MyCPD- Pregablin and Gabapentin reclassification

What are you planning to learn?

Recently the government has decided to reclassify Gapapentin and Pregablin as class C controlled drugs. Whilst, I am aware of issues around this drug I would like to be clear on the rational and the rules that are attached to the supply of this drug

How are you planning to learn it?

Carried out research of reputable sources, the MHRA guidance and NHS publications The information presented below describes my findings.

Misuse of Pregablin and Gabapentin1

My first source was a publication by Nottinghamshire Area Prescribing Committee, ‘misuse potential with pregabalin and gabapentin’ the article was very clear about the growing abuse and increase addiction surrounding these drugs. It stated:

Pregabalin and gabapentin can be sought after, because of both their own inherent misuse potential and their use in enhancing the effects of other drugs . There are ongoing concerns that prescribers are unaware of their illicit value. Prescribing of pregabalin has increased by 350% and 150% for gabapentin in just five years . The anxiolytic and sedative properties of pregabalin and gabapentin make them attractive to patients who have a history of illicit drug or alcohol misuse, or other patients who may wish to use medicines as a way of dealing with life events

The findings from the article described the risk of the recreation misuse of these drugs, particularly when used in combinations other prescribed or illicit medicines such as opioids, other CNS depressant medicines or alcohol. In fact the article concluded that ‘Pregabalin and gabapentin are now being detected in toxicology in autopsies after drug overdoses’.

Managing Pregablin and Gabapentin2

The Home office guidance alongside practical knowledge of a medicine from years of practice. The guidance published by the home office was rather vague, it simply stated that the drug was now a class C, but which schedule? At present what the guidance stated was that the prescription would expire within 28-days and should be physically signed by a prescriber – the part that is confusing in this message is regarding the physical signature, only recently had the government made it legal to have controlled drugs over electronic prescriptions.

Further clarity is needed regarding the schedule, which impacts whether these products are stored under controlled custody.

 

Give an example of how this learning has benefited the people using your services.

As expected the decision by the government triggered concerns from patients whom were taking the medications and concerns from staff working at the pharmacy. They were uncertain as to how to proceed with prescriptions for pregabalin and gabapentin. However, the knowledge ascertained above helped me reassure the staff during my locum shifts regarding the process, I referred them to Benzodiapines i.e diazepam. I informed them to treat it like they would a prescription for diazepam i.e. no emergency supply, ensuring the script is within 28-days and signed. And, if we receive further guidance from the government pertaining to storage we would act on this. This was helpful as it ensured that the staff appeared confident when collecting scripts from already concerned patients, the last thing we wanted was to make them panic even further. Patients, whom were concerned about the new around the reclassification were able to receive reassurance from me, I informed them that as long the medication was taken as prescribed under the supervision of a doctor they need not worry. However, if they felt particularly concerned then they should consider speaking to their prescriber.

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References

  1. https://www.nottsapc.nhs.uk/media/1108/pregabalin-gabapentin-misuse-potential.pdf
  2. https://www.gov.uk/government/news/pregabalin-and-gabapentin-to-be-controlled-as-class-c-drugs
  3. MEP 41

 

 

 

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