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Other drugs ‘could fill the void’ following abused drug controls — HSE addiction specialist

According to meeting minutes of the Department of Health’s Early Warning and Emerging Trends (EWET) sub-committee, Dr Denis O’Driscoll said that when additional controls come into force on benzodiazepines and z-drugs under misuse of drugs legislation, there could be “a knock-on effect” for addiction services, “especially if over-prescribing is reduced and individuals present with an addiction to these drugs”.

“He warned that pregabalin, given its abuse potential, will fill the void created by these controls,” according to minutes of the February meeting.

He was concerned that the group had been discussing misuse of pregabalin over the last couple of years, yet “no developments had been progressed to address the issue”.

Consequently, the sub-committee issued a rare clinical advisory to prescribers and dispensers, noting that pregabalin and gabapentin presented a risk of addiction and potential for illegal diversion and medicinal misuse.

Misuse of drugs legislation passed earlier this year provides for stricter controls on benzodiazepines, as well as controlling zopiclone and zaleplon and the benzodiazepine phenazepam. Controlling the substances is part one of a two-step process and regulations are being developed to allow legitimate users (for example, patients with a prescription and health professionals) to possess the substances.

Over the past two years, the EWET has received a number of “anecdotal reports” on the misuse of pregabalin and to a lesser extent of gabapentin, according to the Department. Recently, this information has been “bolstered with evidence-based reports” and through their appearance in toxicology screenings by the HSE National Drug Treatment Centre and Forensic Science Ireland.

Dispensing data from the HSE PCRS over the past five years “shows a dramatic and continued increase in the volume of dispensed pregabalin, suggesting that those who are misusing these medicines may be sourcing them through legal as well as illegal channels”.

No decision has been taken to place controls on pregabalin or gabapentin under misuse of drugs legislation, stated the Department. “Any decision in this regard will be taken in consultation with relevant stakeholders.”

Legitimate use of these medicines provides “valuable, effective treatment options” for a number of medical conditions, it added.

See investigation on p4-5

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