The increasing use and misuse of gabapentin, an anticonvulsive medication, pose notable risks to public health and traffic safety. After obtaining U.S. Food and Drug Administration approval in 1993 for the treatment of epilepsy and neuralgia, the popularity of gabapentin soared, with the drug now frequently prescribed off-label for conditions such as insomnia, anxiety, and depression. Between 2016 and 2020, approximately 334 million gabapentin prescriptions were dispensed with 69 million in 2020 alone. Gabapentin is available in tablet, capsule, and solution formulations. Seven U.S. states have classified it as a Schedule V controlled substance, and several others have included it in the prescription monitoring programs to regulate its use. However, gabapentin remains unscheduled at the federal level in the United States.
As prescriptions for gabapentin rise, it is increasingly being detected in driving under the influence of drugs (DUID) cases. Gabapentin is currently a Tier II drug (optional, based on regional prevalence) in the National Safety Council Alcohol, Drugs, and Impairment Division’s (NSC-ADID) recommendations for toxicology testing in DUID investigations. While not required, many toxicology laboratories now offer gabapentin testing in DUID investigations. The number of forensic toxicology laboratories reporting gabapentin among their top 15 detected compounds increased from 5 in 2017 to 21 in 2021, according to an NSC-ADID survey. A recent review of DUID cases found that gabapentin was present in approximately 8 percent of cases across 17 states. The mean (median) age of gabapentin-positive drivers was 44 (41) years, and 56 percent of gabapentin-positive drivers were female. Gabapentin blood concentrations in drivers have also increased over the past eight years, as shown in Table 1.
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