Rev. Soc. Esp. Dolor. 2025; 32(1): 69-90 / DOI: 10.1001/ejp.70116
Amy G. McNeilage, Evan Browne, Suzanne Nielsen, Claire E. Ashton-James, Bridin Murnion
ABSTRACT
Background and objective: The global rise in gabapentinoid prescriptions for chronic pain has been striking. However, this trend has been accompanied by growing concerns about misuse and dependence. This qualitative systematic review aimed to synthesise the perspectives of healthcare practitioners and other professionals on these emerging challenges.
Databases and Data Treatment: Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) were searched to May 2025. Eligible studies used qualitative or mixed methods to explore professional views on gabapentinoid misuse or dependence. Studies focusing solely on patient perspectives or therapeutic use were excluded. Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Data were analysed using thematic synthesis, and confidence in the findings was evaluated using GRADE-CERQual.
Results: After screening 1584 records, 19 original studies were included. Most were conducted in substance use treatment and law enforcement settings, where professionals frequently encounter vulnerable populations and more severe patterns of misuse than in general clinical care. Reported drivers of misuse included polydrug use, opioid substitution, psychological distress and poor access to non-pharmacological care. Signs of misuse included early refills, dose escalation and reluctance to taper. Professionals described ethical tensions in prescribing and dispensing and proposed harm reduction strategies, including prescriber education, regulatory reform, expanded treatment access and public awareness.
Conclusions: Gabapentinoid misuse is shaped by clinical, social and structural factors. Tackling these challenges requires systemic responses that go beyond individual prescribers. Lessons from opioid policy responses should inform balanced, compassionate and evidence-informed strategies to reduce harm and improve care.
Significance Statement: This is the first systematic review to synthesise professional perspectives on gabapentinoid misuse and dependence, drawing on studies from Europe, North America, the Middle East and Africa. Integrating insights from healthcare, law enforcement and policy settings, it reveals the structural drivers behind rising misuse—including opioid regulation, socioeconomic hardship and limited access to alternatives—and highlights gaps in clinical guidance. The findings offer actionable, cross-sector strategies to support safer prescribing, informed policy and more effective harm reduction.
RESUMEN
Antecedentes y objetivo: El aumento global de prescripciones de gabapentinoides para el dolor crónico ha sido notable. No obstante, esta tendencia ha ido acompañada de una preocupación cada vez mayor con respecto al uso incorrecto y la dependencia de los mismos. El objetivo de la presente revisión sistemática cualitativa ha consistido en sintetizar los enfoques de los profesionales de la salud y otros profesionales acerca de estos desafíos emergentes.
Bases de datos y tratamiento de los datos: Se ha trabajado buscando en seis bases de datos (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) hasta mayo de 2025. Los estudios aptos utilizaron métodos cualitativos o mixtos para analizar los enfoques profesionales sobre el uso incorrecto o la dependencia de los gabapentinoides. Los estudios centrados únicamente en el punto de vista de los pacientes o en el uso terapéutico fueron excluidos. La calidad metodológica se evaluó empleando la lista CASP (Critical Appraisal Skills Programme). Los datos se analizaron utilizando la síntesis temática, y se evaluó la confianza en los hallazgos usando GRADE-CERQual.
Resultados: Tras el cribado de 1584 registros, se incluyeron 19 estudios originales. La mayoría de ellos fueron realizados en contextos de tratamientos para el consumo de drogas y entornos judiciales, en los que los profesionales encuentran a menudo poblaciones vulnerables y patrones de uso incorrecto más graves que en la atención clínica general. Se citaron causas del uso incorrecto tales como el policonsumo de drogas, la sustitución de opiáceos, el malestar psicológico y el acceso insuficiente a cuidados no farmacológicos. Entre las señales del uso incorrecto se incluyeron las recargas anticipadas, los aumentos de la dosis y la reticencia a disminuirla. Los profesionales señalaron tensiones éticas en cuanto a su prescripción y administración, y propusieron estrategias de reducción de daños, entre las que incluyeron la formación de los médicos, la reforma normativa, el mayor acceso al tratamiento y la concienciación pública.
