Journal of Mental Health and Human Behaviour

LETTER TO EDITOR
Year
: 2021  |  Volume : 26  |  Issue : 2  |  Page : 174--175

Two more cases of pregabalin dependence: The pandora's box is open and needs serious attention


Abhishek Ghosh1, Sambhu Prasad2, Aniruddha Basu3, Debasish Basu1,  
1 Department of Psychiatry, Drug Deaddiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
3 Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India

Correspondence Address:
Sambhu Prasad
Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar
India




How to cite this article:
Ghosh A, Prasad S, Basu A, Basu D. Two more cases of pregabalin dependence: The pandora's box is open and needs serious attention.J Mental Health Hum Behav 2021;26:174-175


How to cite this URL:
Ghosh A, Prasad S, Basu A, Basu D. Two more cases of pregabalin dependence: The pandora's box is open and needs serious attention. J Mental Health Hum Behav [serial online] 2021 [cited 2022 Aug 18 ];26:174-175
Available from: https://www.jmhhb.org/text.asp?2021/26/2/174/337162


Full Text



Sir,

Pregabalin (PGR) is a well-known drug used to treat chronic pain conditions; however, it underscores its potential for abuse and dependence. In patients without a prior abuse history, there are very few cases with gabapentinoid-related behavioral dependence symptoms as per International Classification of Diseases (ICD-10).[1] Here, we try to present two cases of PRG dependence with comorbid opioid dependence.

 Case Reports



First case

PS, 23-year-old, single, farmer presented to Drug Deaddiction outpatient with high dose PRG use. He was primarily dependent on injection heroin for the past 2 years. He attempted to quit heroin with buprenorphine, obtained from his friend. He was told about the analgesic effect of PRG, which he bought over the counter. He used the combination of buprenorphine and PRG to relieve heroin withdrawal symptoms. He started with 150 mg/day PRG and gradually increased the dose up to 1125 mg/day over one year. He reported euphoria, increased self-confidence, increased sociability with PRG. Moreover, he would perceive PRG and buprenorphine potentiating each other's effect. Within couple of months of initiation, he would have intense desire for PRG on the particular time of the day and could differentiate it from the desire for buprenorphine, categorically. He would suffer from trembling, palpitations, sweating, sleeplessness, and inability to concentrate on any work when he would not take the usual dose of PRG, even for 24–48 h. These symptoms would be distinct from buprenorphine withdrawal and would be relieved only with PRG. He had several failed attempts to quit PRG.

Second case

DD, 37-year-old, married, working in the packaging division of a pharmaceutical factory, presented to the Drug Deaddiction outpatient clinic for discontinuation of PRG use. On exploration, he was found to have opioid dependence (natural opioids) in the past, currently abstinent from the last four years. He started PRG two years back to 'get relief' from his work-related stress and reported its effect to be pleasurable and relaxing at the same time. Initially, he would take PRG 75–150 mg/day. He claimed PRG would enhance his 'stamina' and he would be able to work till late at night, at a stretch. He progressively increased the dose and frequency of use and would report craving and preoccupation for the same. Within the next 2 years, increased the dose up to 1500 mg/day to obtain the same effect. On the insistence of his family, when he attempted to quit, he experienced restlessness, increased heart rate, diaphoresis, sleeplessness, and dysphoric mood and was unable to do so. Hence, he sought for the same.

 Discussion



Both the cases described above fulfill the diagnosis of PRG dependence, as per ICD-10 and had either preexisting or ongoing opioid dependence. Given the common indication as analgesic, the possibility of concomitant prescription of both these groups of drugs is high on the cards, and in such a scenario, the reinforcing effects on one another might result in double jeopardy. The abuse potential of PRG indicating its modulatory effects on the GABA and glutamate systems, leaving room for abuse potential.[2] From India, there are few published case reports so far, which has discussed abuse of prescribed PRG.[3],[4],[5] We believe the two cases of PRG dependence in the substance misusing population reported by us are the first of its kind from the Indian subcontinent. The Drug Controller General of India and Central Drugs Standard Control Organization has given approval of PGN use in various pain symptoms, including diabetic neuropathy, as it is used more frequently by the physician in India (http//:www.cdsco.nic.in).[6] This possibility looks sinister given the lack of legal restriction on PRG availability in India, as PRG is a schedule H drug and effectively, like many other drugs in this category. Hence, there might be the need for more stringent legal restrictions, and the physician needs to be more cautious about its use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Bonnet U, Richter EL, Isbruch K, Scherbaum N. On the addictive power of gabapentinoids: A mini-review. Psychiatr Danub 2018;30:142-9.
2Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs 2017;77:403-26.
3Ashwini S, Amit DR, Ivan NS, Alka PV. Pregabalin dependence with pregabalin induced intentional self-harm behavior: A case report. Indian J Psychiatry 2015;57:110-1.
4Chaudhary N, Jain S. Pregabalin addiction: Case report of a young adult. Int Healthc Res J 2020;4:60-3.
5Singh A, Sidana A, Agrawal A, Arun P. Pregabalin dependence. Indian J Psychiatry 2020;62:738-9.
6New Delhi: Ministry of Health and Family Welfare, Government of India, Central Drugs Standard Control Organisation. List of Approved drug from 2001. Available from: http://www.cdsco.nic.in/.../LIST%20OF%20APPROVED%20DRUG%20FROM%2001.htm.