Pregabalin Use Among Opioid-Addicted Patients in Switzerland

Mutschler, Jochen; Gastberger, Salome; Baumgartner, Markus R.; Grosshans, Martin; Seifritz, Erich; Quednow, Boris B.; Herdener, Marcus

doi:10.4088/jcp.15l10296

Cited by 15 publications

(10 citation statements)

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“…The principal population at risk consists of patients with other current or past substance use disorders, mostly opioid and multi-drug users who consume pregabalin in high dosages to achieve euphoria and also to reduce withdrawal symptoms, or to potentiate the effects of methadone ( 27 ). Pregabalin use was detected for example in 10.7% ( 28 ) and 14% ( 27 ) of hair specimens from of opioid maintenance patients in Italy, and in 4 to 17.7% of urine samples from opioid maintenance patients in Switzerland ( 29 ), Ireland ( 30 ), Sweden ( 20 ), and Israel ( 31 ), while one other study found zero prevalence in hair samples ( 32 ). The present finding indicates a constant or even increasing problem concerning pregabalin in the population of illicit drug users.…”

Section: Discussionmentioning

confidence: 97%

Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment

et al. 2020

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Background About 15 years ago, a diverse group of new recreational psychotropic substances began to emerge, which were marketed for example as “legal highs,” “research chemicals,” or “designer drugs.” These substances were later subsumed under the label “Novel Psychoactive Substances” (NPS). Important NPS classes are cathinones, synthetic cannabimimetics, phenethylamines, and herbal drugs. The health care system for psychotropic substance use disorders (SUDs) traditionally focused on a few substances, such as alcohol, heroin, cocaine, amphetamines, or cannabis. Users of illicit substances often engage in polydrug use. However little is known about the prevalence of NPS use within the group of “classical” illicit substance users. Objective We investigated lifetime and recent use of NPS and other drugs in patients who underwent in-patient detoxification treatment from illicit drugs in Germany. Methods In a multicenter study with eight participating facilities, patients admitted to treatment underwent a standardized interview at admission, concerning their past and current substance use. The interview comprised classical substances of abuse, NPS, and rarely used substances such as LSD. In addition, participating sites had the opportunity to analyze their patients’ routine drug screenings by means of gas chromatography/mass spectrometry (GC/MS), which permitted detection of NPS. Results Interviews from 295 patients could be analyzed. Most patients were opiate dependent and multiple substance users. About 32% reported use of synthetic cannabimimetics during lifetime, but usually only a few times. An important reason for their use was that NPS were not detected by drug testing in prisons or drug treatment facilities. Cathinones, herbal drugs or other NPS had rarely been used during lifetime. NPS use during the last 30 days before admission was nearly zero. This was confirmed by urine analysis results. In contrast, lifetime and current use of opiates, alcohol, cocaine, benzodiazepines, and cannabis was high. In addition, 18% reported of regular unprescribed pregabalin use during lifetime, and 20% had recently used pregabalin. Conclusion Patients admitted to drug detoxification treatment showed multiple substance use, but this did not include NPS use. The diversion of legal medications such as pregabalin in this group is a serious concern.

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Section: Discussionmentioning

confidence: 97%

Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment

et al. 2020

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“…Without prescription, these subjects were probably using PGB of their own volition, after acquiring it on the illicit marketplace, which is easily accessed on‐line . Present data on PGB misuse were in good accordance with other studies that were conducted in patients with a previous or present history of misuse or abuse of other substances, but they do not concur with a recent report that PGB was not found in hair samples from 109 patients in opioid substitution therapy …”

Section: Resultsmentioning

confidence: 99%

“…Polydrug use was found in 7/15 cases of non‐prescribed PGB in the MTT group and in 4/6 patients in the ODU group. These results are in agreement with other studies that reported concomitant drug abuse was related to PGB abuse in most cases, and that it was particularly high among opioid dependent and other substance‐dependent patients.…”