Conclusiones: El uso incorrecto de los gabapentinoides está determinado por factores clínicos, sociales y estructurales. Para abordar estos desafíos se necesitan respuestas sistémicas que vayan más allá de los médicos en particular. Las enseñanzas de las respuestas normativas sobre opiáceos deberían guiar la creación de estrategias equilibradas, compasivas y basadas en la evidencia para reducir el daño y mejorar la atención prestada.
Declaración de importancia: Esta es la primera revisión sistemática que sintetiza enfoques profesionales acerca del uso incorrecto y la dependencia de los gabapentinoides, valiéndose de estudios de Europa, América del Norte, Oriente Medio y África. Incorporando reflexiones desde el marco de la asistencia médica, el orden público y las políticas, muestra cuáles son las causas estructurales del aumento de un uso incorrecto —incluyendo la normativa sobre los opiáceos, las dificultades socioeconómicas y el acceso limitado a alternativas— y pone de relieve los vacíos en las recomendaciones clínicas. Los hallazgos ofrecen estrategias factibles e intersectoriales para propiciar prescripciones más seguras, políticas informadas y una reducción del daño más eficaz.
Nuevo comentario
Comentarios
No comments in this article
Bibliografía
1. Chan, A. Y., A. S. Yuen, D. H. Tsai, et al. 2023. “Gabapentinoid Consumption in 65 Countries and Regions From 2008 to 2018: A Longitudinal Trend Study.” Nature Communications 14: 5005.
2. Derry, S., R. F. Bell, S. Straube, P. J. Wiffen, D. Aldington, and R. A. Moore. 2019. “Pregabalin for Neuropathic Pain in Adults.” Cochrane Database of Systematic Reviews 1: CD007076.
3. Wiffen, P. J., S. Derry, R. F. Bell, et al. 2017. “Gabapentin for Chronic Neuropathic Pain in Adults.” Cochrane Database of Systematic Reviews 6: CD007938. https://doi.org/10.1002/14651858.CD007938.pub4.
4. Soliman, N., X. Moisset, M. C. Ferraro, et al. 2025. “Pharmacotherapy and Non-Invasive Neuromodulation for Neuropathic Pain: A Systematic Review and Meta-Analysis.” Lancet Neurology 24: 413–428.
5. Goodman, C. W., and A. S. Brett. 2019. “A Clinical Overview of Off- Label Use of Gabapentinoid Drugs.” JAMA Internal Medicine 179: 695– 701.
6. Mack, A. 2003. “Examination of the Evidence for Off-Label Use of Gabapentin.” Journal of Managed Care & Specialty Pharmacy 9: 559–568.
7. Peckham, A. M., K. E. Evoy, L. Ochs, and J. R. Covvey. 2018. “Gabapentin for Off-Label Use: Evidence-Based or Cause for Concern?” Substance Abuse: Research and Treatment 12: 1178221818801311.
8. Goodman, C. W., and A. S. Brett. 2017. “Gabapentin and Pregabalin for Pain—Is Increased Prescribing a Cause for Concern?” New England Journal of Medicine 377: 411–414.
9. Evoy, K. E., S. Sadrameli, J. Contreras, J. R. Covvey, A. M. Peckham, and M. D. Morrison. 2021. “Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update.” Drugs 81: 125–156.
10. Murnion, B., A. Schaffer, R. Cairns, and J. Brett. 2022. “Gabapentinoids: Repeating Mistakes of the Past?” Addiction 117: 2969–2971.
11. Daly, C., E. Griffin, D. M. Ashcroft, R. T. Webb, I. J. Perry, and E. Arensman. 2018. “Intentional Drug Overdose Involving Pregabalin and Gabapentin: Findings From the National Self-Harm Registry Ireland, 2007–2015.” Clinical Drug Investigation 38: 373–380.
12. Crossin, R., D. Scott, S. Arunogiri, K. Smith, P. M. Dietze, and D. I. Lubman. 2019. “Pregabalin Misuse-Related Ambulance Attendances in Victoria, 2012–2017: Characteristics of Patients and Attendances.” Medical Journal of Australia 210: 75–79.
