The significant rise in deaths linked to the commonly prescribed anxiety drug, pregabalin, has raised serious concerns in England and Wales. In 2018, there were 187 deaths associated with pregabalin, but this number more than doubled to 441 in 2022. Recent press reports have compared these deaths to a “US-style opioid epidemic,” although the comparison may not be entirely equitable given the much higher number of deaths from opioids in the United States.

Pregabalin, known by the brand names Lyrica and Alzain, is prescribed to treat various health conditions such as epilepsy, nerve pain, and anxiety. While the drug itself may not be inherently dangerous, it does have the potential for abuse due to its rewarding properties, which can induce feelings of euphoria, calmness, and relaxation. The risks associated with pregabalin mainly stem from its interactions with other drugs, particularly opioids, benzodiazepines, muscle relaxants, and certain diabetes and epilepsy medications.

An analysis of pregabalin-related deaths in England between 2004-2020 revealed that over 90% of the cases involved the presence of other opioids in the deceased individuals, even though these opioids were not always prescribed. This indicates that many people may have been sourcing these drugs illicitly, leading to potentially fatal interactions with pregabalin. Moreover, the data does not always clarify whether pregabalin was obtained through a prescription or acquired without one.

The recent increase in pregabalin deaths coincides with a rise in prescriptions for the drug. In 2022, there were 8.4 million prescriptions for pregabalin in the UK, up from 5.5 million in 2016. This escalation in prescribing practices suggests the need for more comprehensive support to minimize patient risks, especially concerning the concomitant use of other medications. Prescribers and patients alike should receive education on the potential dangers of pregabalin, including the risk of dependency and harmful drug interactions.

Certain groups, such as individuals with a history of substance use disorder, are at a heightened risk of harm from pregabalin. Additionally, evidence suggests that illicit use of the drug is becoming more prevalent in both Europe and North America, exposing users to unknown risks when combined with other substances like methadone. Moreover, disparities exist in the prescribing patterns of pregabalin, with more people in deprived areas of England receiving prescriptions, potentially due to a lack of necessary support and information on drug risks.

To address the concerning rise in pregabalin-related deaths, it is crucial to understand the underlying reasons for these occurrences. Merely ceasing pregabalin prescriptions or imposing stricter regulations on illicit use may not be effective solutions. Instead, a comprehensive approach that considers the complexities of drug interactions, prescribing practices, patient education, and support systems is necessary to mitigate the risks associated with pregabalin use. Understanding why individuals combine pregabalin with other drugs, both prescribed and illicit, is paramount for developing meaningful prevention strategies.


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