Gabapentin and pregabalin misuse

Misuse is defined as use of a substance for a purpose not consistent with legal or medical guidelines, such as taking another person’s medication or taking a higher dosage than prescribed. Prescription drug misuse is a problem, especially psychoactive drugs such as opioids, benzodiazepines and more recently gabapentinoids. Current estimates suggest 1% of the general population misuse gabapentin, as do 15-22% of people who misuse opioids, and 40-65% of people with gabapentinoid prescriptions. Pregabalin may have a higher misuse potential than gabapentin due to its rapid absorption and faster onset of action. In the UK, gabapentin and pregabalin prescribing has increased by 350% and 150% over 5 years, respectively. In 2016, gabapentin was the 10th most commonly prescribed medication in the United States. This trend is likely due to avoidance of opioid analgesics, despite the use of gabapentin and pregabalin for non-neuropathic pain being unlicensed and ineffective. Patients inappropriately prescribed gabapentin or pregabalin may not benefit and may be exposed to potential harms, which broadly fall into two categories. First, by causing an adverse drug reaction or toxicity, e.g. central nervous system effects (headache, visual disturbance, drowsiness, agitation, delirium, lethargy); cardiac effects (tachycardia, bradycardia); disturbances in muscle control and movement, and gastrointestinal symptoms. Second, gabapentin or pregabalin prescription may result in drug misuse or diversion (the transfer of any legally prescribed substance from the individual for whom it was prescribed to another person for illicit use).