Help For Pregabalin Addiction

July 29, 2024

4:43 pm

pregabalin-addiction

If you are suffering from addiction to pregabalin help is available. You may feel as if you can’t stop taking it, which you shouldn’t without expert help, and that you are destined to be taking it forever: This doesn’t have to be the case. Addiction to Pregabalin is a serious issue which needs professional help to recover from. It cannot be done at home as it needs medical supervision within the safety net of a rehab center. As with all addictions, medical input, while essential, is only one of the components of recovery. Without the appropriate therapy, and aftercare, relapse is inevitable. Aside from working in rehab centers with clients addicted to Pregabalin, I spent several years working with a world-renowned professor of addiction medicine, in two London prisons, drawing up treatment plans to reduce/stop pregabalin use.

Pregabalin addiction is an increasing problem and help, within the statutory sector, is incredibly difficult to obtain. This is because statutory services, where I work, are commissioned for alcohol and opioids, as well as cocaine. Pregabalin is not an opioid and thus Methadone or Buprenorphine, the two drugs most commonly used for opioid addiction will not work. Local commissioned services will offer a keyworker, groupwork sessions, etc. They may discuss a reduction plan and liase with your GP.

All GP services purchased by the NHS are provided by private companies commissioned to provide services. As such, GP services are now under pressure to review, and reduce pregabalin prescribing. The usual rule of thumb is that, unless the drug was prescribed by a hospital consultant neurologist/neurosurgeon or a consultant orthopedic surgeon your GP will be under pressure to reduce/stop your Pregabalin. The computer systems used by GP’s have audit functions where reports can be generated on prescribing trends, etc. Such is the concern about the prolific uplift in cases of addiction to Pregabalin that it is now a controlled drug. Of course, there are patients who take this drug responsibly, and therapeutically, for whom their use has been sanctioned by a hospital consultant and there are no issues.  

As Pregabalin is usually given to patients on a repeat prescription basis this creates a significant issue. Patients may try and report that they have lost their prescription; it was taken from them as part of a street robbery, they left it on a bus, etc. They do this to obtain more but it won’t work. No GP surgery, as I wouldn’t, would honor a replacement. A police crime report number won’t get you a replacement prescription, either. This can mean patients use the internet to buy extra (you might as well flush your money down a drain), ask others prescribed it or, worse still, buy from street dealers. Despite what you might think, there is no such thing as a reputable dealer.

While it is not uncommon for patients to be dependent on Pregabalin alone, it is also very common to find patients using community drug and alcohol services. These patients will, invariably be heavily dependent on heroin and crack cocaine, as well as other drugs such as benzodiazepines.

People who die from drug overdoses normally have, at least, six different drugs in their systems when blood tests are conducted, post-mortem. The difficulty with Pregabalin is that when it is used with opioids, benzodiazepines and Buprenorphine, the usual method of reversing the opioid element of the overdose, Naloxone, becomes much less effective.

All statutory community drug and alcohol services are commissioned by the local authority. They are at carte blanche to commission whomever they choose. Some will buy in services from private companies, some charities and the third sector and some: the NHS. They have a budget for detox/rehab centers, but they are small, and the demand is very high.  To get statutory services to fund a stay for pregabalin there will be lots of hoops to jump through: it is not going to happen overnight. While private rehab centers always provide medical treatment alongside therapy, statutory services may just provide a residential detox: only. Without the correct therapeutic input and aftercare, a relapse is highly likely.

What is Pregabalin?

Pregabalin is a drug prescribed, initially, for epilepsy and seizure control. It is not a cure but will prevent seizures if taken regularly: as directed.  It can also be used for long-term pain caused by Shingles and nerve pain from spinal cord injuries and nerve damage from diabetes. It is also used for muscle pain and stiffness as is common with Fibromyalgia.  Pregabalin can be used for alcohol detox and anxiety disorder. It can be taken in an oral capsule or liquid.

It was discovered through some research in 1988 at Northwestern university in America by a member of Professor Richard Silverman’s lab team. The team discovered that certain artificially created chemicals can help to increase the concentration of a neurotransmitter in the brain. This neurotransmitter is known as an “inhibitory” one, that being a chemical that stops something from happening: In this case epileptic seizures. This discovery led, a year later in 1989, to a new molecule being synthesized, known as Pregabalin.  It was not until ten years later that Pfizer became involved and in 2005 it began to be marketed as Lyrica. This drug, alone, generated over five billion dollars for Pfizer. However, income from the drug was also used to fund other major research studies. Part of the revenue went towards funding a central hub for research at Northwestern university.

Why is it addictive?

