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Independents' Day

GPs warned as gabapentinoids are linked to heroin overdose deaths

GPs should consider alternatives to the prescription drugs pregabalin and gabapentin, according to a new study that suggests a recent substantial increase in prescriptions is closely correlated with a rise in the number of overdose deaths in England and Wales.

The use of gabapentinoids is ‘especially dangerous when used with heroin or other opioids’, according to the new University of Bristol findings published in Addiction.

Pregabalin and gabapentin were originally used to treat epilepsy but more recently have also been used to treat neuropathic pain, anxiety, insomnia and other mental illnesses.

The study points to recent figures that show prescriptions for these drugs rose from one million in 2004 to 10.5m in 2015, a 24% year-on-year increase.

Meanwhile, the number of deaths in England and Wales involving gabapentinoids increased from fewer than one per year before 2009 to 137 in 2015, of which 79% also involved opioids such as heroin.

The team suggests that ‘alternatives to gabapentinoids need to be recommended for clinicians managing opioid dependent patients with neuropathic pain or generalised anxiety, and greater attention given to restricting diversion of gabapentinoid prescriptions’.

Professor Matthew Hickman, professor of public health and epidemiology in the university’s School of Social and Community Medicine, said: ‘It is important that doctors and people dependent on opioids are aware that the number of overdose deaths involving the combination of opioids with gabapentin or pregabalin has increased substantially and that there is evidence now that their concomitant use – either through co-prescription or diversion of prescriptions – increases the risk of acute overdose deaths.’

Professor Graeme Henderson, professor of pharmacology in the University’s School of Physiology, Pharmacology and Neuroscience, said: ‘We need more multi-disciplinary studies like ours which seek to combine evidence from laboratory experiments on how drugs act, with accounts of what users experience and information on the pattern of drug use and drug harms – in order to make health care workers and drug users aware of the dangers of combining specific drugs.’

Concerns about pregabalin and gabapentin were highlighted last year when Government advisors called for them to be classed as controlled drugs.

In a letter to Home Office ministers, Professor Les Iverson, chair of the Advisory Council on the Misuse of Drugs, recommended that both drugs ‘are controlled under the Misuse of Drugs Act 1971 as Class C substances, and scheduled under the Misuse of Drugs Regulations 2001 (as amended) as Schedule 3’.

Under the plan the drugs would not be able to be repeat dispensed and prescriptions would only be valid for one month.

The move last year was also sparked by increasing concerns over the recreational use of the drugs, particularly amongst the opioid-abusing population, and a rise in deaths related to their misuse.

Readers' comments (3)

  • Unfortunately many GPs seem oblivious or indifferent to their role in supplying recreational drugs; and unaware of how poor the evidence of benefit of pregabalin and gabapentin is for some indications.

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  • I work as a GPSI in addictions. I have also worked in the prison system in Scotland and seen the demand for gabapentin and pregabalin. The drugs are used either on their own or combined with opiates/benzos to achieve an enhanced hit.
    I now work in the community and many of my patients report misuse of these drugs and great difficulty in detoxing when they try.I know one person who overdosed with gabapentin( prescribed by his GP for back pain) in combination with opiates and lay on his floor for 36 hours suffering carpet burns and nerve damage.
    I am not anti drugs and I don't believe drugs are the cause of addiction. There is time and a place for gabapentin or pregabalin. However as a prescriber I need to feel confident that I am dealing with a genuine case of neuropathic pain and consider other pharmaceutical/ non pharmaceutical options in somebody with risk factors for addiction before considering this drug type. I am very sceptical about using pregabalin for "anxiety" symptoms as well. Diazepam has caused so much harm due to inappropriate prescribing over the last few decades and I believe we are dealing with a similar type of drug with the gabapentinoids.
    We can be under so much pressure to prescribe drugs to patients in an attempt to alleviate suffering, not always the caring thing to do.

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  • Yes. Huge problem in prisons and I suspect they have the same paradoxical aggression effect that benzo's have. Its not just the spice in prison giving us problems but the disinhibition caused by the prescribed gapapentinoids. Back pain is not a licensed indication for these drugs, and nobody on methadone should be offered it. Too risky and its not being used for pain. The pains are hyperasthesia from heroin use.

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