The misuse of gabapentin and pregabalin has been rapidly rising over the past few years. So, it came as little surprise to me when I heard the announcement that they had been reclassified as schedule 3 controlled drugs. What did surprise me, however, was my initial reaction: an immediate prayer to the pharmacy gods that the reclassification wouldn’t involve safe custody. I had just managed to balance my last box of Palexia atop an open bottle of methadone before slamming the tiny safe’s door shut. I couldn’t fit one box of Lyrica in there, let alone 40.
Thankfully, the gods were kind. Gabapentin and pregabalin shall be treated under the same rules as tramadol and others. What I am less thankful for though, is the added difficulty I now face in procuring these new scripts from the black hole that is a GP reception’s prescription box.
Some of you may be quite lucky, as I have been in the past, but at present, every surgery I deal with appears to approach their controlled drugs prescriptions with the same unpredictability I would expect from a drunkard’s walk home. Some keep them separate. Some keep them together. Some only give them to you if you specifically ask for the controlled drug, staring at the script, then your blank expression, with a look of sheer schadenfreude. I’ve seen surgeries with more separate filing systems than they have doctors.
While these extra pieces of admin may infuriate or frustrate, it is my hope that these changes may just make GPs take an extra second before prescribing both drugs so quickly. In 2013, the National Institute for health and Care Excellence (NICE) stated that pregabalin, gabapentin and amitriptyline should all be considered equally. Before this, amitriptyline was seen as the first-line treatment, followed by gabapentin. Pregabalin had been a last chance saloon drug, due to its cost and addictive properties. Yet since the 2013 guidance has been published, pregabalin appears to have become the drug of choice. A drug that is very prone to abuse.
Nowhere is this seen as much as in Northern Ireland. With a street name of ‘buds’, pregabalin is being swallowed, snorted and who knows what else by drug abusers across the country. I have overheard oblivious patients describe to their friends how their weekend of drug abuse went while picking up their weekly dose of pregabalin.
The issue is quickly becoming an epidemic and any assistance to reduce its prescribing will be welcomed. I just hope other GPs tackle the issue head on, unlike the above patient’s GP, who appeared to laugh off their abuse and get back to their busy day.
The reclassification is a positive step, but I just fear that it will be yet another of society’s problems that pharmacies will have to try and police themselves with little or no help. Either way, I have no doubt we as a profession will meet the challenge head on. Just don’t make me open that safe again today.
The Multiple Manager works in a Northern Irish branch of a major pharmacy chain