13. Bonnet, U., and N. Scherbaum. 2017. “How Addictive Are Gabapentin and Pregabalin? A Systematic Review.” European Neuropsychopharmacology 27: 1185–1215.
14. Schjerning, O., M. Rosenzweig, A. Pottegård, P. Damkier, and J. Nielsen. 2016. “Abuse Potential of Pregabalin: A Systematic Review.” CNS Drugs 30: 9–25.
15. Hofmann, M., and M. Besson. 2021. “Gabapentinoids: The Rise of a New Misuse Epidemic?” Psychiatry Research 305: 114193.
16. Chen, C., W.-H. Lo-Ciganic, A. G. Winterstein, P. Tighe, and Y.-J. J. Wei. 2022. “Concurrent Use of Prescription Opioids and Gabapentinoids in Older Adults.” American Journal of Preventive Medicine 62: 519–528.
17. Montastruc, F., S. Y. Loo, and C. Renoux. 2018. “Trends in First Gabapentin and Pregabalin Prescriptions in Primary Care in the United Kingdom, 1993–2017.” JAMA 320: 2149–2151.
18. Rahman, A., J. Kane, F. Montastruc, and C. Renoux. 2021. “Trends in New Prescription of Gabapentinoids and of Coprescription With Opioids in the Four Nations of the UK, 1993–2017.” British Journal of Clinical Pharmacology 87: 3349–3353.
19. Schaffer, A. L., J. Brett, N. A. Buckley, and S.-A. Pearson. 2022. “Trajectories of Pregabalin Use and Their Association With Longitudinal Changes in Opioid and Benzodiazepine Use.” Pain 163: e614–e621.
20. Schaffer, A. L., D. Busingye, K. Chidwick, J. Brett, and S. Blogg. 2021. “Pregabalin Prescribing Patterns in Australian General Practice, 2012– 2018: A Cross-Sectional Study.” BJGP Open 5: bjgpopen20X101120.
21. Torrance, N., A. Veluchamy, Y. Zhou, et al. 2020. “Trends in Gabapentinoid Prescribing, Co-Prescribing of Opioids and Benzodiazepines, and Associated Deaths in Scotland.” British Journal of Anaesthesia 125: 159–167.
22. Gomes, T., S. Greaves, W. van den Brink, et al. 2018. “Pregabalin and the Risk for Opioid-Related Death: A Nested Case–Control Study.” Annals of Internal Medicine 169: 732–734.
23. Gomes, T., D. N. Juurlink, T. Antoniou, M. M. Mamdani, J. M. Paterson, and W. van den Brink. 2017. “Gabapentin, Opioids, and the Risk of Opioid-Related Death: A Population-Based Nested Case–Control Study.” PLoS Medicine 14: e1002396.
24. Hahn, J., Y. Jo, S. H. Yoo, J. Shin, Y. M. Yu, and Y.-M. Ah. 2022. “Risk of Major Adverse Events Associated With Gabapentinoid and Opioid Combination Therapy: A Systematic Review and Meta-Analysis.” Frontiers in Pharmacology 13: 1009950.
25. Zhou, L., S. Bhattacharjee, C. K. Kwoh, et al. 2021. “Dual Trajectories of Opioid and Gabapentinoid Use and Risk of Subsequent Drug Overdose Among Medicare Beneficiaries in the United States: A Retrospective Cohort Study.” Addiction 116: 819–830.
26. Page, M. J., J. E. McKenzie, P. M. Bossuyt, et al. 2021. “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews.” International Journal of Surgery 88: 105906.
27. Tong, A., K. Flemming, E. McInnes, S. Oliver, and J. Craig. 2012. “Enhancing Transparency in Reporting the Synthesis of Qualitative Research: ENTREQ.” BMC Medical Research Methodology 12: 1–8.
28. Munn, Z., C. Stern, E. Aromataris, C. Lockwood, and Z. Jordan. 2018. “What Kind of Systematic Review Should I Conduct? A Proposed Typology and Guidance for Systematic Reviewers in the Medical and Health Sciences.” BMC Medical Research Methodology 18: 1–9.
