Health experts have raised concerns about a dramatic increase in the number of misuse cases in Australia involving the anti-epileptic drug pregabalin.
Sold under the brand name Lyrica, the drug has been noted by the Turning Point Alcohol and Drug Centre as being involved in 1200 cases of misuse over a five-year period since being subsidised by the Pharmaceutical Benefits Scheme (PBS) in 2013.
A Growing Problem
Dispensing rates of Lyrica increased by nearly three times in the three years following its inclusion on the PBS.
Lyrica was first approved for use in Australia by the Therapeutic Goods Association (TGA) in 2005. One study showed that there have been 88 deaths in New South Wales attributed to pregabalin abuse since its introduction, 82 of those deaths have been since 2013. In Victoria, pregabalin has been linked to 164 overdose deaths in a three year period from 2013.
Lyrica is often prescribed as useful alternative to opiates for treating neuropathic pain but some patients are using it to treat anxiety while others are taking it for recreational use. The Medical Journal of Australia this week published a study which stated that when taken in high doses, or combined with other drugs, the sedative or euphoric effects of Lyrica are increased. Some people using pregabalin for recreational use are taking a packet of 28 tablets a day, or combining Lyrica with alcohol, opioids, or cannabis.
Advice for health professionals
In combination with other drugs, pregabalin can result in delusions, hallucinations, drowsiness and confusion. The study looked at the number of pregabalin misuse-related ambulance attendances in Victoria from 2012 to 2017 and found that almost half of the ambulance attendances were for people with a history of drug misuse or psychiatric problems, although the researchers acknowledge that they could not determine if the drug was obtained illegally.
Currently, authorised nurse practitioners in Australia are also able to prescribe Lyrica. The authors of the study states that health professionals should be cautious when prescribing pregablin for patients using other sedatives.
The drug has only recently been highlighted as being a drug of potential abuse in Australia so it does not currently attract the same scheduling as an opiate or even a benzodiazepine, prompting health experts to caution doctors when prescribing the drug. One study concluded that one in seven patients prescribed Lyrica are at high risk of misusing it. Advice from the Turning Point Alcohol and Drug Centre is for doctors to be aware of their patient’s history and the potential for off-label use.
Controlling Usage
In 2017 the British Medical Association called for pregabalin to be made a controlled substance and consequently from April 2019 pregabalin will be made a class C drug in the United Kingdom. The United States and Norway have also implemented limits on the dispensing of pregabalin to minimise the risks of misuse.