Changes in orthopaedic prescribing patterns of gabapentin associated with state prescribing restrictions: A large database study.

Background: Safety concerns have emerged regarding gabapentin, and as a result several states have recently adopted regulations for prescribing gabapentin. As gabapentin has been commonly used off-label for pain management in orthopedics, a retrospective analysis was conducted to investigate trends in orthopedic prescriptions of gabapentin considering novel state regulations. Methods: The study analyzed gabapentin prescription patterns of orthopedic surgeons from 2013 to 2021 recorded in annual Medicare Part D Public Use Files across the fifty states and Washington DC. Datasets were filtered to only include orthopedic providers. Gabapentin prescriptions were grouped based on state of practice for each surgeon per year for total gabapentin claims, supply in days, and beneficiaries. Twelve states classified gabapentin as a Schedule V drug, seven instituted a Prescription Drug Monitoring Program (PDMP), and 32 had no restrictions. States were grouped by prescription restriction type. Two-tailed t-tests were conducted to compare the annual average percent of change for gabapentin claims, supply, and beneficiaries per state following regulation. Results: Following regulation, the general trend of gabapentin claims, beneficiaries, and supply was a blunting in the annual rate of change. States with PDMPs for gabapentin had the lowest overall claims, supply, and beneficiaries. States with no regulation eclipsed states with Schedule V classifications for the most beneficiaries and supply in 2019 and claims in 2020. Six of 11 PDMP states had significant reductions across gabapentin claims, beneficiaries, and supply following regulation, compared to three of seven Schedule V states. Conclusion: The impact that state-based regulations had on gabapentin claims, supply, and beneficiaries was variable, likely due to different requirements in the enactment of their novel PDMP or Schedule V classifications. To optimize the implementation of these regulatory programs, public health authorities may adopt regulatory strategies that resemble those from states that were more effective in regulating gabapentin prescriptions. Level of evidence: Level III, Therapeutic Study.