Abuse of gabapentinoids in individuals with substance use disorders

The abuse of gabapentinoids has increased rapidly, and death cases have been reported with increasing rates. This study examines the toxicological analysis data of substance abuse cases conducted after legal regulations were implemented in Türkiye. The focus will be on the medicolegal implications of gabapentinoid positivity in these cases. Urine samples collected between July 2021 and July 2022 from individuals (ages 18-45) presenting at Manisa Mental Health and Diseases Hospital with diagnosed or suspected substance use disorders were analyzed for the presence of pregabalin, gabapentin, and other accompanying substances. High-resolution liquid chromatography-mass spectrometry (Orbitrap) was employed for analysis. The analysis reports and sociodemographic data of 10,300 cases were retrieved from the patient record system and subjected to statistical analysis using SPSS 25.0. Gabapentinoid positivity was detected in 21.6% (n = 2224) of these cases (pregabalin (PGB) 18.9% (n = 1943) and gabapentin (GBP) 5.3% (n = 546)). Of the positive cases, 93.9% (n = 2089) were male, with an average age of 28 ± 6.7. Forensic cases (probation and judicial) represented the majority of admitted and positive cases 2.6% (n = 265) of cases tested positive for both pregabalin and gabapentin. While an overall increase in pregabalin and gabapentin positivity rates was observed over time, a statistically significant difference (p < 0.05) was noted between years. Seven substances were detected with gabapentinoids. Methamphetamine was the most common accompanying substance, representing nearly half of the detected substances (46.8%, n = 1040), followed by THC-COOH (26.8%, n = 595). Despite legal regulations, the use of gabapentinoids is increasing rapidly. The study highlights the urgent need to include gabapentinoids in routine screening tests, enforce stricter prescribing guidelines, and actively prevent their illegal use.