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The Workers’ Compensation Research Institute  recently announced that its 2022 Annual Report is now available. The report takes a comprehensive look at all of the Institute’s activities in 2021, from the studies that were published to how that research was used by policymakers and other stakeholders.

One of the 2021 studies highlighted in this annual report wasOff-Label Use of Gabapentenoids for Work-Related Injuries.”

The WCRI reports that with a growing number of workers receiving gabapentinoids (e.g., Neurontin®, Lyrica®) for managing pain arising from work-related injuries results in increasing safety and abuse concerns. Thus  Institute released the study that examined their use for work-related injuries and illnesses across 28 states.

The following are among the study’s findings:

– – When workers were prescribed medications, gabapentinoids were dispensed more often in some states than others ─ 1 in 10 workers with prescriptions were dispensed gabapentinoids in Louisiana, Massachusetts, and New York, whereas 3 percent of workers in California, Kansas, Missouri, and New Jersey received gabapentinoids.
– – Gabapentinoids were almost always dispensed for off-label uses in the workers’ compensation system ─ 99 percent of workers with gabapentin and 96 percent of workers with pregabalin did not have a documented diagnosis for one of the FDA-approved conditions. Roughly 2 out of 3 workers had a diagnosis for neuropathic pain conditions.
– – Off-label use of gabapentinoids is recommended on a limited trial basis for selected conditions with neuropathic features. However, 1 out of 3 workers with gabapentinoid prescriptions in workers’ compensation did not have a diagnosis for neuropathic pain conditions or FDA-approved indications.
– – Workers with gabapentinoids often received opioids concomitantly, which increases the risk of respiratory depression resulting in overdose deaths. Nearly half of the workers with gabapentinoids simultaneously received an opioid prescription in Iowa, Kansas, Louisiana, and Texas, whereas the concomitant use rate was 20 percent or lower in California and Nevada.

So how much of a safety concern for claims administrators might their be?  The Pew Research Center, a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world highlighted the dangers of this off label pain medication.

According to Pew Research, drug users say gabapentin pills, known as “johnnies” or “gabbies,” which often sell for less than a dollar each, enhance the euphoric effects of heroin and when taken alone in high doses can produce a marijuana-like high.

Gabapentin is the sixth most prescribed drug in the United States, and the vast majority of uses are off-label. Gabapentin has landed on Schedule V Controlled Substance lists in 7 states over the last 5 years. During that same time period, 12 other states have placed the drug in their prescription drug monitoring programs (PMP). Three others are in the process of adding the prescription medication to Schedule V lists or state PMPs. California is not one of the states in either category.