Background/Aims: There is emerging evidence of gabapentin and pregabalin (gabapentinoid) abuse, particularly in the substance misuse population, and some suggestion of gabapentinoids being abused alongside methadone. Methods: A questionnaire-based survey was carried out in six substance misuse clinics, looking for evidence of gabapentinoid abuse. Results: 22% (29/129) of respondents admitted to abusing gabapentinoids, and of these, 38% (11/29) abused gabapentinoids in order to potentiate the ‘high' they obtained from methadone. Conclusions: Gabapentinoid abuse along with methadone has not previously been described. These findings are of relevance to clinicians working within both substance misuse services and chronic pain services.

In this article, I present a firsthand account as an anaesthetist with substance use disorder who has been through rehabilitation and returned to clinical anaesthesia, followed by an overview of substance use disorder in anaesthesia. Substance use disorder is prevalent within the anaesthesia community and can result in tragic consequences, including death in many cases. The incidence is around one to two per 1000 anaesthetist years and this appears to be rising, perhaps mirroring the population-wide increase in substance use disorder as a result of the opioid epidemic. Recognising substance use disorder in a colleague and intervening to try and help them and protect patients can be immensely challenging. Carrying out a successful intervention requires careful planning and coordination in order to protect the affected individual, their colleagues and patients. Returning to clinical anaesthesia following a diagnosis of substance use disorder is also contentious, with the high abstinence rate (relative to the wider substance use disorder population) having to be balanced against the risk of death following relapse. Any return to practice must be well planned and supported, and include appropriate toxicology screening. With such measures, rehabilitation and a return to clinical anaesthesia is possible in certain cases. For the affected individual regaining, then maintaining, their professional identity can be a powerful motivator to remain abstinent. Drug diversion and substance use disorder in anaesthesia is unlikely ever to be fully preventable, but strategies such as biometric dispensing, analysis of unused drugs, random toxicology and ongoing education may help to keep it to a minimum.