Pregabalin misuse rising
Ambulance calls for misuse of an anti-epileptic drug called have increased tenfold in Victoria since 2012.
Originally developed as an anti-epileptic agent, the drug pregabalin is now also used to treat fibromyalgia, generalised anxiety disorder, and neuropathic pain.
It is subsidised by the Pharmaceutical Benefits Scheme as an anti-epileptic and, since 2013, for treating neuropathic pain. Since 2015, total PBS costs for pregabalin are among the highest for any drug.
Mirroring the increase in prescription rates, ambulance attendances associated with the misuse of pregabalin have risen.
“Individuals take higher than recommended doses of pregabalin for its euphoric effects … or is implicated in self-harm,” says a report by Rose Crossin, a research officer at the Turning Point Alcohol and Drug Centre in Melbourne.
“There is a growing black market for pregabalin in populations at high risk of misuse, including in prisons, where pregabalin is sometimes prescribed for pain relief in preference to opioids. Alcohol should not be consumed while taking pregabalin, and additive side effects are also possible if it is taken with other central nervous system depressants, including benzodiazepines and narcotic pain medications.”
There were 1,201 pregabalin misuse-related attendances in Victoria between January 2012 and December 2017.
The rate increased from 0.28 cases per 100,000 population in the first half of 2012 to 3.32 cases per 100,000 in the second half of 2017.
Of those ambulance attendances, 49 per cent were for people with a history that may have contraindicated prescribing pregabalin.
Pregabalin was frequently misused with other sedatives (68 per cent of call-outs), particularly benzodiazepines (37 per cent). Thirty-nine per cent of attendances were associated with a suicide attempt.
The authors warn that physicians need to be particularly cautious when prescribing pregabalin.
“Clinicians should ensure that consumers are aware of the risks of these interactions, and be particularly cautious when considering prescribing pregabalin for patients who are taking other sedatives,” they write.
“Interventions being considered in other countries may be relevant to Australia, including changes to scheduling, as implemented or planned in the United Kingdom, the United States, and Norway, and limits on dispensing to minimise the risks of pregabalin misuse.”