Gabapentin in drugged driving investigations

Area of Science:

• Forensic Toxicology
• Neuropharmacology
• Public Health

Background:

• Gabapentin, FDA-approved for epilepsy and neuralgia, is increasingly used off-label for conditions like insomnia and anxiety.
• Reported side effects include drowsiness, blurred vision, and loss of coordination, impacting driving safety.
• Gabapentin-associated drugged driving incidents and crashes are a growing concern.

Purpose of the Study:

• To analyze gabapentin's role in driving under the influence of drugs (DUID) cases.
• To provide toxicological insights for DUID investigations involving gabapentin.
• To assess the prevalence and patterns of gabapentin in DUID cases.

Main Methods:

• Review of approximately 108,000 gabapentin-positive DUID cases, with 858 meeting inclusion criteria.
• Blood specimen analysis using enzyme-linked immunosorbent assay (ELISA) and liquid chromatography tandem mass spectrometry (LC-MS/MS).
• Evaluation of driving and human performance data in selected cases.

Main Results:

• Overall DUID gabapentin positivity was 7.9% between January 2020 and December 2022 across 17 states.
• In 94% of cases, gabapentin was detected with other drugs, most commonly opioids (64%).
• Half of the reviewed cases involved at-fault crashes, consistent with gabapentin's known side effects.

Conclusions:

• Gabapentin is frequently involved in DUID incidents, often in poly-drug use cases.
• The drug's side effects can impair driving ability, increasing crash risk.
• Toxicological data on gabapentin is crucial for DUID case interpretation and public safety efforts.