Pregabalin causes euphoria, which can be a welcomed side effect. However, it you stop taking it, it will cause withdrawal symptoms. These can be very unpleasant, indeed. The most common being:

  • Changes in mood
  • Severe agitation
  • Headaches
  • Depression
  • Chronic anxiety
  • Serious suicidal ideas
  • Severe nausea
  • Very heavy sweating
  • Chronic diarrhea
  • Rapid heart rate
  • Extreme cravings for pregabalin
  • Severe insomnia
  • Seizures

Withdrawal signs and symptoms can start within a couple of days, depending on how much pregabalin is taken and how long for. While stopping Pregabalin suddenly can cause seizures, for those prescribed it for seizure prevention, this makes sudden cessation incredibly dangerous. Even for those who have a supervised taper in a residential center, residual withdrawal symptoms can present after a week. A study in Japan in 2021 showed that patients who take Pregabalin for as little as two months can encounter significant difficulties in reducing and ending their use of the drug.

pregabalin-addiction

Pregabalin poisioning

Patients poisoning themselves (either deliberately or accidentally) with Pregabalin alone is uncommon. Used in isolation, it normally causes only mild sedation. However, what is far more common is for patients to take Pregabalin in common with other medications that can cause sedation. This, massively, increases the risk of breathing difficulties, coma and death. It is not just those who take it as part of a treatment plan from a doctor that experience difficulties. There are increasing cases of those who use it recreationally, and by mixing it with other drugs end up in hospital or worse. Prescribing clinicians must be extremely cautious about prescribing Pregabalin to those with a history of substance dependency.

Interactions with other drugs

Pregabalin is excreted in an unchanged form in urine. What this means is that the body is unlikely to change the drug when it is in your system. Pregabalin is what is known as a central nervous system depressant (CNS). As such, when one CNS depressant is taken with another (and that includes alcohol, a CNS depressant) the effects on the central nervous system can be drastically increased. This can lead to extreme drowsiness, heavy sedation, respiratory depression and, in extreme cases: death.

Some commonly used medications are CNS depressants and accidents happen. Some hay fever medications, pain killers, anti-sickness medications are of this class as are benzodiazepines and anti-psychotic medication. Even some muscle relaxants can cause these problems. Research papers have already reviewed cases of patients ending up in comas due to patients mixing Pregabalin with other drugs.

A study in the United Kingdom in 1994, estimated that as many as 6000 traffic accident deaths could be attributed to the use of psychoactive drugs. For those being held in secure settings such as prisons and secure mental health units, there are significant issues with diversion of medication. Mixing Pregabalin and Oxycodone can cause significant cognitive impairment and seriously affect gross motor function (ie walking, carrying a box, driving a car).

What help is available

For those who are experiencing dependency on Pregabalin: help is available. There are centers across the UK and Spain that can offer a tailored medical treatment plan, as well as a package of therapy and aftercare to get a patient free of Pregabalin and onto a trajectory of sustained recovery.  

As with treatment for all dependency, there are three different elements:

  • Medical treatment plan
  • Therapy
  • Aftercare

No element is more important than the other, but if the initial element is not in place, then the recovery trajectory will not work well. A tapered reduction, within a residential unit, will enable the client to safely get away from Pregabalin. However, there is a caveat to that in that the patients GP (or whomever prescribed it) needs to be made aware so that, if necessary, an alternative drug can be provided. As previously mentioned, GPs are under increasing pressure to reduce and stop pregabalin prescribing so will be on board if a patient enters treatment to reduce and stop. For those using illicitly obtained Pregabalin, it can be a little more complicated to work out a reduction regime due to not being able to verify the drug being taken but all in a day’s work for an experienced clinician.

For those who are taking high doses, it may be more cost effective to start a reduction plan, in the community, with the support of the GP/specialist doctor. A reduction plan could last for several weeks, or even months, which could make a residential treatment plan cost prohibitive. Thus, a community element might help reduce costs.

A center will make an informed decision as to whether they can provide a treatment plan for a client and a reduction plan drawn up. Clinical guidelines differ as to the rate of reduction, but not widely. In a nutshell, if someone is reducing, and not too quickly, the actual mechanics are not that important. Unlike alcohol withdrawal, it is unlikely that someone who comes into treatment for Pregabalin will need time to “settle in” before being able to take part in therapy. Sometimes, with alcohol withdrawal, it can take a day or two before a client is physically able to take part in group sessions: This is unlikely with Pregabalin. A reduction plan will be like reducing the amount of Pregabalin taken in a day and (towards the end of the reduction plan) the number of times a day it is taken.

All private centers operate on a group therapy basis, whether this is based around a 12-step abstinence-based approach or a SMART approach (some use an eclectic mix). To be honest, as a clinician, therapy is not my strongpoint. However, from my observations of working in centers across the UK, the approach used is not that important. What is important is that a client goes into treatment with an open mind ready to address issues that lead to addiction. There are arguments for and against a twelve-step approach on which I am not going to comment: I am not in recovery and am not a therapist. What I will say is that 12 step programmes have helped millions of people, all over the world, for many decades and continue to do so. Indeed, most of the staff who work in centers are in recovery themselves, mostly due to 12-step programmes. Individual therapy is not something that has been found to be productive in rehab. One session a week is usually provided for those clients staying a week. No reputable Centre will accept a client for a rapid detox. This is dangerous, unethical and bound to fail.

The third element is aftercare, which is essential. When I speak to clients who have relapsed, it is invariable that they did not make use of the aftercare provided. There are those in recovery who have remained abstinent for decades, which they put down to continuing along the pathway introduced in treatment, be it a twelve-step approach or a SMART or eclectic approach.

Help is available. It need not be expensive, and this is not something that can be done at home. Call and speak to an experienced clinician who has many years’ experience of Pregabalin treatment and recovery.