Pregabalin abuse among opiate addicted patients

Grosshans, Martin; Leménager, Tagrid; Vollmert, Christian; Kaemmerer, Nina; Schreiner, Rupert; Mutschler, Jochen; Wagner, Xenija; Kiefer, Falk; Hermann, Derik

doi:10.1007/s00228-013-1578-5

Cited by 109 publications

(83 citation statements)

References 21 publications

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“…Pregabalin was detected in 12.1 % (n = 15) of urine samples from opiate-addicted subjects attending a German addiction clinic. None of these patients were suffering from any of the indications for pregabalin prescribing, with most having confirmed that they had acquired pregabalin illicitly whilst being well aware that the molecule was not included in the standard drug monitoring system [2]. Similarly, Baird et al [33] carried out a questionnaire-based survey in six Scottish substance misuse clinics; 22 % (29/129) of respondents admitted to abusing gabapentinoids, with 38 % (11/29) of these clients abusing these molecules to potentiate the 'high' they obtained from methadone.…”

Section: Addiction Clinics' Surveys; Results From Online Data Analysismentioning

confidence: 99%

“…This may be considered an observation that is in apparent contrast with gabapentinoids, similar to benzodiazepines, being GABA analogues only [26]. With a relatively short half-life of about 6 h, gabapentinoids are mostly ([98 %) excreted unchanged in the urine [15], with a urine specimen being positive for pregabalin for up to 5-6 days after intake in subjects with normal renal function [2].…”

Section: Methods/literature Search Strategymentioning

confidence: 98%

“…Pregabalin has been identified within the 30 most prescribed medications in the USA in 2011 [2]. In Europe, pregabalin is approved for the treatment of epilepsy (partial seizures), neuropathic pain and generalised anxiety disorder.…”

Section: Introductionmentioning

confidence: 99%

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Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

2014

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Gabapentinoids (e.g. pregabalin and gabapentin) are widely used in neurology, psychiatry and primary healthcare but are increasingly being reported as possessing a potential for misuse. In fact, increasing levels of both prescriptions and related fatalities, together with an anecdotally growing black market, have been reported from a range of countries. This article reviews the current evidence base of this potential, in an attempt to answer the question of whether there is cause for concern about these drugs. Potent binding of pregabalin/gabapentin at the calcium channel results in a reduction in the release of excitatory molecules. Furthermore, gabapentinoids are thought to possess GABA-mimetic properties whilst possibly presenting with direct/indirect effects on the dopaminergic 'reward' system. Overall, pregabalin is characterized by higher potency, quicker absorption rates and greater bioavailability levels than gabapentin. Although at therapeutic dosages gabapentinoids may present with low addictive liability levels, misusers' perceptions for these molecules to constitute a valid substitute for most common illicit drugs may be a reason of concern. Gabapentinoid experimenters are profiled here as individuals with a history of recreational polydrug misuse, who self-administer with dosages clearly in excess (e.g. up to 3-20 times) of those that are clinically advisable. Physicians considering prescribing gabapentinoids for neurological/psychiatric disorders should carefully evaluate a possible previous history of drug abuse, whilst being able to promptly identify signs of pregabalin/gabapentin misuse and provide possible assistance in tapering off the medication. Key pointsGabapentinoids are thought to possess GABAmimetic properties, whilst possibly presenting with direct/indirect effects on the dopaminergic 'reward' system.Gabapentinoid experimenters are profiled here as individuals with a history of recreational polydrug misuse, who self-administer with dosages clearly in excess (e.g. up to 3-20 times) of those that are clinically advisable.Physicians considering prescribing gabapentinoids for neurological/psychiatric disorders should carefully evaluate for a possible previous history of drug abuse, whilst being able to promptly identify signs of pregabalin/gabapentin misuse and provide possible assistance in tapering off the medication.

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Section: Addiction Clinics' Surveys; Results From Online Data Analysismentioning

confidence: 99%

Section: Methods/literature Search Strategymentioning

confidence: 98%

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Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

2014

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“…In a study, 12.1% of 124 patients with opiate dependence were found to be pregabalin positive in urine test, and none of these patients reported using pregabalin because of medical indications (22). The common features of the cases in the literature are: pregabalin is used at much higher doses than treatment doses; even though there have been uses via intravenous or rectal routes, most of the cases take orally; the effect occurs within 10 minutes to 2 hours; tolerance and withdrawal develops very rapidly (23,24).…”

Section: Discussionmentioning

confidence: 99%

Pregabalin addiction in a case with synthetic cannabinoid use

Köroğlu¹

2017

Dusunen Adam

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Pregabalin addiction in a case with synthetic cannabinoid use Pregabalin is a gamma-aminobutyric acid (GABA) analog that is approved for the treatment of neuropathic pain and partial-onset seizures. Pregabalin selectively binds to the alpha 2 delta subunit of voltage-gated calcium channels. Thus, the release of excitatory neuro-transmitters are inhibited and neuronal GABA levels are increased. Pregabalin has also been approved in the European Union for treatment of Generalized Anxiety Disorder. The anxiolytic effects of pregabalin are similar to the benzodiazepines and occur rapidly after administration. However, the Food and Drug Administration in the USA (FDA) and European Medicines Agency (EMA) have included pregabalin in the "Schedule V Controlled Substances". This means that just like the benzodiazepines, pregabalin is considered to be a drug with a low potential for abuse.

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“…35,42 Opioid treatment programmes have reported approximately 10% of patients test positive for pregabalin, the majority of whom were not prescribed this medication. 43,44 Co-misuse of gabapentinoids and opioids is particularly concerning because high-dose pregabalin may exaggerate the respiratory depression seen with opioid use. 35 Seventy-nine percent of deaths attributed to gabapentinoids also involved opioids.…”

Section: Patterns Of Misusementioning

confidence: 99%

Gabapentin and Pregabalin: Do the Benefits Outweigh the Harms?

Morrison

Sandilands

Webb

2017

Journal of the Royal College of Physicians of Edinburgh

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Gabapentin and pregabalin prescribing in Scotland has increased substantially over recent years. Evidence suggests that prescribers may be advocating the use of these medicines off-label to avoid prescribing opioid analgesics. The evidence to support gabapentin and pregabalin use in non-neuropathic pain disorders indicates they are less effective than several other licensed non-opioid analgesics. Notably, patients may not bene t from gabapentin and pregabalin but remain at risk of adverse drug reactions. Furthermore, greater availability has resulted in increased diversion of gabapentin and pregabalin; creating problems within the opioid misuse population and prison service. As a consequence, both gabapentin and pregabalin may soon be controlled under the Misuse of Drugs Act 1971. Prescribers should be aware of the very limited clinical evidence for use of gabapentin and pregabalin outside their licensed indications, as well as their capacity to do harm.

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Pregabalin abuse among opiate addicted patients

Abstract: Our data suggest that pregabalin is liable to be abused among individuals with opiate dependency syndrome Thus, vigilance and caution are called for when patients with a past or current opiate dependency are exposed to treatment with pregabalin.

Cited by 109 publications

References 21 publications

Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

Misuse and Abuse of Pregabalin and Gabapentin: Cause for Concern?

Pregabalin addiction in a case with synthetic cannabinoid use

Gabapentin and Pregabalin: Do the Benefits Outweigh the Harms?

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