Pregabalin Abuse and the Risks Associated for Patients with a Previous History of Substance Misuse

School of Psychology, Queen’s University, Belfast, Northern Ireland, United Kingdom

*Corresponding Author:

Alistair D Sweet, School of Psychology
Queen’s University, Belfast, Northern Ireland
40 Elmwood Avenue, Belfast
BT9 6AZ, Northern Ireland
United Kingdom
E-mail: alistairdsweet@yahoo.co.uk

Received date: January 31, 2013; Accepted February 15, 2013; Published date: February 22, 2013

Citation: Sweet AD (2013) Pregabalin Abuse and the Risks Associated for Patients with a Previous History of Substance Misuse. J Addict Res Ther 4:e116. doi:10.4172/2155-6105.1000e116

Copyright: © 2013 Sweet AD. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

In this article the author explores the risks associated with the prescription of pregabalin (Lyrica) to those patients who have had a prior history of alcohol and/or other substance misuse problems. It is suggested that the abuse potential of pregabalin may have been underestimated and that a number of recent studies tend to indicate there is in fact a considerable risk of abuse of pregabalin when this drug is prescribed to patients who have a history of substance misuse.

Introduction

Pregabalin (Lyrica) is a novel 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. In so doing the release of excitory neuro-transmitters are inhibited and neuronal GABA levels are increased.

Pregabalin has also been approved in the European Union and Russia (but not in the US) for treatment of Generalized Anxiety Disorder (GAD). The anxiolytic effects of pregabalin occur rapidly after administration, similar to the benzodiazepines, which gives pregabalin an advantage over many anxiolytic medications. However, the Drug Enforcement Agency in the US has denoted pregabalin as a Schedule V drug under the terms of the Controlled Substances Act. This means that pregabalin is considered to be a drug with a low potential for abuse relative to those drugs, such as the benzodiazepines, coded under Schedule IV of the Controlled Substances Act.

Recent Clinical Studies

Two recent studies have flagged the risks associated with the prescription of pregabalin to individuals who evidence a prior propensity to abuse other substances. In the first of these studies Grosshans et al. [1] give an account of pregabalin abuse, dependence and withdrawal involving a 47 year old male patient admitted to a department of addiction medicine. The authors report the patient, Mr B, in addition to his pregabalin consumption, was also consuming cannabis and alcohol at irregular intervals. The authors further describe the extent of dependence that Mr B developed in relation to pregabalin with the patient meeting the full diagnostic criteria as set out by DSM IV for both psychological and physical dependence on substances. In attempting to wean himself of pregabalin Mr B apparently experienced vegetative withdrawal symptoms including: sweating, unrest, arterial hypertension, tremor and a subjective craving for pregabalin. Although a medically supervised detoxification was undertaken in the case of this patient, Mr B, he repeatedly complained of severe cravings for pregabalin and discontinued treatment prematurely. He subsequently relapsed immediately at home, to abuse of pregabalin.

In a second recently published article on pregabalin abuse by Filipetto et al. [2], the authors reviewed the potential for the abuse of pregabalin, in light of work with a 35 year old female patient who presented initially with a 2 year history of neuropathic abdominal pain, resulting from a prior history of Guillain-Barré syndrome. The patient had been prescribed opioid analgesics for pain relief in the past though had abused these by sourcing additional opioids from other ambulatory care physicians. Filipetto et al. [2] reported that the patient herself requested pregabalin rather than continued use of opioids for pain relief and was subsequently titrated on a dose regimen to 600 mg/d – the maximum recommended daily dose of pregabalin. When, two months after beginning treatment, the patient requested an increase in her dosage of pregabalin. The physician managing her case refused an increase in the medication dose. The patient subsequently presented herself at three different hospitals complaining of various symptoms including: abdominal pain, nausea and headache. The patient was provided with supportive care and discharged on each occasion with a seven day supply of pregabalin. When the original treating physician learned of the patient’s augmentation of her pregabalin prescription through attendance at other medical institutions, in line with state regulations, the physician discharged the patient from the practice and referred the patient to a local detoxification center. It was later revealed that the patient never entered the detoxification program.

Discussion

In both cases reported above, the predilection to abuse of pregabalin appears to have been predicated on the patients’ previous histories of drug abuse and the reward expectations which they may have held in an anticipatory sense and in relation to their use of pregabalin. Interestingly Filipetto et al. [2], in reviewing the literature on pregabalin use make the point that a 450 mg dose of the drug had previously been found to produce a very similar response in patients to that experienced after taking a 30 mg dose of diazepam [3]. Perhaps more than anything else these recent studies and others that are emerging, including a wide ranging study by Schwan et al. [4] involving the Swedish adverse drug reaction reporting system, seem to indicate the abuse/dependence potential of pregabalin. Patients at a heightened level of risk, in terms of developing abuse or dependence with pregabalin, seem to be those who have had a prior history of substance use disorder. On this basis, clinicians should be mindful, in their therapeutic treatment of patients presenting to addiction services, of the potential for abuse/dependence in relation to pregabalin and the associated complex difficulties that may be encountered should such abuse/dependence develop.

References

1. Grosshans M, Mutschler J, Hermann D, Klein O, Dressing H (2010) Pregabalin abuse, dependence, and withdrawal: A case report. Am J Psychiatry 167: 869.
2. Filipetto FA, Zipp CP, Coren JS (2010) Potential for pregabalin abuse or diversion after past drug-seeking behavior. J Am Osteopath Assoc 110: 605-607.
3. Drug Enforcement Administration (2005) Department of Justice Schedules of controlled substances: placement of pregabalin into Schedule V. Proposed rule Fed Regist 70: 25502-25505.
4. Schwan S, Sundström A, Stjernberg E, Hallberg E, Hallberg P (2010) A signal for an abuse liability for pregabalin--results from the Swedish spontaneous adverse drug reaction reporting system. Eur J Clin Pharmacol 66: 947-953.