for low back pain…and learn from the lessons of the opioid crisis…we do not want to head to a gabapentinoid crisis in the near future.” -Christine Lin, lead author and associate professor at the University of Sydney School of Public Health

Unfortuantely doctors are finding themselves in a tough situation as they attempt to avoid over prescribing opioids without a relatively risk free alternative that adequately relieves the pain of their patients.

Between 2013 and 2017, the number of pregabalin prescriptions nearly doubled across Canada, from 3.4 million to 6.1 million. Gabapentin prescriptions rose from 3.1 million to 4.7 million.

Patients who take gabapentinoids are also more likely to use opioids, which increases the risks associated with both drugs. Dr. David Juurlink, head of clinical pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre, has stated his concern regarding the overprescription of gabapentinoids, especially because of the risks posed by the drugs. He found that Canadians who take both opioids and gabapentinoids are 50% more likely to die from opioid-related causes. In Ontario alone, over the last year, fifteen opioid-related deaths were linked to gabapentin; in eleven of those cases, gabapentin was found to be one of the direct causes of death.

In response, Pfizer Canada, the manufacturer of gabapentin and pregabalin, has restated its belief that these drugs are safe, adding that they are not meant for lower back pain and offering no comment on off-label prescribing.

Health Canada spokesman Eric Morrissette has offered assurance that his department will review the Canadian Medical Association Journal’s study and “take any necessary actions” in response.

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