Rising numbers of people are being treated for addiction to a prescription drug with similar effects to Valium, doctors have warned – an issue that could be made worse when the medication becomes cheaper later this month.
Pregabalin, used to treat nerve pain, epilepsy and anxiety, has become a “massive” problem in prisons and is increasingly being used recreationally, according to substance misuse experts.
The British Medical Association (BMA) has called for the drug, first approved for medical use in 2004, to be made a controlled substance in the UK in the same class as steroids, Valium and 'club drug' GHB.
Yasir Abbasi, a consultant psychiatrist and clinical director for addiction services at Mersey Care NHS Foundation Trust, told The Independent pregabalin dependency was “very much widespread, all over the UK”.
“It works in a similar fashion to diazepam [Valium]. It sedates you and takes the edge off,” he said, adding that people sometimes misuse it if they have an undiagnosed mental health problem as they find it gives them relief.
“It’s a growing problem. We’ve seen more and more people coming through for it in the past four to five years or so.”
Its misuse is said to be particularly prevalent in Northern Ireland, with border control officers saying packages of the drug have been intercepted regularly for a number of years.
While the most at-risk patients are hard drug users, Dr Abbasi said he had seen people develop damaging dependencies after being prescribed pregabalin to treat pain after incidents such as road accidents.
As the drug is relatively new and there is not much information available, “people are left to deal with withdrawal symptoms, which can potentially lead to seizures and fits,” he warned.
“People are using very high doses; the maximum recommended dose is around 600mg, we’ve seen people misuse up to 3,000mg per day, which is a huge amount.”
One pregabalin user who wished not to be named said he has been taking the drug for anxiety for around nine years, and on some days takes up to 2500mg.
“I have been lying to chemists and doctors as I run out quickly, so I don’t go into massive withdrawal,” he said. “I have run out of options; the only thing is to come clean to the doctors, but I know they would flip and get me off it quick-step.
“I could not handle it, it has become my crutch and without it I would be in a very bad situation.”
Pregabalin has until now only been available for prescription in a branded form called Lyrica, produced by Pfizer, with pharmacists advised to reject any requests for the cheaper generic version of the drug due to an ongoing legal dispute between pharmaceutical companies.
However, GPs will be able to prescribe the cheaper, non-branded version of the drug when Pfizer’s patent expires on 17 July, NHS England has announced – which could cause an “explosion” in its misuse, Dr Abbasi said.
“When it goes off patent, and there are cheaper versions available, people will start buying it more and more, particularly over the internet.”
Pfizer has said it will take its case over the drug's patent to the Supreme Court after a High Court appeal was rejected.
At the BMA’s annual representative meeting in Bournemouth, Dr Mark Pickering called on the union to lobby the appropriate authorities to make pregabalin, which can produce a “euphoric high similar to opiates”, a controlled drug.
Presenting the motion, he said the drug was mentioned on 38 death certificates in 2014, up from five in 2009, but this was the “tip of the iceberg”.
If pregabalin were a controlled drug, it could be supervised when administered in prisons, like the painkiller tramadol, he added.
Dr Pickering told The Independent the scale of its abuse in prisons is “massive” and it has become a “very tradeable and desirable commodity”.
“People will manage to get it from GPs in the community who are less aware of the problems of it, then it will come into prisons,” he said.
If the drug becomes generic in July, prescribers “may face more pressure” to dispense the drug, said Dr Pickering, but there may not be a huge spike in new addictions as “most prescribers are aware of the addiction and abuse potential of pregabalin”.
“If someone was being prescribed [pregabalin] privately, and they could afford the cost of the medication, they could afford to get more,” he said. “We’d only find out if people were smuggling it into prisons.”
David*, a photographer from Brighton, said his experience with pregabalin, which he was first prescribed six months ago for anxiety and to ease pain caused by nerve damage in his hand, has been “absolutely horrendous”.
“I didn’t like it at all. It made me feel very nauseous and dizzy, and so I didn’t take it at first,” he said. But difficulties sleeping led him to take it more often, despite experiencing a number of side effects, and he has now developed a dependency to the drug.
The 41-year-old said he had been taking 300mg of pregabalin each day, but has managed to cut down to 100mg a day.
“I’ve taken valium in the past – I’d use it while I was studying as I’d get nervous before presentations, but there’s nothing bad about it compared to [pregabalin]. This is more dangerous,” he said. “I just can’t get off it.”
Julia Buckley, acting head of travel for The Independent, said she had taken pregabalin for chronic pain for around six weeks but stopped as “it felt was like I was lobotomised”.
“I was massively constipated – I didn’t do a poo for the whole time I was on it – but that didn’t occur to me as I was so mentally out of it,” she said. “I couldn’t write a one-line email and my memory was completely shot, I’d walk into a room and not realise what I’d gone in for.”
Suicidal urges are a recognised side effect of pregabalin. Ms Buckley had never experienced them before, but even while taking a low dose of the drug, she said she felt them “constantly”.
“It was almost like an instinct: ‘There’s a bus, jump in front of it’. It was scary but also I could tell it wasn’t coming from me, so I was able to protect myself. But it was terrifying to think I wasn’t in control of my thoughts or behaviour.”
Dr Pickering told the BMA annual meeting on Wednesday: “On any given day up and down the country, patients with substance abuse problems will deploy a variety of tactics in order to get pregablin prescribed.
“For those already prescribed it a range of imaginative stories are told about why they need their prescription early.
“In prisons, where I work, the picture is even more stark – patients will sell it for tobacco, they will break open the capsules and fill it with crushed paracetamol and then try to convince the nurse that 'this one fell on the floor' and they need a new one.
”Other inmates who don't want to sell their pregabalin will be threatened and bullied on a daily basis, including physical violence.“
The Home Office said it will launch a public consultation on advice issued by the Advisory Council for the Misuse of Drugs in 2016, which recommended controlling pregabalin and another drug gabapentin as class C drugs.
*Name has been changed
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