Pregabalin is authorised for some types of epilepsy, pain and generalised anxiety disorder, although its mechanism of action is unclear. The risk of abuse and dependence has been known since around 2005. Users describe euphoria, with effects similar to those of alcohol and benzodiazepines.

In France, between 2014 and 2018, 181 cases of abuse were reported, including 106 cases in 2018 alone. In that year, pregabalin was in 4th place among the drugs most often mentioned in falsified prescriptions, whereas in 2017 it was only in 15th place. In a study based on a representative sample of individuals covered by France's national health insurance system, 13% of patients receiving pregabalin were prescribed more than the recommended dose at least once over a two year period. Increases in cases of abuse and dependence have also been observed in the European Union and the United States.

The Technical Committee of the CEIP (French centres for evaluation and information on drug dependency) has recommended that pregabalin should only be prescribed using so called secure prescription sheets (specific prescription forms used, notably to prescribe opioids), limited to 12 weeks duration, but as of September 2020, this measure had still not been implemented in France. In the United Kingdom, access to pregabalin was restricted in 2019.

Patients and, if appropriate, those around them should be informed of the risk of pregabalin abuse and dependence. Health professionals should be wary of excessive requests, and should respond appropriately depending on the context, by refusing or limiting prescription, or by discussing with the patient the possibility of dependence.

©Prescrire 1 February 2021

Source: "Pregabalin abuse and dependence: on the increase in Europe and elsewhere" Prescrire International 2021; 30 (223): 46-47. Subscribers only.

Download the full article