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Flora is a 27-year-old woman with few health problems. Like many of us, she got Covid and seemed to recover very quickly. A few weeks later, though, she developed severe anxiety, nausea, diarrhoea, weakness, palpitations and “cotton wool brain”. Her GP could find no cause for this, and as it got worse over the next few days she was referred to the emergency department of a Dublin hospital. She was admitted and a wide range of investigations were done.
The results were normal and she was told she probably had long Covid. After discharge, she continued to feel so unwell that she went back to be cared for by her mother. Flora recovered gradually and has since told her GP the real cause of her illness.
She had become anxious, and a neighbour had given her a few pregabalin tablets to relax her; within weeks she was taking three a day, every day. This went on for months, until the neighbour moved away, and suddenly Flora did not have pregabalin any more. All of her symptoms were caused by sudden withdrawal from pregabalin that had not been prescribed for her.
I have written before of the dangers of the misuse of pregabalin (the brand name for which is Lyrica). Readers have also shared their stories of how the drug affected them. But now pregabalin has become a “street drug” and is contributing to an increasing number of deaths in people attending drug addiction services.
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It has also emerged as a dangerous drug of misuse among homeless people, as the following story illustrates:
Ann was a 32-year-old who lived in a hostel for homeless people. Estranged from her family, she attended a GP working in the homeless service. Ann told the doctor she was taking the maximum dose of pregabalin (900mg daily). This had been initially prescribed for back pain and she was adamant that she needed to continue taking the drug.
[ Dead or alive? The doctor’s challenge ]
Over the following year Ann experienced multiple pregabalin overdoses. She “stocked up” on pregabalin by attending a number of different doctors and also by repeatedly returning to doctors declaring that her medications had been stolen and seeking “replacement”. A year later, Ann was found dead on the floor of her hostel room with an empty bottle of pregabalin beside her.
These cases are among many known to GPs working in homeless and drug addiction services. Doctors Deirdre Dowdall, Angy Skuce and Kieran Harkin, along with Suzi Lyons of the Health Research Board, presented their concerns about the misuse and detrimental outcomes of pregabalin to the Coroners Society of Ireland (CSI) recently. The CSI has called on the Ministers for Justice and Health to designate pregabalin as a controlled drug (Class C), a move made by US authorities in 2005 and by the UK in 2019. Prescribing controlled drugs places additional responsibilities on doctors, including that they follow relevant national and international prescribing guidelines
Originally approved for use here in 2004, Lyrica (and two generic versions of the drug) has a product licence for three indications in Ireland – pain associated with certain types of nerve damage; epilepsy; and for the treatment of generalised anxiety disorder. But it is also prescribed “off label” for other conditions.
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A 2019 study published in Drugnet Ireland found a direct link between the level of dispensing of pregabalin and an increase in poisoning deaths here. The latest prescribing data shows that pregabalin is now among the top 20 drugs prescribed for medical card holders in the Republic of Ireland.
Known as coffin tablets among drug users, four 300mg pregabalin tablets can be bought on the street for €10. “There is a lack of awareness among prescribers of the abuse potential of pregabalin and the harm and suffering caused by it,” Dr Dowdall and her colleagues say.
Clearly, it is past time for pregabalin to be declared a controlled drug in Ireland.