test

Gabapentin and pregabalin misuse

Posted · 18 Comments

 

Gabapentin-caution-2

ResearchBlogging.orgGabapentin and pregabalin misuse are problems that are not going to go away. My post on gabapentin is one of the most-read on this site. While these are useful medicines, workers in drug treatment and support see patients regularly on gabapentin or pregabalin who have misused the drugs or who are misusing them. Guidance is to avoid these in folk with a history of substance dependence. Guidance, it seems, is not being followed.

The problems

A paper in CNS Drugs by Prof. Fabrizio Schifano at the University of Hertfordshire takes a closer look. Awareness of the issues and the problems arising is increasing:

  • The drugs are widely prescribed in neurology, primary care and psychiatry
  • Prescription volumes are rising
  • Increasing reports of misuse are coming through
  • Fatalities are being reported

How do they work?

Prescribed for nerve pain or epilepsy (and less commonly for anxiety) they ‘soothe’ nerves by working on GABA systems, but may also indirectly influence the dopamine reward pathway. Both pathways could explain their potential for misuse. Users may take 3-20 times the recommended dose, chasing an effect which can include ‘euphoria, improved sociability, and a marijuana-like high/relaxation.’ Stopping abruptly can cause withdrawal, including ‘insomnia, nausea, headache or diarrhoea.’

Warning signs

  • In the UK… pregabalin and gabapentin prescribing has increased, respectively, by 350 and 150 % in just 5 years
  • There is an anecdotally growing black market, with gabapentinoids being allegedly available without prescriptions through online pharmacies
  • Pregabalin and gabapentin first emerged in the UK mortality databases in 2006 and have shown an increasing trend since then in respect of being implicated in death
  • Most gabapentin victims (e.g. two-thirds in 2012) were not being prescribed the drug
  • In a Swedish analysis of almost 50,000 patients who had received three or more gabapentin prescriptions, a third had a history of drug misuse
  • In a Scottish survey of drug clinic patients 22% (29/129) admitted to using gabapentin or pregabalin

Discussion

Prof Schifano points out that these drugs may be safer for non-addicted populations than other medications that are available. He also notes that although gabapentin and pregabalin received licenses in Northern America in 2005, the debate around misuse did not appear in the literature until 2010 and this lag mirrors the pattern with other ‘safe’ drugs like benzodiazepines. The reason for this may be in how trials are set up with carefully controlled dosing. Such trials typically exclude substance misusers. The Prof explains:

As a consequence, the real potential of misuse of the index molecule will be more properly appreciated only when a large number of clients, who will involve vulnerable individuals, are exposed to the drug.

Doctors need to be aware of the risk and cautious in prescribing and in withdrawing patients from the drug. They should ‘carefully evaluate a possible previous history of drug abuse’ and they need to be able to quickly identify problem use. But there is much more to be done:

The epidemiology of gabapentinoid misuse needs further detailed and urgent assessment, and consideration of gabapentin/pregabalin testing in urine drug screens should be routinely considered. Further empirical studies with gabapentinoids should be encouraged, focusing on a better assessment of their addictive liability levels across a range of dosages and in individuals with a previous substance misuse history.

Schifano, F. (2014). Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern? CNS Drugs, 28 (6), 491-496 DOI: 10.1007/s40263-014-0164-4

    18 Responses to "Gabapentin and pregabalin misuse"
    1. Detox Nurse says:

      Like antidepressant withdrawals, I wonder if Gabapentin/Pregabalin withdrawals will be rebranded as a discontinuation syndrome?

      • djmac says:

        Is it a ploy of Big Pharma to blur what’s really going on?

        • Detox Nurse says:

          Quite possibly, but if it walks like a duck and quacks like a duck, it’s probably a duck. I just don’t agree with Dirk Hanson (see his comments on your post about antidepressant withdrawals) that because there isn’t a psychological component (e.g. cravings) then it can’t be withdrawal.

    2. Dirtdealer says:

      I’m sorry, but I suspect that conventional treatment services, especially the medicalised ones will do their best to ignore Gabapentin or Pregabalin related issues for as long as they possibly can, regardless of what the withdrawal process is branded as. They’ll be far to busy scratching their heads over the opioids and benzodiazepine conundrum.

