Gabapentin was thought to have low abuse potential, but it is increasingly being abused by people with substance use disorder in an attempt to potentiate the euphoric effects from opioids and other CNS depressants. Additionally, infants co-exposed to gabapentin and opioids during pregnancy tend to exhibit prolonged and more severe neonatal abstinence syndrome. In this study, we describe positivity rates among commonly abused drugs and rates of co-medication with gabapentin in a large dataset of umbilical cord tissue specimens (n = 25,422) submitted for routine newborn drug testing at a national clinical reference laboratory (ARUP Laboratories, Salt Lake City, UT, USA). Detection of prenatal drug exposure in umbilical cord tissue specimens was accomplished using a semi-quantitative liquid chromatography–tandem mass spectrometry assay designed to detect 47 specific drugs and drug metabolites including opioids, stimulants, sedative-hypnotics and hallucinogens. A positive result for at least one of the measured drugs or drug metabolites was reported in 7,054 (28%) of the umbilical cord tissues analyzed. Gabapentin had a positivity rate of ~2% with 562 positive results. Of the 562 gabapentin-positive samples, 395 (70%) also had a positive result for at least one other drug or drug metabolite, with the highest co-positivity rate observed for norbuprenorphine (32%, n = 182) followed by amphetamine (15%, n = 84), buprenorphine (13%, n = 74), methamphetamine (12%, n = 68), morphine (11%, n = 64), fentanyl (10%, n = 54) and naloxone (10%, n = 54). Notably, the concentration of gabapentin in gabapentin-positive umbilical cord specimens was higher in buprenorphine-containing specimens as compared to specimens containing other opioids, stimulants or benzodiazepines. Identification of neonatal co-exposure to gabapentin and opioids, particularly buprenorphine, may guide clinicians in rapid initiation of monitoring and intervention for neonatal abstinence syndrome.

中文翻译：

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新生儿共同暴露于加巴喷丁和脐带组织中常见滥用药物的模式

加巴喷丁被认为具有较低的滥用潜力，但是越来越多的物质滥用障碍者正在滥用加巴喷丁，以增强阿片类药物和其他中枢神经系统抑制剂的欣快感。另外，在怀孕期间同时暴露于加巴喷丁和阿片类药物的婴儿往往表现出长期禁忌和更严重的新生儿禁欲综合症。在这项研究中，我们描述了脐带组织样本（n = 25,422）已提交给国家临床参考实验室（美国犹他州盐湖城的ARUP实验室）进行常规新生儿药物测试。使用半定量液相色谱-串联质谱分析法检测脐带组织标本中的产前药物暴露，该检测方法旨在检测47种特定药物和药物代谢产物，包括阿片类药物，兴奋剂，镇静催眠药和致幻剂。在所分析的脐带组织中，有7,054个（28％）报告了至少一种所测药物或药物代谢产物的阳性结果。加巴喷丁的阳性率为〜2％，阳性值为562。在562个加巴喷丁阳性样品中，有395个（70％）对至少一种其他药物或药物代谢产物也呈阳性结果，对去甲丁丙诺啡的共阳性率最高（32％，n  = 182），然后是苯丙胺（15％，n  = 84），丁丙诺啡（13％，n  = 74），甲基苯丙胺（12％，n  = 68），吗啡（11％，n  = 64），芬太尼（10％ ，n  = 54）和纳洛酮（10％，n  = 54）。值得注意的是，含丁丙诺啡的标本中加巴喷丁阳性脐带标本中加巴喷丁的浓度高于含有其他阿片类药物，兴奋剂或苯二氮卓类的标本。新生儿与加巴喷丁和阿片类药物特别是丁丙诺啡的共同暴露的鉴定，可以指导临床医生快速开始对新生儿禁欲综合征的监测和干预。