Doctors have been warned about the dangers of prescribing a whole class of painkillers after they were linked to Scotland’s drugs-death crisis.
Scientists have long been worried that medicines such as pregabalin — dubbed the “new Valium” or even “Bud”, like the beer — are finding their way on to the black market across the UK.
Now they are warning that the drug and its sister product gabapentin are being prescribed by Scottish doctors “off label” for conditions they were never supposed to help — and in ever-increasing quantities.
Known collectively as gabapentinoids, the two products were originally licensed for use to treat the kind of nerve pain which can be caused by conditions such as epilepsy, diabetes and shingles. Pregabalin can also be prescribed for anxiety.
Gabapentin is usually prescribed for nerve pain caused by epilepsy, diabetes and shingles
ALAMY
However, a study has found that these medicines were implicated in nearly two out of five drugs deaths in Tayside, usually when used together with a narcotic. More than three quarters of victims had got the drugs through “diversion” — meaning they were passed on or sold by others — rather than directly by prescription.
The research, published in the British Journal of Anaesthesia, documented a huge rise in the number of scripts written for the drugs in Scotland. Pregabalin, introduced in 2004, went from just over 27,000 prescriptions in 2006 to 966,000 in 2024.
Professor Blair Smith, chair of Population Health Sciences at the University of Dundee’s School of Medicine and an expert in pain, said: “Gabapentin and pregabalin are first-line treatments for neuropathic pain and there is evidence to support that. However, the evidence may not be there for any unlicensed use. It is important we should go on the evidence because these drugs have side effects and dangers attached to them.
“One hypothesis for the increase is the pressure on GPs to prescribe less opioids, as these have been heavily implicated in drugs deaths. There may also be diversion of prescription drugs into street drugs and for recreational use and sold on that basis.”
• On the front line of Britain’s growing synthetic opioid crisis
The UK has the largest reported opioid using population in Europe. In 2018 these toxic drugs were mentioned or implicated in 80 per cent of drugs deaths across the UK, a figure that goes up to 86 per cent for just Scotland.
A 2022 report in the British Journal of Clinical Pharmacology found that, of 3,051 drug-related deaths in England between 2004 and 2020, gabapentin was detected in 913 cases, pregabalin in 2,322, and both drugs in 184.
According to the Clinical Practice Research Datalink, an estimated 50 per cent of gabapentinoid prescriptions are issued for unlicensed uses, such as osteoarthritis and back pain.
“Gabapentinoids are a good thing if used appropriately and for conditions for which they are known to be effective,” Smith said. “But an eye has to be kept on side effects to ensure these don’t outwith the benefits.”
• Inside the UK’s first drug consumption room in Glasgow
In 2019, the Medicines and Healthcare products Regulatory Agency reclassified the drugs as Class C due to their potential for misuse.
Dr Chris Williams, the vice-chair of the Royal College of General Practitioners Scotland, said doctors were aware of the dangers posed by gabapentinoids, especially when combined with other substances, and reviewed repeat prescriptions.
He said: “The rise in prescriptions may reflect broader demographic and health trends, such as Scotland’s ageing population and increasing levels of physical and mental health problems. In some cases, GPs are also asked to prescribe these medications following recommendations from secondary care specialists, such as psychiatrists and chronic pain services, which may further contribute to the overall increase.”
A Scottish government spokesman said: “Repeat prescriptions for these medicines should be reviewed to ensure they remain appropriate. It is recommended that they are only issued on a monthly basis. Decisions about the appropriateness of certain medicines for pain management, or referral to pain services, will be made by the clinician in discussion with the patient, and with reference to their medical history and current guidance.”
Source link