Unlike many other developed countries, rates of pregabalin use and overdose have levelled off and declined in Australia since 2018 following high profile media coverage of harms, restrictions on prescriptions and supply, and new boxed warnings, finds a study published by The BMJ today.
Compared with earlier trends, prescriptions were 25% lower and intentional poisoning calls 47% lower than expected, the results show.
While the researchers can’t attribute a direct (causal) link between this decline and these measures, they say the results are promising and may help inform similar interventions elsewhere.
Pregabalin is a gabapentinoid drug used to treat epilepsy, nerve pain, and anxiety disorders. Alongside increased use in recent years, there is mounting evidence of misuse, dependence, and harms in Europe, the USA, Asia, and Australia.
For example, in the UK, one third of substance use deaths involve a gabapentinoid, predominantly pregabalin, and deaths involving gabapentinoids have more than doubled from 2018 to 2022. Similar concerns have been reported elsewhere, prompting many countries to implement restrictions and interventions.
To evaluate recent trends in pregabalin use and misuse across Australia, researchers examined dispensing claims and poison centre data from 2016 to 2024 with a focus on three key events: widespread media reporting on the harms of pregabalin in December 2018, tighter prescribing restrictions from April 2020, and the introduction of boxed warnings in February 2021.
During the study, 227,864 people were dispensed 3,441,851 pregabalin prescriptions and 4,871 pregabalin overdose calls were reported to the poisons centre.
Pregabalin use and overdose peaked in 2018 before declining. Three timepoints were observed when pregabalin dispensing decreased significantly: in December 2018 (corresponding to high profile press coverage), in May 2020 (the month after tighter prescribing restrictions were introduced), and in December 2021 (following boxed warnings and the introduction of real time prescription monitoring).
Compared with the projected historical trend, there was a 25% decrease in dispensing, with approximately 118,390 fewer pregabalin prescriptions in December 2021, and an ongoing reduction of 0.7% each month. There was also a 47% decrease in overdose rates, with an estimated 41 fewer pregabalin overdose calls in December 2021, and an ongoing reduction of 1.6% each month.
These are observational findings and the researchers acknowledge that they relied on subsidised prescriptions only, that poisons centre data is subject to reporting bias, and they were unable to report access to pain treatment and switching to other drugs, such as opioids. Nonetheless, findings were consistent after further analyses, suggesting they are robust.
As such, they say, after many years of escalating pregabalin use and overdose in Australia, rates appear to have plateaued and started to decline since 2018.
And although they can’t attribute causality, they note that this decline coincided with widespread media coverage of harms, prescribing restrictions, and boxed warnings, and they suggest similar measures could be considered in other countries where pregabalin misuse is of concern.
However, while these findings are positive, they point out that pregabalin use and overdose remain high, with dispensing rates still far outstripping what would be expected if pregabalin was prescribed for approved indications alone, prompting them to call for ongoing monitoring and further restrictions.
These figures are striking, but warrant caution, says Professor David Juurlink in a linked editorial, arguing that pregabalin should be used more selectively and only when patients experience meaningful benefit.
He cautions against viewing it as a safe everyday analgesic, advising it be reserved for proven conditions such as diabetic nerve pain and chronic widespread pain (fibromyalgia), while avoiding it for low back pain and sciatica.
“Persisting with ineffective treatment or escalating the dose in pursuit of relief that has yet to materialise is more than misplaced optimism. It is an invitation to harm,” he warns.
The BMJ