Growing use of off-label neurological drugs for pain: Study

Ninety-nine percent of injured workers who were prescribed a common epilepsy drug did not have a documented diagnosis for one of the approved conditions per the Food and Drug Administration, according to a study released Tuesday linking the use of such drugs as an alternative to opioids in workers compensation.

The Cambridge, Massachusetts-based Workers’ Compensation Research Institute studied prescription trends across 28 states, noting a growing number of workers receiving gabapentinoids – an umbrella classification for some neurological drugs — for managing pain arising from work-related injuries and raising safety and abuse concerns.

The study also found that when workers were prescribed medications, gabapentinoids were dispensed more often in some states than others ─ 10% of injured workers with prescriptions were dispensed gabapentinoids in Louisiana, Massachusetts and New York, whereas 3% of workers in California, Kansas, Missouri and New Jersey received gabapentinoids.

Gabapentinoids were almost always dispensed for off-label uses in the workers compensation system, with between 96% and 99% of injured workers lacking a documented diagnosis for one of the FDA-approved conditions for such drugs.

While off-label use of gabapentinoids is recommended on a limited trial basis for selected conditions with neuropathic features, one-third of workers with gabapentinoid prescriptions in workers compensation did not have a diagnosis for neuropathic pain conditions or FDA-approved indications. 

Workers with gabapentinoids often received opioids concomitantly, which increases the risk of respiratory depression resulting in overdose deaths. Nearly half of the workers with gabapentinoids simultaneously received an opioid prescription in Iowa, Kansas, Louisiana and Texas, whereas the concomitant use rate was 20% or lower in California and Nevada, according to WCRI.