Following our recent article regarding Pregabalin and its suggested link to a rise in deaths, it has now been announced that both Pregabalin and Gabapentin are set to become controlled ‘Class-C’ drugs. This followed the Advisory Council on the Misuse of Drugs (ACMD) recommending to the Home Office in January 2016 that they should be controlled, warning that both drugs “present a risk of addiction and a potential for illegal diversion and medicinal misuse.”
The Home Office has now accepted this recommendation, subject to a consultation.
Dr Steve Brinksman of Substance Misuse Management in Group Practice network, said “they have psychotropic effects, which means patients are likely to continue taking them even if they are not proving effective. They probably do have a withdrawal effect – though that has not been proven conclusively yet”.
Earlier this year, a Cochrane Review concluded that Gabapentin “can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy” but “evidence for other types of neuropathic pain is very limited.” Further, “over half of those treated with gabapentin will not have worthwhile pain relief but may experience adverse events.”
This followed a study published last year by researchers from the University of Kentucky that found that misuse of Gabapentin was “40-65% among individuals with prescriptions”. In this study, misuse was defined as using Gabapentin “primarily for recreational purposes, self-medication or intentional self-harm” where it is “misused alone or in combination with other substances, especially opioids, benzodiazepines and/or alcohol.”
Concern for chronic pain sufferers
Many thousands of people in the UK suffering CRPS and other forms of chronic pain take Pregabalin or Gabapentin as part of their daily medication regime. It is yet to be seen exactly how the re-classification of the drugs will affect not only those already taking them, but also those who develop chronic pain in the future. However, at the very least it is bound to result in a greater reluctance among doctors to prescribe them.
Whilst there are clearly a minority of people misusing these drugs for a variety of purposes, for the majority the thought of their possible withdrawal will undoubtedly cause concern. People suffering chronic pain often find themselves taking Pregabalin or Gabapentin following considerable trial and error in exploring what type and combination of medication best suits them and their condition, including the ‘pain versus side effects’ set off. For many there is unlikely to be a readily identifiable alternative.
I have spoken today to one client with CRPS who takes Pregabalin in conjunction with Amitriptyline and Celebrex. It is now 18 months since she was first prescribed Pregabalin and whilst her daily dosage required increasing initially, she reports that since adding Pregabalin to her medication, her level of pain has improved. Whilst she does experience some side effects including drowsiness and occasional slurred speech, she is able to function better and, with less pain, her sleep has improved. She says that “since I heard the news last week I am dreading what might happen. I just hope that as my doctor knows I’ve gotten myself into a good routine that works, they’ll leave me alone.”