Researchers from the University of Bristol in England have linked opioid alternatives pregabalin (Lyrica) and gabapentin (Neurontin) to an increasing number of heroin-related overdose deaths in both England and Wales.
The two drugs are in a class of medications known as gabapentoids. Initially indicated to treat epilepsy, they have also been commonly prescribed to treat nerve pain (neuropathy), fibromyalgia, and chronic pain.
As reported in the journal Addiction, overdose deaths involving both opioids and gabapentoids rose from less than one death per year on average before 2009, to 137 fatalities in 2015. Of no coincidence, the surge closely aligned with a marked increase in the number of pregabalin and gabapentin prescriptions – a jump from one million prescriptions in 2004 to more than ten million in 2016.
Researchers state the rise in prescriptions has increased the drugs’ obtainability, and thus, abuse. When used in conjunction with heroin, the combined effect is enhanced, according to some users. Experiments have revealed that pregabalin decreases respiration, and therefore increases the risk of an opioid overdose.
Considering these drugs are thought of as “safe” medications and commonly used as alternatives to opioid painkillers, it is a bit strange to think of them being abused. Indeed, one 2016 study found that more than 20% of a pain clinic’s patients tested positive for illicit gabapentin (no prescription.) But that is not to say they are not the lesser of two evils, unquestionably.
Gabapentin is FDA-approved in the treatment of neuropathy due to shingles and epilepsy. It is also sometimes prescribed for migraines and fibromyalgia. In the U.S. in 2016, around 64 million prescriptions were written – a 49% increase from 2011.
While gabapentin is not classified as a controlled substance, pregabalin is. It’s a Schedule V drug, meaning it has a low potential for abuse. It is FDA-approved to treat epilepsy, diabetic nerve pain and neuropathy related to shingles, and fibromyalgia.
The opioid prescribing guidelines issued by the Centers for Disease Control and Prevention last year recommended both Lyrica and gabapentin as opioid alternatives but said nothing about their abuse potential.