Welcome to this April issue of the Journal of Prescribing Practice.
Recently, in a lecture around legal aspects of prescribing there was a discussion on classifications of controlled drugs and why some start not controlled but then go on to be in one of the five schedules and three classes. A good discussion was had and examples given, but not the one I read about just this week making the BBC headlines (BBC News, 2024). Pregabalin and gabapentin are drugs used for epilepsy, nerve pain and anxiety, and only became Class C drugs under the Misuse of Drugs Act (1971) in 2019. Since being introduced in the US and UK in 1993, pregabalin has spread across the world, but more recently has been linked to a number of deaths both here and abroad. Recent figures from the Care Quality Commission (CQC) show that pregabalin prescribing has gone up by 5% to 8 636 909 items in 2002 (CQC, 2023).
Indeed, the reason for making it a controlled drug was due to concerns over its harm and addiction potential; however, this has not stopped the illicit trade in these drugs, and a report found that in many of the cases where pregabalin was linked to death, the drug itself had not been prescribed to the person in question. According to the latest data from the Northern Ireland Statistics and Research Agency (NISRA, 2022), 71 of the 213 drug-related deaths recorded in 2021 mentioned pregabalin on the death certificate.
There are, of course, many people taking pregabalin legally and for medicinal purposes, but there needs to be caution as these drugs can become problematic in those with a prior history of drug abuse or addiction, and they can interact with other medications such as opioids to potentiate their effects.
There are many aspects of taking a drug history that can alert the prescriber to potential problem situations, such as asking about other prescribed or over-the-counter medications and any illicit or borrowed drugs. There is also the issue of withdrawal symptoms if people wish to change due to the addictive nature of the drugs, and prescribers should be carefully monitoring these situations. It is important to remember that prescribing controlled drugs comes with extra legal responsibility and prescribing arrangements as well as monitoring and review.