Why Gabapentinoid Prescribing Is Rising Despite Declining Opioid Use

A trend in chronic pain management reveals that while prescriptions for long-term opioid therapy have decreased in the United States, the co-prescribing of gabapentinoids has increased. This shift raises significant safety concerns for patients, particularly older adults who may be more susceptible to adverse drug interactions.

Data analyzed from 2015 through 2023 shows a 24.3% decline in the number of U.S. Individuals receiving long-term opioid therapy. The number of patients on these therapies fell from 5.6 million in 2015 to 4.2 million in 2023.

Despite this overall decline, the frequency with which opioids are prescribed in tandem with gabapentinoids—such as gabapentin and pregabalin—has risen. The rate of co-prescribing increased from 47% in 2015 to 58.7% in 2023.

The Shift in Pain Management Strategies

Gabapentinoids were originally developed to treat epilepsy and neuropathic pain. As the medical community sought alternatives to opioids to avoid documented risks of overdose and addiction, clinicians found these medications attractive due to their specific mechanism of action in the central nervous system.

However, the data indicates that this transition has not been a simple substitution. Rather than replacing opioids entirely, gabapentinoids are increasingly being prescribed alongside them, creating a high-risk pharmacological combination.

Safety Concerns and FDA Warnings

The increase in co-prescribing has drawn attention from regulators due to the potential for severe side effects. The U.S. Food and Drug Administration (FDA) has warned that the combination of opioids and gabapentinoids can lead to respiratory depression.

This risk is further compounded by changes in the patient population receiving long-term opioid therapy. Between 2015 and 2023, the mean age of patients on these therapies rose from 52.5 years to 60.5 years.

The aging demographic of long-term opioid users increases the risk of polypharmacy, where patients take multiple medications simultaneously. This increases the likelihood of adverse events and complicates the standard of care for older adults managing chronic pain.

Summary of Prescribing Trends (2015–2023)

• The number of U.S. Patients on long-term opioid therapy decreased from 5.6 million to 4.2 million.
• The percentage of opioid patients also prescribed gabapentinoids rose from 47% to 58.7%.
• The average age of patients receiving long-term opioid therapy increased by 8 years, moving from 52.5 to 60.5 years.

These shifts raise critical questions regarding the long-term strategy for managing chronic pain. While global healthcare initiatives have successfully driven a decline in traditional narcotic prescriptions to combat the addiction crisis, the rise of co-prescribing suggests a new pharmacological challenge for providers and patients.