A change in the prescribing practice of prebagalin that has had a direct negative effect on drug-induced deaths in Ireland

Pregabalin is a prescribed medication licensed for used in Ireland in the treatment of a number of medical conditions including epilepsy, neuropathic pain, and generalized anxiety disorder. Research has shown that pregabalin can be addictive especially among people who have used drugs, particularly opiates. The potential risk of misuse of pregabalin relates to its rapid absorption and faster onset of its relaxant and sedative effects. Pregabalin was included in the routine post mortem blood testing by the State Laboratory in Ireland from 2013.

Objective; To examine the impact of increased prescribing of pregabalin on drug-induced deaths in Ireland, especially among women. Method; Review of data recorded by the National Drug-Related Deaths Index (NDRDI). Results; Since 2013 a dramatic upward trend in both the presence of pregabalin on post mortem toxicology reports and implication of pregabalin in drug-induced deaths has been noticed. Between 2013 and 2016, a total of 1,489 drug-induced deaths were recorded by the NDRDI. Of these, 155(10.4%) involved pregabalin, from 14 (3.5%) in 2013 to 16 (18.4%) in 2016. Half of those who died were females (78, 50%), in fact poisoning deaths among females were twice as likely to include pregabalin compared to males (Pearson Chi-Square = 0.00). Almost all deaths involved polydrugs. Opiates (83%), Benzodiazepines (77%) and antidepressants (56%) were the most common drugs implicated along with pregabalin in these polydrug deaths. Of note from 2014 to 2016 there has been a corresponding decrease in the number of diazepam drug-induced deaths. Conclusions; This study is the first to describe the upward trend in drug-induced deaths involving pregabalin in Ireland between 2013 and 2016. The analysis provides evidence for policy makers and treatment providers to rethink medical treatment they provide and consider more circumspect prescription of medications, particularly combination of medications especially among people with a history of misusing opiates ena