29. Dunn, K. E., F. S. Barrett, M. Fingerhood, and G. E. Bigelow. 2017. “Opioid Overdose History, Risk Behaviors, and Knowledge in Patients Taking Prescribed Opioids for Chronic Pain.” Pain Medicine 18: 1505– 1515.
30. Saunders, J. B. 2017. “Substance Use and Addictive Disorders in DSM-5 and ICD-10 and the Draft ICD-11.” Current Opinion in Psychiatry 30: 227–237.
31. McNeilage, A. G., S. Nielsen, B. Murnion, and C. Ashton-James. 2023. “Experiences of Misuse and Symptoms of Dependence Among People Who Use Gabapentinoids: A Qualitative Systematic Review Protocol.” BMJ Open 13: e073770.
32. McNeilage, A. G., A. Sim, S. Nielsen, B. Murnion, and C. E. Ashton- James. 2024. “Experiences of Misuse and Symptoms of Dependence Among People Who Use Gabapentinoids: A Qualitative Systematic Review.” International Journal of Drug Policy 133: 104605.
33. Long, H. A., D. P. French, and J. M. Brooks. 2020. “Optimising the Value of the Critical Appraisal Skills Programme (CASP) Tool for Quality Appraisal in Qualitative Evidence Synthesis.” Research Methods in Medicine & Health Sciences 1: 31–42.
34. Thomas, J., and A. Harden. 2008. “Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews.” BMC Medical Research Methodology 8: 1–10.
35. Booth, A., J. Noyes, K. Flemming, et al. 2016. Guidance on Choosing Qualitative Evidence Synthesis Methods for Use in Health Technology Assessments of Complex Interventions. Integrate-HTA.
36. Flemming, K., and J. Noyes. 2021. “Qualitative Evidence Synthesis: Where Are We at?” International Journal of Qualitative Methods 20: 1609406921993276.
37. Sandelowski, M. 2000. “Whatever Happened to Qualitative Description?” Research in Nursing & Health 23: 334–340.
38. Sandelowski, M. 2010. “What's in a Name? Qualitative Description Revisited.” Research in Nursing & Health 33: 77–84.
39. Lewin, S., A. Booth, C. Glenton, et al. 2018. “Applying GRADE- CERQual to Qualitative Evidence Synthesis Findings: Introduction to the Series.” Implementation Science 13: 1–10.
40. Altayeb, L., A. Zkriea, E. El Imam, et al. 2025. “Perceptions of Community Pharmacists Regarding Pregabalin Abuse: A Survey From Sudan.” International Journal of Pharmacy Practice 33: 52–57.
41. Buttram, M. E., S. P. Kurtz, R. C. Dart, and Z. R. Margolin. 2017. “Law Enforcement-Derived Data on Gabapentin Diversion and Misuse, 2002–2015: Diversion Rates and Qualitative Research Findings.” Pharmacoepidemiology and Drug Safety 26: 1083–1086.
42. Buttram, M. E., S. P. Kurtz, M. S. Ellis, and T. J. Cicero. 2019. “Gabapentin Prescribed During Substance Abuse Treatment: The Perspective of Treatment Providers.” Journal of Substance Abuse Treatment 105: 1–4.
43. Buttram, M. E., M. S. Ellis, and Y. Stivers. 2023. “Law Enforcement Experiences With Gabapentin: Non-Medical Use, Diversion, and State Controlled Substances Laws.” Journal of Substance Use 1, no. 6: 1–1069.
44. Chandrasiri, A., N. Darshana, I. Wanniarachchi, S. De Silva, and K. Somarathne. 2024. “Illicit Drug Use Among Sri Lankan School-Going Adolescents: A Qualitative Study.” Heroin Addiction and Related Clinical Problems 26: 36.
45. Coombes, H., and R. J. Cooper. 2019. “Staff Perceptions of Prescription and Over-The-Counter Drug Dependence Services in England: A Qualitative Study.” Addiction Science & Clinical Practice 14: 1–12.
