Claims Q&A: RX Drugs of Abuse: Which Non-Opioid Drugs Present Concern?

BENZODIAZEPINES

Benzodiazepines are a class of psychoactive drugs with sedative properties, often prescribed in workers’ comp for the treatment of anxiety, muscle spasms, insomnia, and other concerns. While benzodiazepines can be abused by themselves to achieve a mild to moderate high, they are often abused in tandem with other substances to produce a greater high, such as alcohol or opioids.

Common benzodiazepines: alprazolam, diazepam, and lorazepam

ABUSE-RELATED CONCERNS

Benzodiazepines are not meant to be taken chronically. Long-term adverse effects associated with benzodiazepines include cognitive impairment, physical dependence and withdraw, an increase in anxiety and depression, overdose, and death.

Additionally, even though evidence-based guidelines warn against combining benzodiazepines and prescription pain medications, benzodiazepines are almost always prescribed in combination with opioids in workers’ comp, despite significant risks.²

• Benzodiazepines are involved in 31% of opioid overdose deaths³
• Benzodiazepine overdoses are 75% likely to involve opioids⁴

MUSCLE RELAXANTS

Muscle relaxants are frequently used in workers’ comp to alleviate muscle spasms, pain, and overresponsive reflexes. While muscle relaxants can help with pain, they are not meant to be taken chronically as overreliance can lead to dependence and withdrawal, fueling abuse.

Common muscle relaxants: cyclobenzaprine, carisoprodol, methocarbamol, and tizanidine

ABUSE-RELATED CONCERNS

Muscle relaxants should be used with caution, as they present the risk of adverse effects such as mood changes, impaired thinking, paralysis, CNS depression, respiratory depression, and heart failure.

Risk varies among products. Carisoprodol (Soma^®) is known for having more severe withdrawal symptoms than cyclobenzaprine, increasing its risk for abuse. From 2004-2009, emergency department visits involving carisoprodol doubled from 16,000 to 32,000.⁵

While muscle relaxants can be abused by themselves, as depressants they can be more dangerous when combined with other depressants, such as alcohol, benzodiazepines, and opioids, increasing the likelihood of potentially fatal adverse effects.

ANTICONVULSANTS

Gabapentin and pregabalin are anticonvulsants (anti-seizure drugs) often used off-label for the treatment of certain types of neuropathic pain. While these drugs are considered very safe by themselves, they do have mood-altering properties and can be abused to boost the high of other drugs of abuse.

Abuse-Related Concerns

The excessive ingestion of gabapentin or pregabalin significantly increases risk for suicidal thoughts and overdose, a cause for concern as these drugs are seeing rising levels of abuse to boost the euphoric high of opioids.

• Law enforcement-derived data has found that gabapentin diversion is closely tied to the opioid epidemic and has slowly been on the rise⁶
• A systematic review of various databases found that increasingly, people are self-administering higher-than-recommended doses of pregabalin and gabapentin to achieve a high, particularly among opioid users⁷
• Of nearly 12,000 reported cases of abuse since 2004, 75% of those cases have occurred since 2012⁷

The state of Kentucky recently classified gabapentin as a Schedule V drug,⁸ while Ohio and Massachusetts now require the dispensing of gabapentin to be reported to their respective prescription drug monitoring programs.^9-10

In the event assistance is required analyzing a patient’s drug regimen, Healthesystems’ clinical pharmacists are available to answer questions for our customers and pharmacists within our network. Please contact our Ask a Pharmacist Drug Line at 866.646.2828. Questions can also be submitted online at www.healthesystems.com, or emailed to DrugInformation@Healthesytems.com