Patterns of pregabalin prescribing in four German federal states: analysis of routine data to investigate potential misuse of pregabalin

Abstract

ObjectivesThe objectives of this study were to investigate the utilisation patterns of pregabalin, to identify users potentially misusing pregabalin and to compare this group of patients to patients prescribed recommended doses of pregabalin concerning their personal characteristics and the coordination among their prescribers. Unintended coprescription of drugs with addictive potential might occur when care is insufficiently coordinated.DesignSecondary data analysis of linked data from three regional sickness funds in Germany (AOK) for the years 2014–2016.SettingAmbulatory and hospital care sector in four German federal states.MethodsOn the basis of routine data, patients who received at least three prescriptions of pregabalin were identified and classified into patients prescribed pregabalin as recommended and those dispensed with a higher than recommended dose (>600 mg/day). Social network analysis was applied to identify prescription networks and to analyse cooperation among the prescribers. With descriptive statistics and univariate statistical tests, typical characteristics of the group of patients potentially misusing pregabalin were compared with the others.ResultsAmong the 53 049 patients prescribed pregabalin, about 2% (877) were classified as potentially misusing pregabalin. The majority of this group was male and aged between 30 and 60 years. Of the patients misusing pregabalin, 365 (42%) had a diagnosed history of substance use disorders and 359 (41%) had been prescribed another drug with addictive potential (opioids) before. The prescribers of those patients potentially misusing pregabalin were more loosely connected within networks compared with prescribers of patients prescribed pregabalin as recommended.ConclusionThis study found that patients could exceed recommended doses of pregabalin by getting prescriptions from multiple physicians. Specific patients were at increased risk of potentially misusing pregabalin, and these patients sought to obtain their prescriptions from physicians who were as loosely connected as possible. Coordination and sharing a relevant number of patients seem to be levers to avoid these problems of unintended coprescribing.

Trends in Pregabalin Use and Prescribing Patterns in the Adult Population: A 10-Year Pharmacoepidemiologic Study

“…As observed in other countries, the vast majority of pregabalin prescriptions in our study were for neuropathic pain and pain indications in general [ 4 , 29 ]. While pregabalin is also registered in Israel for the treatment of generalized anxiety disorder, it is not commonly used for this indication in practice, as shown by our results (0.2 and 0.09% prescriptions dispensed in 2010 and 2019, respectively).…”

“…In part, it is possible that the perception that pregabalin poses a lower potential for abuse than opioids has prompted its consideration as an alternative to general pain management. This includes acute perioperative treatments and chronic pain management, aiming to reduce opioid consumption due to the sharp increase observed in the use of opioids, as previously reported in the USA, UK, and Europe [ 10 , 28 , 29 , 31 – 33 ]. In this regard, between 2008 and 2018, the use of strong opioids in Israel increased two-fold among elderly patients without cancer and more than seven-fold among patients younger than 65 years old [ 34 ].…”

“…While pregabalin is also registered in Israel for the treatment of generalized anxiety disorder, it is not commonly used for this indication in practice, as shown by our results (0.2 and 0.09% prescriptions dispensed in 2010 and 2019, respectively). A German study also reported an uncommon use for generalized anxiety disorder within the corresponding years [ 29 ]. Pregabalin’s infrequent prescription for generalized anxiety disorder in Israel may be related to several factors; however, it is beyond the scope of the current study.…”

Occurrence of involuntary movements after prolonged misuse of zolpidem: a case report

“…Pregabalin is widely used in elderly people with a diagnosis of a generalized anxiety disorder (Montgomery et al , 2008). However, some cases of GABA mimetics abuse and dependence have been documented, especially in people with a history of substance abuse disorder and treated with opioids (Flemming, 2022). In our case, pregabalin was prescribed in combination with clonazepam to reduce zolpidem craving in the acute phase (Oulis et al , 2011), slowly tapering both medications in the next weeks.…”

Liver disease epidemiology and burden in patients with alterations in plasma protein metabolism: German retrospective insurance claims analysis

“…This data set covers approximately 3.3 million individuals from the federal states of Saxony and Thuringia, accounting for approximately 4.5% of the German statutory health insured (SHI) population in 2020. The age and comorbidity characteristics of patients insured by AOK PLUS are similar to those in the general German population who are insured by sickness funds[ 11 - 14 ].…”