{"doi":"10.1002/cpt.3019","title":"Concurrent Gabapentin and Opioid Use and Risk of Mortality in Medicare Recipients with Non‐Cancer Pain","abstract":"Gabapentin is prescribed for pain and is perceived as safe generally. However, gabapentin can cause respiratory depression, exacerbated by concomitant central nervous system depressants (e.g., opioids), a concern for vulnerable populations. We compared mortality rates among new users of either gabapentin or duloxetine with or without concurrent opioids in the 20% Medicare sample. We conducted a new-user design retrospective cohort study, in Medicare enrollees ages 65-89 years with noncancer chronic pain and no severe illness who filled prescriptions between 2015 and 2018 for gabapentin (n = 233,060) or duloxetine (n = 34,009). Daily opioid doses, estimated in morphine milligram equivalents (MMEs), were classified into none, low (0 < MME < 50), and high (≥ 50 MME), based on Centers for Disease Control and Prevention (CDC) recommendations. The outcomes were all-cause mortality (primary) and out-of-hospital mortality (secondary). We used inverse probability of treatment weighting to adjust for differences between gabapentin and duloxetine users. During 116,707 person-years of follow-up, 1,379 patients died. All-cause mortality rate in gabapentin users was 12.16 per 1,000 person-years vs. 9.94 per 1,000 in duloxetine users. Risks were similar for users with no concurrent opioids (adjusted hazard ratio (aHR) = 1.03, 95% confidence interval (CI): 0.80-1.31) or low-dose daily opioids (aHR = 1.06, 95% CI: 0.63-1.76). However, gabapentin users receiving concurrent high-dose daily opioids had an increased rate of all-cause mortality compared with duloxetine users on high-dose opioids (aHR = 2.03, 95% CI: 1.19-3.46). Out-of-hospital mortality yielded similar results. In this retrospective cohort study of Medicare beneficiaries, concurrent use of high-dose opioids and gabapentin was associated with a higher all-cause mortality risk than that for concurrent use of high-dose opioids and duloxetine.","journal":"Clinical Pharmacology & Therapeutics","year":2023,"id":329711,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9513,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":580234,"name":"Laura L. Daniel","orcid":"0000-0003-3143-5915","position":1,"is_corresponding":false},{"id":422422,"name":"Alyson L. Dickson","orcid":"0000-0003-3404-3802","position":2,"is_corresponding":false},{"id":884676,"name":"Puran Nepal","orcid":"0000-0001-8550-5101","position":3,"is_corresponding":false},{"id":1053419,"name":"Kathi Hall","orcid":null,"position":4,"is_corresponding":false},{"id":370302,"name":"W. Dale Plummer","orcid":null,"position":5,"is_corresponding":false},{"id":275874,"name":"William D. Dupont","orcid":"0000-0002-8166-599X","position":6,"is_corresponding":false},{"id":478589,"name":"Katherine T. Murray","orcid":"0000-0002-1342-4457","position":7,"is_corresponding":false},{"id":251751,"name":"Christoph Stein","orcid":"0000-0001-5240-6836","position":8,"is_corresponding":false},{"id":1052859,"name":"Wayne A. Ray","orcid":"0000-0001-9188-9017","position":9,"is_corresponding":false},{"id":273407,"name":"Cecilia P. Chung","orcid":"0000-0001-5908-9423","position":10,"is_corresponding":false},{"id":1052858,"name":"M. Corriere","orcid":"0000-0003-2181-7100","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T01:09:05.843139Z","pmid":"37548889","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}