The serious issue of iatrogenic harm associated with prescription opioids is an international emergency. It has recently been estimated that 1 in every 550 chronic opioid users die within 2½ years of their first opioid prescription. The use of gabapentin is widespread as an adjuvant pain relief strategy but can also cause respiratory depression. Co-prescription of gabapentinoids and opioids is now common. A recent study has demonstrated that the co-prescription of opioids and gabapentin is associated with an increased risk of accidental opioid-related mortality. After multivariable adjustment, co-prescription of opioids and gabapentin was associated with a significantly increased odds of opioid-related death (odds ratio [OR] 1.99, 95% CI 1.61 to 2.47, p < 0.001; adjusted OR [aOR] 1.49, 95% CI 1.18 to 1.88, p < 0.001) compared to opioid prescription alone. The increase in the odds of opioid-related death (relative to no concomitant gabapentin use) was markedly increaased with high dose gabapentin. This findings of this research accord with those of another study published in the British Journal of Anaesthesia, which found that the use of gabapentinoid medications into the postoperative period is associated with the increased use of naloxone to reverse over-sedation or respiratory depression.

Take home message: the prescription of gabapentin or pregabalin for people treated with opioids increases the risk of serious (potentially lethal) complications