Letter to the Editor: On Patient Safety: It Is Time to Rethink Gabapentin

To the Editor,

I was pleased to read the column, “On Patient Safety: It Is Time to Rethink Gabapentin,” by James Rickert [2]. I believe it accurately describes the widespread overuse of the drug gabapentin for multiple pain diagnoses and the harm that may result from this. I think it is worth recalling the sordid history associated with the marketing of this drug for off-label indications. This history includes guilty pleas to civil and criminal charges, large criminal fines, and large settlements to multiple entities. The marketing of gabapentin was a masterclass in all of the shady techniques we have come to be familiar with, from cultivating a group of influential physicians with lucrative consulting agreements to exaggerating the benefits of treatment for conditions it was not approved for. Sadly, the results of those marketing efforts were “profoundly effective,” as noted by whistleblower David Franklin [1].

Orthopaedic surgeons who prescribe gabapentin may find it difficult to believe that the evidence on the effectiveness of such a ubiquitous drug is as flimsy as Dr. Rickert shows in his column [2]. They should understand that illegal and unethical practices are, to some extent, at the root of its widespread use.