Gabapentin and Opioid Prescribing Trends among Adolescents Undergoing Common Procedures: A National Retrospective Cohort Study

BACKGROUND: Adolescents who fill an opioid prescription for surgery are at increased risk of adverse outcomes, including persistent opioid use, addiction, or overdose. Limited evidence suggests clinicians may increasingly prescribe gabapentin as an opioid-sparing strategy, although gabapentin is increasingly associated with adverse outcomes. We examined perioperative gabapentin and opioid prescribing trends over time. METHODS: Using a national, private insurance claims database, we identified a cohort of gabapentin and opioid-naïve adolescents 11-21 years old who underwent 7 procedures that are either common or associated with postoperative persistent opioid use between 2012-2022. We quantified initial gabapentin and opioid prescriptions, refills within 60 days, and number of days and pills dispensed and used multivariable logistic regression analysis to assess the association between gabapentin dispensing and opioid refills. RESULTS: Of 181,225 gabapentin and opioid-naive adolescents, 32.1% (n=58,139) filled a new prescription for one or both. Specifically, 1.1% (n=662) filled a gabapentin prescription, 96.7% (n=56,210) filled an opioid prescription, and 2.2% (n=1,267) filled both. Initial gabapentin prescriptions included a mean supply of 22.0 days (SD, 15.0), 55.3% contained an initial daily dose ≥600mg, and 36.5% obtained ≥1 refill. Opioid-only prescriptions declined during the study period, while gabapentin prescriptions with and without opioid increased. Adolescents who filled both opioid and gabapentin versus opioid-only prescriptions had a 14% (95% CI 11.0-16.8%) adjusted probability difference with regard to obtaining an opioid refill (40.7% versus 21.6%). CONCLUSIONS: Gabapentin dispensing increased over time, and more than one-third of adolescents were dispensed a refill prescription. Co-prescription with opioids did not appear to be associated with decreased opioid quantity in the initial prescription or decreased likelihood of obtaining a refill opioid prescription after undergoing a study procedure. In addition, opioids were often prescribed when they were unlikely to be needed for postoperative pain management.