The national opioid epidemic affects millions of Americans. Overdoses claimed more than 42,000 lives in 2016, according to the , up from 33,000 in 2015, and Kentucky has the fifth highest rate of overdose deaths of any state, at 33.5 per 100,000 population. Unfortunately, many people who abuse opioids were introduced to the drugs through a physician’s prescription to control pain.

“Spine surgery patients deal with an immense amount of pain both before and after surgery. Opioids are used to manage that pain,” said Mayur Sharma, MD, MCh, a resident in the UofL Department of Neurological Surgery who led the study. “Patients have been abusively using opioids for pain resulting in the recently declared national opioid crisis. Our work indicates that surgery for degenerative spondylolisthesis is associated with a reduced risk of opioid dependence.”

In the research, published last week in Journal of Neurosurgery: Spine, the authors analyzed records for 10,708 patients who had surgery between 2000 and 2012 for degenerative spondylolisthesis, a condition in which one vertebra slips over another one, compressing the nerves in the spinal column, most often occurring in the lower back. The researchers found that 14.85 percent of the patients were opioid dependent within one year prior to the surgery, and 9.9 percent were opioid dependent 3 to 15 months after the surgery. Most of the patients received decompression and fusion surgery for the condition. The authors concluded that overall, opioid dependence was reduced by nearly 5 percent following surgery for degenerative spondylolisthesis.

In addition to the reduction in dependency, analysis of the records showed that younger age and prior opioid dependence were associated with a higher risk for post-surgery opioid dependence. This information may guide physicians in predicting which patients are at higher risk for opioid dependence following surgery.

“It is important to note that 10 percent of patients who come for surgery for degenerative spondylolisthesis will be opioid dependent after surgery. These patients require special attention. Our paper discusses some of the predictive factors to consider,” Sharma said.

“,” was coauthored by Sharma, Maxwell Boakye, MD, chief of spinal neurosurgery, Beatrice Ugiliweneza, PhD, MSPH, assistant professor, and Zaid Aljuboori, MD, of UofL, and colleagues at University of California, Davis and Swedish Medical Center in Seattle.

Gabapentin, a nerve pain medication and anticonvulsant sold under the brand name Neurontin and others, increasingly is being misused, necessitating prescribers to understand its abuse potential and risk profile, said Rachel Vickers Smith, PhD, MPH, assistant professor in the University of Louisville School of Nursing.

She has found that abusers typically mix gabapentin with opioids, marijuana, cocaine and opioid treatment medication, compounding side effects to the central nervous system that include euphoria and sedation.

Some people who have primarily abused opioid pain medication have turned to gabapentin after crackdowns made it more difficult to obtain opioid prescriptions or purchase the drug on the street because of its expense.

“People are looking for other drugs to substitute for opioids, and gabapentin has filled that place for some,” Vickers Smith said. “Some have said it gives them a high similar to opioids. It had been easy to get a prescription for gabapentin and it’s very cheap.”

Vickers Smith and other researchers authored a  recently published in Psychology of Addictive Behaviors that explores recreational gabapentin use by a cohort of study participants in Appalachian Kentucky. Thirty-three people who reported recent recreational use of gabapentin were recruited from two ongoing longitudinal studies of drug users to participate in focus groups.

Overall, participants reported having started taking gabapentin more than 10 years ago after it was prescribed for a legitimate, though generally off-label reason, including pain, anxiety and opioid detoxification.

The findings highlight the low cost of gabapentin and its increasing recreational popularity, particularly over the past two years.

In July, Kentucky became the first state to classify gabapentin as a controlled substance, making it more difficult for the medication to be prescribed. State lawmakers relied on research findings of Vickers Smith and others as evidence during senate hearings.

Despite its abuse risk, the Centers for Disease Control and Prevention two years ago released  recommending gabapentin as an alternative to opioids for pain treatment.

Since gabapentin’s release in 1993, there have been no human laboratory studies done on the drug, Vickers Smith said.

“Early on, it was assumed to have no abuse potential,” she said. “There’s a need to examine it in further detail, especially if prescribing it is going to be encouraged.”