What is Pregabalin?

Pregabalin is an anti-convulsant, pain-relieving medication, under the classification of Gabapentinoids, used in the treatment of1:

  • Fibromyalgia
  • Diabetes
  • Epilepsy
  • Anxiety disorders
  • Seizures
  • Management of neuropathic pain – pain caused by damage to the nerves that transmit messages between the brain and spinal cord to the skin, muscles, and other parts of the body.

As an anti-convulsant, or anti-epileptic drug, Pregabalin works by reducing the intensity of ‘abnormal electrical activity in the brain.’2 For the treatment of neuropathic pain, it reduces pain sensitivity by disrupting the pain signals sent from the brain through the spinal cord.3

Pregabalin is sold under the brand name Lyrica. Pregabalin prescriptions have sky-rocketed in recent years because it is highly effective for pain management. For those suffering from chronic pain, pregabalin offers some much needed relief from their condition. However, there have been enquiries into the safety, potential for abuse, and addictive power of pregabalin since its rise in popularity. Once believed to be non-addictive and non-narcotic, recent research reports that Pregabalin may be more dangerous than previously known particularly when misused.4

Side Effects of Pregabalin

As with any prescription medication, pregabalin comes with some side effects. According to Pfizer, some of the most common side effects include5:

  • Drowsiness, sleepiness during the day
  • Weight gain
  • Blurred vision
  • Impaired concentration
  • Constipation
  • Dry mouth
  • Increased appetite
  • Oedema (swelling)
  • Dependence

Pregabalin also poses a risk of some more serious side effects. According to the FDA, approximately one in every five hundred people ‘may have suicidal thoughts or actions with Lyrica’. Such reactions are not uncommon when it comes to anti-epileptic medications. Other serious, but rare, side effects include:

  • Difficulty breathing
  • Skin problems (blisters, rash, hives)
  • Chest pain, muscle pain, joint pain

Over-Prescription of Pregabalin

According to Yasir Abbasi, Consultant Psychiatrist and NHS Clinical Director, the use of Pregabalin is widespread across the UK.6 In 2016 alone there were over five million prescriptions for the drug.7

Pregabalin prescriptions rose in popularity as people began to understand the impact that excessive opioid prescriptions were having on the global population. The opioid epidemic has led many to search for alternative, non-opioid treatment options. As a result, more doctors prescribed pregabalin, once believed to be relatively safe and non-addictive. It is difficult to place blame on any one culprit for the excess of Pregabalin prescriptions as there are several factors at play. Doctors and physicians do of course hold some responsibility when it comes to safe and effective patient care, yet there is also enormous pressure on these professionals to fix the issues that arose following the over-prescription of opioids as well as pressure by pharmaceutical companies to prescribe their medications.8

According to Theresa E. Vitesse of Emory University School of Medicine, Atlanta, the increase is pregabalin prescriptions is ‘both in response to the epidemic of opioid use disorder and our decrease in prescribing opioids in an effort to find something in our ‘toolbox’ that might help patients with chronic pain and in response to the pharmaceutical industry.’9

As of April 2019, new rules on pregabalin prescriptions were put in place. Doctors can now only prescribe pregabalin for 30 days at a time, and a new prescription must be filled out after those 30 days if the course of medication must continue.

Pregabalin Abuse Potential

As mentioned earlier, Pregabalin (and another Gabapentinoid medication known as Gabapentin) have been subject to enquiry in recent years as clinicians and patients alike have become more aware of their side effects and potential for abuse.

Studies conducted to investigate the abuse potential of Pregabalin reported that Pregabalin abuse creates a similar effect to that of Valium10, a common benzodiazepine. It is most commonly abused among heroin users who use the drug to amplify the sedative and euphoric effects of heroin, teenagers who are experimenting with drugs, who may find the drug easy to attain as it is relatively inexpensive, and elderly patients who have been prescribed the drug by a doctor. Pregabalin is intended to be swallowed in pill form. It is often abused by users who crush the pill to snort the powder, smoke it, chew it, or inject it.

Pregabalin Abuse Across the Globe

Pregabalin abuse affects people in many countries, including the UK, Ireland, and the United Arab Emirates (UAE). In Ireland, the Irish Medical Council has warned doctors against overprescribing following the increase in Pregabalin-related poisoning and death in the country, and doctors guilty of overprescribing will face disciplinary action.11

In the U.A.E., public warnings have been issued against misuse of the drug. According to the Health Authority of Abu Dhabi (HAAD), the organisation received multiple reports about theft of the pain-relieving drug from pharmacies, and people threatening pharmacists to force them to provide it12. Approximately 68% of 68% of people undergoing drug treatment in the United Arab Emirates use pregabalin13. It has been found to be a popular drug of abuse in Jordan14 and there have been reports in Saudi Arabia of health workers misusing it15.

According to Dr. Farrukh Alam, Senior Psychiatrist at Addcounsel, we are now experiencing ‘the highest levels in history’ of people seeking treatment for pregabalin addiction.

