Opioid Use Disorder, Cannabinoid Use Disorder and Gabapentinoid Disorder: Compare and Contrast

Opioids (morphine, fentanyl, codeine etc), cannabinoids (dronabinol and nabilone) and gabapentinoids (gabapentin and pregabalin) are chemically unrelated compounds used for various clinical purposes including the treatment of pain. The recreational and therapeutic use of opioids and cannabinoids has evolved over thousands of years. By contrast, gabapentinoids were developed relatively recently as anticonvulsant drugs. While drugs in each class are useful as analgesics, they are also prone to misuse. The illicit use of opioids and cannabinoids and the underlying mechanisms for their hedonic effects are well documented. There is only a relatively recent recognition of the propensity for the diversion of prescribed gabapentinoids for illicit use. An unfortunate consequence is an increasing number of drug deaths associated with combining opioids and gabapentinoids. We will consider the term “use disorder” in the context of opioids, cannabinoids and gabapentinoids. We will examine mechanistic interactions between gabapentinoids and opioids and evidence for high levels of prescribing contributing to rapidly escalating drug deaths. We will also consider evidence for environmental factors that may influence the analgesic and hedonic response to opioids.