Section: Resultsmentioning

confidence: 99%

GC‐MS/MS detects potential pregabalin abuse in susceptible subjects’ hair

Ianni

Aroni

Gili

et al. 2018

Drug Testing and Analysis

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Pregabalin, a GABA analogue, binds to the alpha 2 delta subunit of voltage-dependent calcium channels. It is recognised as efficacious in pathologies such as epilepsy, neuropathic pain, and anxiety disorders. Since pregabalin prescriptions have increased worldwide, reports of its abuse have been accumulating, mainly in patients with opioid abuse disorders. The present study investigated potential pregabalin abuse by means of hair analysis, a matrix that provides valuable retrospective information. Half of the pool of 280 susceptible patients had been occasional drug users and were being monitored for driving licence renewals. The other 140 patients had a history of opiate dependency and were monitored to assess compliance with methadone therapy. In view of determining pregabalin in hair samples, it was extracted in methanol, successfully derivatised to give the ethyl chloroformate derivative, and finally pregabalin was analysed by gas chromatography-tandem mass spectrometry. Selectivity, linearity, limit of detection, limit of quantification, recovery, intra- and inter-day precision, and accuracy of the quantification procedure were appraised. Pregabalin limits of detection and quantification were 30 pg/mg and 50 pg/mg, respectively. We found 10.7% of hair samples from methadone patients and 4.29% from occasional drug users were positive to pregabalin without medical prescription. The mean pregabalin concentration in hair was higher than in consumers with medical indications (1.45 ng/mg vs 0.74 ng/mg). These results suggest that pregabalin possesses a significant abuse potential particularly among individuals attending opiate dependence services and that pregabalin abuse is a serious emerging issue, which should be carefully monitored.

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“…The study was conducted in 2014 in an outpatient setting at the Centre for Addictive Disorder of the Psychiatric Hospital Zurich [21]. OATs in Switzerland are covered by mandatory health insurance.…”

Section: Subjectsmentioning

confidence: 99%

Concomitant Heroin and Cocaine Use among Opioid-Dependent Patients during Methadone, Buprenorphine or Morphine Opioid Agonist Therapy

et al. 2019

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Background: Among all the treatment methods developed so far, opioid agonist treatment (OAT) is the most effective therapy for opioid dependence. While methadone (MTD) is the most commonly used, fewer data are available on alternative opioid agonist. The aim of this study was to assess the efficacy of buprenorphine (BUP) and slow-released morphine compared to MTD with regard to the reduction of concomitant heroin and cocaine use. Methods: This cross-sectional study included 105 patients receiving MTD, BUP, or slow-release morphine as opioid agonist therapy at the Psychiatric Hospital of Zurich. Illicit drug use was assessed using a retrospective 3-month hair toxicology analysis to quantify concentrations of heroin degradation products and metabolites, as well as cocaine and cocaine metabolites. We have also collected self-reports, but in the data of the study, only the results of the hair analysis were considered. Results: BUP-treated patients showed lower rates of illicit opiate consumption in comparison to the group treated with MTD or slow-released morphine (p < 0.05). The proportion of heroin-positive hair samples associated with slow-release morphine treatment was similar to the proportion associated with MTD treatment. Neither the MTD vs. slow-released morphine groups nor the BUP vs. MTD groups showed significant differences in the number of patients consuming cocaine although patients in the BUP group had significantly lower concentrations of cocaine in hair testing compared to the patients in the MTD group. Prevalence of cocaine consumption was also significantly lower in the BUP group compared to patients in the slow-release morphine group (p < 0.05). Conclusion: This study suggests that BUP OAT is associated with reduced additional opiate co-use.

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Pregabalin Use Among Opioid-Addicted Patients in Switzerland

Cited by 15 publications

References 0 publications

Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment

Prevalence of Novel Psychoactive Substance (NPS) Use in Patients Admitted to Drug Detoxification Treatment

GC‐MS/MS detects potential pregabalin abuse in susceptible subjects’ hair

Concomitant Heroin and Cocaine Use among Opioid-Dependent Patients during Methadone, Buprenorphine or Morphine Opioid Agonist Therapy

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