Reductions in prescribing following legislative intervention to make gabapentin a controlled substance at the state level in the U.S.

From 2002-2015, prescriptions for gabapentin in the U.S. tripled, and gabapentin-involved opioid overdoses have also increased. Research suggests that nonmedical use of gabapentin is increasing and in part driven by a desire to achieve desired psychoactive effects or to potentiate the euphoric effects of opioids. Thus, beginning in 2017, seven U.S. states have reclassified gabapentin as a Schedule V controlled substance. To examine changes in gabapentin utilization by state-level reclassification, rates of prescriptions dispensed per 1,000 population were calculating by year/quarter using projections from IQVIA™’s (Danbury, CT) US-based Longitudinal Patient Data. Data from 3rd quarter 2016 through the end of 2020 were used. We calculated a change ratio the rate observed in 4th quarter 2020 relative to the highest rate observed during the study period. Seven states reclassified gabapentin as a controlled substance. In each state, the highest prescribing rates were observed prior to this change. In six states, prescriptions per person decreased by more than 10% relative to previous highs: Kentucky, the first state to make gabapentin a controlled substance, (decreased from 115.2 to 84.0, 27.1%), West Virginia (from 93.3 to 69.3, 25.7%), Michigan (from 52.2 to 43.1, 17.4%), Tennessee (from 73.6 to 63.7, 13.5%), North Dakota (from 38.0 to 33.1, 13.0%), and Alabama (from 68.3 to 61.1, 10.5%). Virginia observed an 7.8% decrease (from 46.1 to 42.5). By contrast, prescription rates only decreased 3.5% (from 44.1 to 42.6) in the rest of the U.S. during this time. These data suggest that legislative interventions to reclassify gabapentin as a controlled substance reduced the rate of prescriptions dispensed. Additional research is needed to investigate whether reclassification of gabapentin also led to reductions in diversion and non-medical use in these states.