Unravelling the Pregabalin and Gabapentin Epidemic: A rising menace in the UK

Pregabalin, initially designed to offer relief for neuropathic pain and epilepsy, has emerged as a significant concern due to its widespread abuse and misuse, particularly in the UK.

Here Lee Hawker-Lecesne MBPsS, Clinical Director at The Cabin<https://www.thecabinchiangmai.com/>, Asia’s premier rehabilitation center with over 50 years of clinical expertise.

Looks at the multifaceted impacts of pregabalin misuse, including its structural association with gabapentin, and the concerning statistics surrounding its escalating prevalence.

Lee comments: “Pregabalin belongs to the class of drugs known as gabapentinoids, and it is structurally related to gabapentin. Both pregabalin and gabapentin are prescribed for various conditions. Pregabalin and gabapentin are frequently discussed together, usually under their group name ‘gabapentinoid’. This is because they are a similar type of drug, both cited as having a risk of misuse or dependency.  This class of drugs are structural analogues of the neurotransmitter GABA. Pregabalin and gabapentin are often referred to regarding their ‘off label’ use, in terms of being prescribed (or used) for a condition outside the terms of its original product authorization, or in different doses, or to patient groups not specified in the authorization. For example, avoiding prescribing an opioid/for chronic pain.”

What is Pregabalin and Gabapentin?

Pregabalin and Gabapentin: Pregabalin is a prescription-only drug, licensed in the UK to treat epilepsy (anti seizure), neuropathic pain (pain relief) and generalised anxiety disorder (anti anxiety). In the US it is also licensed to treat fibromyalgia.

A common brand name for pregabalin is Lyrica. Gabapentin is a prescription-only drug, similar to pregabalin, and prescribed for epilepsy (anticonvulsant) and neuropathic pain (pain relief). A common brand name for gabapentin is Neurontin.

Pregabalin Misuse Impacts in the UK

Recreational Use and Psychoactive Effects: Pregabalin’s psychoactive properties have led to its misuse for recreational purposes, inducing euphoria and relaxation. Users seek a sense of calmness and sedation, fostering a troubling trend in certain social circles.

Risk of Dependence and Addiction

Pregabalin poses a significant risk of dependence and addiction, especially when taken in excess or not as prescribed.

Tolerance development increases the likelihood of escalating doses, heightening the risk of addiction. Pregabalin and gabapentin, structural analogues of the neurotransmitter GABA, are frequently associated with a risk of misuse or dependency. Reports highlight concerns about their “off-label” use, prescribed for conditions beyond their original product authorization.

Both drugs are misused at multiples of therapeutic ranges, particularly in poly drug-taking repertoires, notably with opioids. Pregabalin, due to its rapid absorption and potency, appears more susceptible to misuse than gabapentin. The pharmacokinetic properties of pregabalin contribute to its heightened danger in high doses.

Increased Incidents of Overdose

Lee describes how “the misuse of pregabalin, often combined with other substances, has resulted in a surge of overdose incidents. The drug’s depressant effects on the central nervous system become perilous when taken excessively or in conjunction with other CNS-affecting substances.”

Regulatory Response and Healthcare Concerns

Lee says “in response to mounting issues with misuse and abuse, regulatory authorities in the UK have taken stringent measures to control the prescribing and dispensing of pregabalin. In 2019, pregabalin was classified as a controlled substance under the Misuse of Drugs Act, making its possession illegal without a prescription. Healthcare professionals are increasingly cautious about prescribing both pregabalin and gabapentin, weighing the legitimate medical benefits against potential misuse risks.”

Health agencies and law enforcement entities in the UK have implemented robust monitoring systems to track the misuse of pregabalin and other prescription medications. This includes vigilant monitoring of prescription patterns, identification of potential diversion cases, and tackling the illicit distribution of the drug.

Pregabalin and Gabapentin Dynamics

There has been a worrying rise in prescribing “in Europe since 2008, there has been a significant upswing in the prescribing rates for both pregabalin and gabapentin. In the UK, between 2004 and 2015, a staggering 24% increase in the prescribing rate of gabapentinoids was recorded, with a 46% rise in gabapentin and 53% increase in pregabalin prescribing since 2011.”

Prevalence and Risk Populations

In the UK problem drug users and prison populations are at increased risk of gabapentinoid misuse. Among opioid substitution treatment clients, prevalence has been shown to vary from 3% to 68%, with higher rates observed among psychiatric patients and within prison environments.

Statistics and Real-World Insights

Between 2013 and 2019, the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) received 113 reports of abuse and 98 reports of dependence associated with pregabalin. For gabapentin, 11 reports of abuse and 9 reports of dependence were recorded during the same period. Pregabalin-related drug deaths in Northern Ireland rose from 1 in 2013 to a peak of 77 in 2019, with 71 recorded in 2021. Police seizures of pregabalin in the UK increased by over 34% between July 2021 and June 2022.

Lee explains that “the escalating misuse of pregabalin and gabapentin in the UK presents a complex challenge, intertwining regulatory responses, healthcare caution, and real-world user experiences. Addressing this public health crisis demands ongoing monitoring, education, and collaborative efforts among healthcare professionals, regulators, and law enforcement to strike a balance between medical necessity and the potential risks associated with misuse and dependence.”