Pilot trial of gabapentin for the treatment of benzodiazepine abuse or dependence in methadone maintenance patients

Am J Drug Alcohol Abuse. 2016 May;42(3):333-40. doi: 10.3109/00952990.2015.1125493. Epub 2016 Mar 10.

Abstract

Background: Benzodiazepine use disorders are a common clinical problem among methadone maintenance treatment patients and have adverse effects on clinical outcomes.

Objectives: To evaluate gabapentin for the outpatient treatment of benzodiazepine abuse or dependence in methadone maintenance patients.

Methods: Participants (n = 19) using benzodiazepines at least 4 days per week were enrolled into an 8-week randomized double-blind placebo-controlled outpatient pilot trial. All participants received a manual-guided supportive psychotherapy aimed to promote abstinence. Study medication was titrated over a 2-week period to a maximum dose of gabapentin 1200 mg or placebo three times a day. Benzodiazepine use was assessed using urine toxicology confirmed self-report. Benzodiazepines were not provided as part of study participation; participants were provided guidance to gradually reduce benzodiazepine intake.

Results: Sixteen participants had post-randomization data for analysis. Retention at week eight was 50%. The mean dose of gabapentin achieved by titration was 2666 mg/day (SD = ± 1446). There were no significant between group differences on benzodiazepine use outcomes (amount benzodiazepine per day [Mann-Whitney U = 27, p = 0.745], abstinent days per week [U = 28, p = 0.811]) and Clinical Instrument Withdrawal Assessment (CIWA)-benzodiazepines scale (U = 29.0, p = 0.913). One participant in the gabapentin group discontinued study medication because of peripheral edema. Two participants in the placebo group requested admission for inpatient detoxification treatment.

Conclusion: In outpatient methadone-maintained patients with benzodiazepine use disorder, gabapentin did significantly decrease benzodiazepine use relative to placebo. The small sample recruited for this trial may have limited the ability to detect a group difference.

Trial registration: ClinicalTrials.gov NCT00420771.

Keywords: Benzodiazepines; gabapentin; methadone treatment.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amines / therapeutic use*
  • Benzodiazepines / adverse effects*
  • Combined Modality Therapy
  • Cyclohexanecarboxylic Acids / therapeutic use*
  • Double-Blind Method
  • Female
  • Gabapentin
  • Humans
  • Male
  • Methadone / therapeutic use
  • Middle Aged
  • Opiate Substitution Treatment / methods
  • Pilot Projects
  • Psychotherapy
  • Substance Withdrawal Syndrome / drug therapy
  • Substance-Related Disorders / drug therapy*
  • Substance-Related Disorders / therapy
  • Young Adult
  • gamma-Aminobutyric Acid / therapeutic use*

Substances

  • Amines
  • Cyclohexanecarboxylic Acids
  • Benzodiazepines
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Methadone

Associated data

  • ClinicalTrials.gov/NCT00420771