46. Covvey, J. R., K. E. Evoy, R. Singh, M. L. Blakely, and A. M. Peckham. 2022. “Pharmacist, Prescriber, and Drug Policy Expert Opinions on Gabapentinoid Misuse: A Qualitative Study.” Journal of the American College of Clinical Pharmacy 5: 1378.
47. Covvey, J. R., M. L. Blakely, R. Singh, and A. M. Peckham. 2023. “Pharmacist, Prescriber, and Drug Policy Expert Opinions on Gabapentinoid Misuse.” Research in Social and Administrative Pharmacy 19: 599–609.
48. De Kock, C., T. Černíková, K. Palczak, et al. 2023. “Professionals Working in Reception Centres in Europe: An Overview of Drug-Related Challenges and Support Needs: Joint Report by EMCDDA and EUAA.”
49. Falzon, D., T. Parkes, H. Carver, et al. 2023. ““It Would Really Support the Wider Harm Reduction Agenda Across the Board”: A Qualitative Study of the Potential Impacts of Drug Checking Service Delivery in Scotland.” PLoS One 18: e0292812.
50. Ghinea, N., W. Lipworth, and I. Kerridge. 2015. “Evidence, Regulation and ‘Rational’ Prescribing: The Case of Gabapentin for Neuropathic Pain.” Journal of Evaluation in Clinical Practice 21: 28–33.
51. Gittins, R. E., R. Vaziri, and I. Maidment. 2024. “Experiences of Treating Problematic Over the Counter and Prescription Only Medication Use in Substance Misuse Services.” International Journal of Pharmacy Practice 32: ii16–ii17.
52. Gittins, R. E. 2024. “An Exploration of the Misuse of Over the Counter and Prescription Only Medication in Substance Misuse Treatment Services (Doctoral Dissertation, Aston University).”
53. Jeffries, M., A. S. Abuzour, D. Ashcroft, et al. 2025. “Understanding the Implementation of a Multidisciplinary Intervention Using a Suite of Prescribing Safety Indicators to Improve Medication Safety in Prison Healthcare Settings: A Qualitative Study.” BMJ Open 15: e086309.
54. Jorgenson, D., D. Alazawi, J. Bareham, and N. Bootsman. 2021. “Saskatchewan Physicians' Opinions of Their Personalized Prescribing Profiles Related to Opioids, Benzodiazepines, Stimulants, and Gabapentin.” Journal of Medical Regulation 107: 7–16.
55. Lehnus, K. S., P. S. Fordyce, and M. W. McMillan. 2024. “Electronic Survey Investigating UK Veterinarians' Perceptions of the Potential for Veterinary Prescription Medication Misuse or Abuse.” Veterinary Anaesthesia and Analgesia 51: 16–25.
56. May, T., J. Dawes, D. Fancourt, and A. Burton. 2022. “A Qualitative Study Exploring the Impact of the COVID-19 Pandemic on People Who Inject Drugs (PWID) and Drug Service Provision in the UK: PWID and Service Provider Perspectives.” International Journal of Drug Policy 106: 103752.
57. Mikhael, E. M., N. J. Jebur, M. Y. Jamal, and T. A. Hameed. 2024. “Perception, Experience, and Practice of Iraqi Community Pharmacists Towards Customers With Substance Use Disorder.” SAGE Open Medicine 12: 20503121241275472.
58. Mohamed, S. A. M., and A. M. Bashir. 2024. “Voices of Change: Stakeholders' Roles in the Fight Against Substance Abuse in Mogadishu, Somalia.” Substance Abuse and Rehabilitation 15: 1–7.
59. Parbery-Clark, C. L., J. S. Portice, and S. Sowden. 2025. “Realities of Opioid and Gabapentinoid Deprescribing in Socioeconomically Disadvantaged Communities: A Qualitative Evaluation.” BJGP Open 9: BJGPO.2024.0160.
