Lyrica®: Filling a pain fap or emerging threat? Penington institute recently hosted a public information forum with experts speakers discussing pregabalin (sold as Lyrica®). Subsidised as an antiepileptic and to treat neuropathic pain, prescriptions rates have increased dramatically in recent years, along with reports of harms relating to use. Dr Shaun Greene (Austin Health) Dr Rose Crossin (Penington Institute) and Melanie Walker (AIVL) discussed the uses, benefits, risks and harms of pregabalin, and what can be done to ensure those who need it can continue to access while minimising the harms.

To watch the videos view the playlist.

 

Leading independent drug research, policy and education organisation Penington Institute is calling for state and federal government action to help reduce the number of overdose deaths resulting from the misuse of pregabalin (sold under the brand name Lyrica®).

Pregabalin was subsidised on the Australian Pharmaceutical Benefits Scheme (PBS) as a treatment for nerve pain in 2013, having been first introduced in Australia in 2004 as an anti-epileptic medication.

Since 2013, the use of pregabalin has skyrocketed. PBS figures report that in 2017/18 there were 3.75 million prescriptions for pregabalin, at a cost to the PBS of $133 million[1].

Penington Institute’s Dr Rose Crossin said that pregabalin was an important medication, but with a sharp downside.

“While pregabalin is an effective, non-opioid treatment for neuropathic pain, it also has the potential for misuse, including being misused to increase the effects of other drugs such as pharmaceutical opioids and heroin,” Dr Crossin said.

“Recent Australian studies have shown a significant increase in pregabalin prescribing, misuse, and harms.

“People at high risk of harms include those using pregabalin with other sedatives as well as those with a history of mental health issues or of suicidal thoughts or behaviours, and people who have substance use disorders (i.e. a dependency on alcohol or other drugs),” she said.

“A recent NSW study estimated that 86,000 people were high-risk users of pregabalin in 2016[2], Australia needs to take strong action to help keep people safer, including interventions targeted at vulnerable groups,” said Dr Crossin.

“In addition, a recent Queensland coronial study of pregabalin-related deaths reported evidence that pregabalin use is common among people who inject drugs.”[3]

Penington Institute staff have received anecdotal reports indicating problematic use is becoming more common, including amongst people who inject drugs. A worker in a regional health service said: “I have seen an increase in the problematic use of pregabalin among young people. The problem with pregabalin is usually found in combination with other medicines like benzos [benzodiazepines] which are very popular drugs among our youth.”

Penington Institute recommends:

For regulators

  • Consider scheduling changes (pregabalin was recently re-scheduled in the US and the UK)
  • Consider inclusion in SafeScript in Victoria

For doctors

  • Take precautions when co-prescribing other sedatives
  • Communicate to patients the risks of interaction with other sedatives such as opioids and alcohol
  • Undertake a risk assessment for misuse
  • Avoid off-label prescribing for indications without a strong evidence base
  • Review the patient’s indications, including psychiatric history

For people who are taking pregabalin

  • Learn about the potential adverse effects
  • Tell your prescribing doctor about your relevant medical, mental health and substance use history
  • Take care when using pregabalin with other drugs and alcohol

What is pregabalin?

Pregabalin is a medication usually taken by people with epilepsy or neuropathic pain. Neuropathic pain results from damage or disease affecting nerves. Neuropathic pain may not respond to traditional pain medications. In such cases, pregabalin can provide important relief from pain that has not responded to normal pain treatments.

Pregabalin is also sometimes prescribed for other conditions including fibromyalgia, non-neuropathic pain, anxiety, insomnia, panic disorder and alcohol withdrawal; however, pregabalin is not subsidised for use in these conditions and they are not currently included in the approved product information sheet.

Pregabalin comes in tablet/capsule form. While pregabalin is an effective treatment for some conditions, there are risks associated with over- or misuse.

– ENDS –

Media Contact at Penington Institute: Sophie Marcard on 0400 089 653 and at s.marcard@penington.org.au

About Penington Institute

Officially launched in 2014, Penington Institute grew out of the work of Anex and its 20 years’ experience working with people directly affected by problematic drug use. Penington Institute’s mission is to actively support the adoption of approaches to drug use that promote safety and human dignity. It does so through independent, non-partisan thought leadership, community education, training, research and policy formation.

[1] http://www.pbs.gov.au/statistics/expenditure-prescriptions/2017-2018/expenditure-and-prescriptions-twelve-months-to-30-june-2018.pdf

[2] Cairns, R., Schaffer, A. L., Ryan, N., Pearson, S. A., & Buckley, N. A. (2018). Rising pregabalin use and misuse in Australia: trends in utilization and intentional poisonings. Addiction.

[3] Thompson, A., Morey, S., & Griffiths, A. (2019) Pregabalin and Its Involvement in Coronial Cases. Journal of Analytical Toxicology, 2019;1–7