Abuse of Pregabalin and Gabapentin in France, Germany and Italy

Background: When prescribing pharmacotherapies for chronic pain, healthcare professionals and patients are often concerned about abuse of these drugs. Alpha2delta ligands (eg, pregabalin & gabapentin) are often recommended as first-line treatments for some chronic pain conditions, but these drugs are increasingly reported globally as drugs of abuse. This study’s objective was to assess abuse of pregabalin, gabapentin and prescription opioids in France, Germany and Italy.

Methods: The Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System was used for prescription drug abuse estimates in each country, including: 1) Survey of Non-Medical Use of Prescription Drugs (NMURx) Program, an anonymous online survey; 2) Global Toxicosurveillance Network Program (GTNet), a network of poison centres and 3) European Opiate Addiction Treatment Association (EUROPAD), a surveillance population of individuals seeking treatment for substance abuse disorders. Data collection was from 2012–2017. Pregabalin, gabapentin and opioid analgesics were evaluated.

Results: The table shows abuse prevalence of each drug and abuse of single vs multiple comparator drugs (NMURx & EUROPAD). The prevalence of lifetime abuse of pregabalin was low and comparable with gabapentin and numerically lower than opioids. In addition pregabalin lifetime abuse (NMURx) was often reported along with lifetime abuse of another drug group; it was less commonly reported as the only drug with lifetime abuse. The route of administration was primarily oral for pregabalin and gabapentin, with opioids demonstrating a smaller relative prevalence of oral administration as assessed by GTNet.

Conclusions: The rates of abuse of pregabalin and gabapentin were low and much less than with opioids in France, Germany and Italy. When pregabalin or gabapentin were abused, it was generally reported with abuse of another prescription drug and rarely via non-oral routes of administration.

Abuse of Prescription Drugs by Country

Drug

Prevalencea of Lifetime Abuse in 2017Q4 NMURx

% (95% CI)

EUROPAD Program Cumulative Rates of Past 90 Day Abuse Through 2017Q4b

Rate per 100,000 Population (95% CI)

Case Counts of Lifetime Abusec in 2017Q4 NMURx

Single vs Multiple Drug Groupsd n (%)

France

Gabapentin

0.1 (0.02, 0.16)

0.01 (0.00, 0.05), n=2

0 (0.0) vs 8 (100.0)

Pregabalin

0.1 (0.07, 0.23)

0.05 (0.02, 0.10), n=7

1 (7.1) vs 13 (92.9)

Opioid analgesics

2.5 (2.20, 2.84)

1.35 (1.17, 1.55), n=199

122 (49.0) vs 127 (51.0)

Germany

Gabapentin

0.1 (0.04, 0.13)

3.65 (2.54, 5.07), n=35

3 (21.4) vs 11 (78.6)

Pregabalin

0.2 (0.08, 0.22)

1.77 (1.03, 2.84), n=17

4 (20.0) vs 16 (80.0)

Opioid analgesics

1.8 (1.55, 2.01)

8.44 (6.70, 10.49), n=81

114 (45.6) vs 136 (54.4)

Italy

Gabapentin

0.0 (0.00, 0.08)

0.02 (0.00, 0.13), n=1

1 (20.0) vs 4 (80.0)

Pregabalin

0.1 (0.05, 0.17)

0.02 (0.00, 0.13), n=1

2 (14.3) vs 12 (85.7)

Opioid analgesics

1.4 (1.20, 1.69)

0.75 (0.51, 1.06), n=32

70 (39.5) vs 107 (60.5)

aWeighted estimates calculated from all survey respondents, bAbuse was use in past 90 days “to get high”, cCase counts too low for weighted estimates and thus represent unweighted number of respondents who reported abuse, dMultiple Drugs defined as a =1 endorsement from the drug group + another drug group; these do not imply concomitant abuse.