60. Pivovarova, E., F. S. Taxman, A. K. Boland, D. A. Smelson, S. C. Lemon, and P. D. Friedmann. 2023. “Facilitators and Barriers to Collaboration Between Drug Courts and Community-Based Medication for Opioid Use Disorder Providers.” Journal of Substance Use & Addiction Treatment 147: 208950.
61. Tang, H., J. Lu, Y. Duan, and D. Li. 2023. “The Clinical Application and Progress of Mirogabalin on Neuropathic Pain as a Novel Selective Gabapentinoid.” Mediators of Inflammation 2023: 1–13.
62. Al-Husseini, A., M. Wazaify, and M. C. Van Hout. 2018. “Pregabalin Misuse and Abuse in Jordan: A Qualitative Study of User Experiences.” International Journal of Mental Health and Addiction 16: 642–654.
63. Buttram, M. E., and S. P. Kurtz. 2021. “Descriptions of Gabapentin Misuse and Associated Behaviors Among a Sample of Opioid (Mis)users in South Florida.” Journal of Psychoactive Drugs 53: 47–54.
64. McNeilage, A. G., C. E. Ashton-James, and B. Scholz. 2023. ““We Were All Looking for the Magic Pill”: A Qualitative Study of Patient Experiences Using Gabapentinoids for Chronic Pain.” International Journal of Drug Policy 119: 104112.
65. Servais, L., V. Huberland, and L. Richelle. 2023. “Misuse of Pregabalin: A Qualitative Study From a Patient's Perspective.” BMC Public Health 23: 1339.
66. Vickers Smith, R., E. M. Boland, A. M. Young, et al. 2018. “A Qualitative Analysis of Gabapentin Misuse and Diversion Among People Who Use Drugs in Appalachian Kentucky.” Psychology of Addictive Behaviors 32: 115–121.
67. Portenoy, R. K. 1996. “Opioid Therapy for Chronic Nonmalignant Pain: A Review of the Critical Issues.” Journal of Pain and Symptom Management 11: 203–217.
68. Webster, L. R., and R. M. Webster. 2005. “Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool.” Pain Medicine 6: 432–442.
69. Klimas, J., L. Gorfinkel, N. Fairbairn, et al. 2019. “Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain: A Systematic Review.” JAMA Network Open 2: e193365.
70. Ansari, B., K. M. Tote, E. S. Rosenberg, and E. G. Martin. 2020. “A Rapid Review of the Impact of Systems-Level Policies and Interventions on Population-Level Outcomes Related to the Opioid Epidemic, United States and Canada, 2014–2018.” Public Health Reports 135, no. Suppl: 100S–127S.
71. Furlan, A. D., N. Carnide, E. Irvin, et al. 2018. “A Systematic Review of Strategies to Improve Appropriate Use of Opioids and to Reduce Opioid Use Disorder and Deaths From Prescription Opioids.” Canadian Journal of Pain 2: 218–235.
72. Haegerich, T. M., C. M. Jones, P.-O. Cote, A. Robinson, and L. Ross. 2019. “Evidence for State, Community and Systems-Level Prevention Strategies to Address the Opioid Crisis.” Drug and Alcohol Dependence 204: 107563.
73. Cole, F., B. Kinchin, and L. Johnson. 2021. “Gabapentinoids and Opioids Tapering Tool Box (GOTT): Early Findings.” British Journal of Pain 15: 1–22.
74. Collinson, M. J. 2019. “33 Reducing Medication-Related Harm From Gabapentinoids in Primary Care: A Quality Improvement Project With a Completed PDSA Cycle.” Age and Ageing 48: ii1–ii10.
75. Reeve, E., W. Thompson, and B. Farrell. 2017. “Deprescribing: A Narrative Review of the Evidence and Practical Recommendations for Recognizing Opportunities and Taking Action.” European Journal of Internal Medicine 38: 3–11.
76. Anderson, P. A., A. J. McLachlan, C. Abdel Shaheed, D. Gnjidic, R. Ivers, and S. Mathieson. 2023. “Deprescribing Interventions for Gabapentinoids in Adults: A Scoping Review.” British Journal of Clinical Pharmacology 89: 2677–2690.