Clinical Variables among Egyptian Patients with Opioid Use Disorder Only versus with comorbid Gabapentin Use Disorder
Authors: Nagy Nahla El Sayed , Mohsen Nesreen Mohamed , Elrassas Hanan Hany , Elawady Sara Abd Elkader , Dardeer Nourhan Mohamed 
Published: November 2024

Abstract

Background
Like the increased clinical use of gabapentin, these trends appear to chronologically align with the opioid overdose crisis and particularly with the increased restrictions on opioid prescription. Among the published literature, the prevalence of gabapentin misuse has been estimated at 1.6% to 6.6% in the general population and 3% to 68% among individuals with a substance use disorder. Gabapentin is well tolerated when consumed at or below the FDA maximum recommended dose of 3600 mg/day.

Objective
the study aims to assess and compare between clinical variables, rate of relapses, Overdose symptoms, pain quality and severity, among patients with OUD only and Opioid with comorbid GUD. Furthermore, this study was conducted to assess clinical correlates in relation to socio-demographics, personality disorders and degree of addiction severity in patient with OUD only and Opioid with comorbid GUD.

Patients and Methods
The study was carried out at Okasha Institute of Psychiatry, Ain Shams University, particularly the outpatient clinic and inpatient unit of addiction medicine. Participants were selected as sample sizes of 30 and 30 according to those meeting, the inclusion Criteria for participants: diagnosed with opioid use disorder/ opioid use disorder with comorbid gabapentin use disorder according to DSM-V, both genders, aged between (18 – 45) years old, Egyptian nationality, and Agreement for written informed consent for participation in this study.

Results
In our study, dose of oral opioid was found to be more than 225mg in 46.7% of the opioid group and less than 225 mg in 33.3% of the gabapentin group with an evident statistically high significant difference between both groups and a P-value of 0.004,while heroin sniffing was 76.7% in the opioid group and 33.3% in the gabapentin group with an evident statistically high significant difference between both groups and a P-value of 0.001 and regarding dose of sniffed heroin, it was &gt;1gm in 70% of the opioid group and in 10% of the gabapentin group with an evident statistically high significant difference between both groups and a P-value of 0.000. In addition, heroin IV route was 70% in the opioid group and 20% in the gabapentin group with an evident statistically high significant difference between both groups and a P-value of 0.000 and regarding dose of IV heroin, it was &gt;1gm in 63.3% of the opioid group and in 13.3% of the gabapentin group with an evident statistically high significant difference between both groups and a P-value of 0.000. Euphoria was found to be the desirable effect in 86.7% of the opioid group and 23% of the gabapentin group, meanwhile, pain relief was the desirable effect in 3.3% in the opioid group and 66.2%in the Gabapentin group with an evident statistically high significant difference between both groups and a P-value of 0.000. Regarding overdose, it was found to be 16.7% of the opioid group and 56.7%% of the Gabapentin group with statistical significance between both groups and a P-value of 0.018. Respiratory complications were found to be 20% of Gabapentin group statistical significance between both groups and a P-value of 0.049. Moreover, regarding history of pain, the percentage was 16.7% in the opioid group and 83.3% % in the gabapentin group with high significance between both groups and a P-value of 0.000. Also, the presence of significant neuropathic pain was 3.3% in the opiod group versus 80% in the Gabapentin group. There was a high significance between both groups with a P-value of 0.000. Regarding addiction severity, the percentage of very severe medical problems was 36.7%% in the opioid group and 13.3% % in the gabapentin group with high significance between both groups and a P-value of 0.025,inaddition, the percentage of mild psychiatric problems was 23.3%% in the opioid group and 10% % in the gabapentin group with high significance between both groups and a P-value of 0.023. Finally, the current study showed that the incidence of abstinence was 83.3% in the opioid group and 56.7% in the gabapentin group with statistical significance between both groups and a P-value of 0.024.

Conclusion
The current study showed that patients with opioid with comorbid GUD were associated with higher incidence overdose, history of pain and presence of significant neuropathic pain. The incidence of pain relief as a desirable effect higher in patients with opioid with comorbid GUD compared to patients with OUD. While, the incidence of euphoria as a desirable effect was higher in patients with OUD compared to patients with opioid with comorbid GUD. The patients with OUD have higher incidence of abstinence compared to patients with opioid with comorbid GUD. The patients with OUD have higher doses of oral, Sniffed, and IV opioids compared to patients with opioid with comorbid GUD. OUD patients have more severe medical and psychiatric problems than with comorbid GUD.