      For those who are experiencing problems resulting from their use/misuse it’s probably going to be a difficult time as (some) medical providers (conventional or otherwise) try to avoid being part of the solution, having originally been somewhat complicit in creating the problem.

      For those who decide to seek support in the form of prescribing orientated treatment services, assuming they are able to, they might just want to reflect upon what has been achieved by these services when they were liberally armed with methadone……..

      • detox nurse says:

        Interestingly, a few years ago, we arranged for someone to undergo an inpatient detoxifixation for pregabin. Not sure exactly how they did it though. Perhaps just treated symptomatically.

      • djmac says:

        I think some prescribers have a blind spot with gabapentin and pregabalin and it’s a blind spot that’s not doing their patients any favours.

        • Detox Nurse says:

          I think the problem with Dirtdealer’s comment is he seems to consider all treatment services as the same. The problem – from my view point – of pregabalin/gabapentin prescribing is coming from GPs in general practice so I’m not sure you could consider conventional drug or alcohol services as being “complicit in creating the problem”.

          • Dirtdealer says:

            Hi

            Sorry if my perspective was unclear….

            I was primarily referring to GP’s which is why I used the term ‘medical providers’. I was also referring to those (medicalised) treatment services, especially the ones that mimic the worst of the GP and Specialist prescriber practices.
            Particularly the ‘get em in and stack em high types of services.

            I certainly don’t think that treatment services are all the same. It I truly believed that, then I would have given up thinking or feeling anything about human beings and recovery a long time ago.

          • matt says:

            I have an idea for u. Take 600 mg of pregablin a day for 6 weeks and then classify the detox. Oh good luck on that one

            • James says:

              To me the detox felt like a benzo detox, but thank god only lasted 5 days, not several months like with benzos. Unlike benzodiazepines however, I found the compulsion to take Pregabs was far stronger than anything I’ve experienced – even mid tier opioids like Dihydrocodeine

    3. Dirtdealer says:

      You’re welcome (sorry…I can’t find any smileys).

    4. Sally says:

      I personally know that gabapentin is addictive. I always quickly ran out, and was suddenly switched to Depakote. I went to the ER, and was treated like a drug addict and sent home.

    5. James says:

      I was prescribed Pregabalin for anxiety in July 2013. I found it the MOST addictive drug I’ve ever experienced – much more so than opioids or benzos.

      I got the high immediately from my prescribed dose of 75mg twice a day. By December 2013 I was taking 1500mg a day by topping up from street buying.

      I told my GP about it & asked for a daily tapering script to come off Pregabalin, because the compulsion to take large amounts of it was something I couldn’t control.

      Again as said, I’ve never known compulsions like it.

      My GP said he could only do a weekly script – which I knew I’d have taken in one day, so I quit 1,500mg a day cold turkey, with the help of 15mg each day of diazepam.

      Thereafter followed 5 days of very, very intense anxiety & being bed ridden.

      I haven’t touched the stuff since.

      In Bristol, England, drug counsellors say Pregabalin is a bigger problem than heroin & crack cocaine.

      It’s the new Valium scandal waiting to happen, in my opinion.

    6. John says:

      I was addicted to pregabalin since 2006.They have become one of the most missusd drugs on the market.Where I live in Bradford,West Yorkshire there’s a massive pregab epidemic.It’s a naughty withdrawl.I was thieving them from a chemist for 7 months and eventually got caught and charged.It’s like an opiate/benzo withdrawl.Never again!!!!!

    7. koky says:

      i cant believe the amount of lterature about pre gablin and gabapentin being a low risk drug in terms of addiction.i am currently going through a cold turkey from pre gablin and i find that it is fully as addictive as benzos if not worse.the hot flushes and sweating is absolutely unbearable and thats not even mentioning the anxiety and the insomnia. i have a history of drug abuse and was taking it to stop seizures and fits that i was getting from detoxing from valium but it has created a whole new problem and i would say a worse one.there needs to be some sort of support out there with coming off pre gablin or something that will ease the withdrawals.it has set me back in my recovery, about a year to a year and a half because i am being forced to buy other prescribed drugs off the street to help with these withdrawals and i have started taking things that i was previously off of just to get me through the day and to get a sleep. Something needs to be done about this drug because in the last couple of years it has become readily available on the street and as i said it is fully as addictive as benzos or mabey even heroin.

    Leave a Reply

    Your email address will not be published. Required fields are marked *