It was announced last week that the home office is going to crack down on the massive over prescription of Pregabalin and Gabapentin by GP's and hospital doctors that we have seen in the last few years in an attempt to reduce the widespread abuse of these addictive drugs. The changes will mean the drugs will no longer be allowed on a routine repeat prescription and the doctor must actually sign the prescription. The changes will come into effect in August 2019.
Evidence suggests that many of these prescription painkillers are ending up on the streets of the UK, and are being sold and abused often in much larger does than they would have been prescribed in.
In response to escalating concerns over the misuse and overprescription of pregabalin and gabapentin, the UK Home Office reclassified both medications as Class C controlled substances under the Misuse of Drugs Act 1971, effective from 1 April 2019 . This decision followed recommendations from the Advisory Council on the Misuse of Drugs (ACMD), which highlighted the growing potential for abuse, addiction, and illegal diversion of these drugs .
Understanding Pregabalin and Gabapentin
Originally developed as anticonvulsants, pregabalin (marketed as Lyrica) and gabapentin (marketed as Neurontin) are prescribed for various conditions:
- Pregabalin: Used to treat epilepsy, neuropathic pain, and generalised anxiety disorder.
- Gabapentin: Prescribed for epilepsy and peripheral neuropathic pain, such as diabetic neuropathy and post-herpetic neuralgia .
Despite their therapeutic benefits, both drugs have been increasingly misused for their euphoric effects, especially when combined with other central nervous system depressants like opioids and alcohol. Such combinations can lead to severe side effects, including respiratory depression and death .
Rising concerns and misuse
The reclassification was driven by alarming statistics:
- Between 2013 and 2017, deaths linked to pregabalin and gabapentin rose from 32 to 127 annually in England and Wales.
- In Northern Ireland, pregabalin-related deaths increased from 8 in 2016 to 33 in 2017.
New regulations and prescribing practices
With their reclassification, the following measures were implemented to curb misuse:
- Doctors must provide handwritten prescriptions; electronic prescriptions are no longer accepted.
- Pharmacists are required to dispense these medications within 28 days of the prescription date.
- Possession without a valid prescription, as well as unauthorised supply or sale, is now illegal .
These steps aim to enhance accountability and reduce the potential for these drugs to be diverted for non-medical use.
Ongoing monitoring and public health implications
The reclassification of pregabalin and gabapentin underscores the delicate balance between providing effective pain management and preventing drug misuse. Healthcare professionals are now urged to:
- Thoroughly assess patients for any history of substance abuse before prescribing these medications.
- Monitor for signs of misuse, such as escalating doses or drug-seeking behavior.
- Educate patients about the risks associated with these drugs, especially when combined with other depressants.
As the situation evolves, continuous monitoring and public education remain crucial in addressing the challenges posed by prescription drug misuse.