Development of the Gutti Score: A Universal Clinical Assessment Framework for Patients Receiving Gabapentinoids, Opioids, Benzodiazepines, and Other Central Nervous System Depressants

Introduction: The use of gabapentinoids, opioids, benzodiazepines, and other central nervous system (CNS) depressants has increased significantly, raising concerns about respiratory depression and overdose risk, particularly when used in combination. Existing risk assessment tools primarily focus on opioids and do not comprehensively account for multiple medication classes and patient comorbidities. Objective: To develop and retrospectively apply a structured clinical framework (“Gutti Score”) intended to organize medication-related and patient-specific factors associated with overdose risk among patients receiving gabapentinoids, opioids, benzodiazepines, and other central nervous system depressants. Methods: A retrospective observational pilot study was conducted using an existing patient database from 2017 to 2019. Patients prescribed gabapentinoids (gabapentin or pregabalin), opioids, benzodiazepines, or other CNS depressants were included. A structured scoring framework incorporating medication exposure and comorbid conditions was retrospectively applied using exploratory cumulative burden categories. Patients were followed for one year, and outcomes included overdose events and mortality. Results: A total of 112 patients were included. Forty-six patients (41.1%) demonstrated lower cumulative burden profiles, while sixty-six patients (58.9%) demonstrated intermediate cumulative burden profiles. No overdose events or overdose-related deaths were observed during the follow-up period, limiting assessment of predictive performance. Patients within the intermediate cumulative burden category demonstrated a higher burden of comorbid conditions and greater medication exposure compared with those in the lower cumulative burden category. Conclusion: These findings support the feasibility of the proposed framework; however, no conclusions regarding predictive validity or discriminatory performance can be established from the present study. Further prospective investigation involving larger and more diverse populations is required before broader clinical applicability can be determined.