Signs of Pregabalin Abuse

One of the earliest signs of pregabalin abuse is an increased tolerance, which happens when higher doses are taken with greater frequency. The body soon builds tolerance and the recreational effects of Pregabalin, namely euphoria and a sense of relaxation, become harder to achieve with a normal, therapeutic dose. Misuse of Pregabalin has been reported among multiple demographics, including teenagers, elderly patients, and those with a history of substance abuse.16

Some of the most common warning signs of Pregabalin abuse include:

  • Obtaining multiple prescriptions from different doctors
  • Decreased work or academic performance
  • Neglecting personal and familial responsibilities and personal hygiene
  • Loss of interest in hobbies
  • Short-term memory loss
  • Drastic mood swings
  • Exhibiting irritability and/or hostility when pregabalin is not accessible

If you see the above signs in yourself or a loved one, don’t hesitate to reach out to a professional therapist. Addcounsel can offer addiction services in the U.K and can make arrangements for residents of other countries to receive high-quality addiction treatment in the U.K.

1 Cross AL, Viswanath O, Sherman Al. Pregabalin. [Updated 2020 Mar 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470341/

2 “Pregabalin: Medicine To Treat Epilepsy And Anxiety”. Nhs.Uk, https://www.nhs.uk/medicines/pregabalin/. Accessed 1 Dec 2020.

3 “Pregabalin: Medicine To Treat Epilepsy And Anxiety”. Nhs.Uk, https://www.nhs.uk/medicines/pregabalin/. Accessed 1 Dec 2020.

4 Green, Katlyn et al. “Prescribing trends of gabapentin, pregabalin, and oxycodone: a secondary analysis of primary care prescribing patterns in England.” BJGP open vol. 3,3 bjgpopen19X101662. 29 Oct. 2019, doi:10.3399/bjgpopen19X101662

5 U.S. Food & Drug Administration. Lyrica [labeling]. Updated May 2018.

6 Obirenjeyi Oluyase, Adejoke. A Study Of The Appropriateness Of Prescriptions For Mental Health Disorders Or Pain Among Users Of A Specialist Treatment Service For Substance Use Disorders. University Of York, 2015, https://core.ac.uk/download/pdf/77023945.pdf. Accessed 1 Dec 2020.

7 Onakpoya, Igho J et al. “Benefits And Harms Of Pregabalin In The Management Of Neuropathic Pain: A Rapid Review And Meta-Analysis Of Randomised Clinical Trials”. BMJ Open, vol 9, no. 1, 2019, p. e023600. BMJ, doi:10.1136/bmjopen-2018-023600. Accessed 1 Dec 2020.

8 Kelly, Sharon et al. “”Pressured to prescribe” The impact of economic and regulatory factors on South-Eastern ED physicians when managing the drug seeking patient.” Journal of emergencies, trauma, and shock vol. 9,2 (2016): 58-63. doi:10.4103/0974-2700.179454

9 Frost, Mollie. “The Risky Rise Of Gabapentinoids”. Acphospitalist.Org, 2019, https://acphospitalist.org/archives/2019/12/the-risky-rise-of-gabapentinoids.htm. Accessed 1 Dec 2020.

10 Marsh, Sarah. “Pregabalin, Known As ‘New Valium’, To Be Made Class C Drug After Deaths”. The Guardian, 2017, https://acphospitalist.org/archives/2019/12/the-risky-rise-of-gabapentinoids.htm. Accessed 1 Dec 2020.

11 Ryan, Valerie. “Medical Council Issues Advice To Doctors Prescribing Benzodiazepines, Z-Drugs And Pregabalin”. Irish Medical Times, 2019, https://www.imt.ie/news/medical-council-issues-advice-doctors-prescribing-benzodiazepines-z-drugs-pregabalin-19-09-2019/. Accessed 1 Dec 2020.

12 Khaleej Times. “Public Warned Against Misuse Of Anxiety Drug”. 2011, https://www.khaleejtimes.com/nation/general/public-warned-against-misuse-of-anxiety-drug. Accessed 1 Dec 2020.

13 Evoy, Kirk E et al. “Abuse and Misuse of Pregabalin and Gabapentin.” Drugs vol. 77,4 (2017): 403-426. doi:10.1007/s40265-017-0700-x

14 Al-Husseini, A., Wazaify, M. & Van Hout, M.C. Pregabalin Misuse and Abuse in Jordan: a Qualitative Study of User Experiences. Int J Ment Health Addiction 16, 642–654 (2018). https://doi.org/10.1007/s11469-017-9813-4

15 Alsubaie SS, Zarbah AA, Alqahtani AS, Abdullah AS, Aledrees NS, et al. (2020) Prevalence of Pregabalin (Lyrica) Abuse among Healthcare Professionals in Asser Province Saudi Arabia. Int J Ment Health Psychiatry 6:1. doi: 10.37532/ijmhp.2020.6(1).175

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

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