Intentional Drug Overdose Involving Pregabalin and Gabapentin: Findings from the National Self-Harm Registry Ireland, 2007–2015
- 324 Downloads
Intentional drug overdose (IDO) is a significant public health problem. Concerns about the misuse of gabapentinoids, i.e. pregabalin and gabapentin, including their consumption in IDO have grown in recent years. This paper examines the trends in the prevalence of gabapentinoids taken in IDO, the profile of individuals taking them, and associated overdose characteristics.
Presentations to emergency departments involving IDO, recorded by the National Self-Harm Registry Ireland between 1 January 2007 and 31 December 2015 were examined. Data items included patient demographics, drug names, total tablet quantity consumed and alcohol involvement.
Gabapentinoids were involved in 2115 (2.9%) of the 72,391 IDOs recorded. Presentations involving a gabapentinoid increased proportionally from 0.5% in 2007 to 5.5% in 2015. The majority of IDOs involving a gabapentinoid were made by females (59.9%), with over one-third (37.2%) involving alcohol. Compared with IDOs involving other drugs, presentations with a gabapentinoid were made by persons who were older (median 37 vs. 32 years) and involved a significantly greater median quantity of tablets (30 vs. 21, p ≤ 0.001), with over one-quarter (27.4%) of these involving the ingestion of 50 tablets or more. Admission to hospital was significantly more common following IDOs with a gabapentinoid compared with those without (49.4% vs. 41.4%, p ≤ 0.001).
This study identified the increasing use of gabapentinoids in IDO, describing the profile and overdose characteristics of presentations. It is important for clinicians to exercise vigilance while prescribing gabapentinoids, including being aware of other medications that their patients may have access to. Our findings support the need for routine monitoring for signs of misuse among those prescribed gabapentinoids.
The authors would like to thank the DROs who work on the National Self-Harm Registry Ireland, collecting information on self-harm presentations to hospitals across Ireland.
This research was conducted as part of a Ph.D. that was jointly funded by the University of Manchester and the National Suicide Research Foundation, Cork, Ireland. The National Self-Harm Registry Ireland is funded by the Health Service Executive’s National Office for Suicide Prevention.
Compliance and Ethical Standards
Conflict of interest
Ms. Caroline Daly, Dr Eve Griffin, Prof. Darren M. Ashcroft, Prof. Roger T. Webb, Prof Ivan J. Perry and Prof Ella Arensman have no conflicts of interest to declare.
The National Self-Harm Registry Ireland has received ethical approval from the National Research Ethics Committee of the Faculty of Public Health Medicine and the Clinical Research Ethics Committees of all 36 hospitals. The National Suicide Research Foundation is registered with the Data Protection Agency and complies with the Irish Data Protection Act of 1988 and the Irish Data Protection (Amendment) Act of 2003.
- 19.Public Health England and National Health Service England. Advice for prescribers on the risk of the misuse of pregabalin and gabapentin. 2014. Available at: http://guildfordadvancedcourses.co.uk/wp-content/uploads/2017/10/PHE-2014.pdf. Accessed 1 Sept 2017.
- 33.Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2016 registrations. 2017. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations. Accessed 1 Sept 2017.
- 34.Health Research Board. National Drug-Related Deaths Index, 2004 to 2014 data. 2014. Available at: http://www.hrb.ie/uploads/tx_hrbpublications/National_Drug-Related_Deaths_Index_2004_to_2014_data_01.pdf. Accessed 18 Dec 2017.
- 39.Health and Social Care Information Centre. Prescription Cost Analysis England 2012-Prescription items dispensed in the community in England and listed alphabetically within chemical entity by therapeutic class. 2013. Available at: https://digital.nhs.uk/catalogue/PUB10610. Accessed 1 Sept 2017.
- 41.US FDA. Statistical review and evaluation-Antiepileptic drugs and suicidality. 2008. Available at: https://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4372b1-01-FDA.pdf. Accessed 1 Sept 2017.
- 42.EMCDDA-Europol 2009 Annual Report on the implementation of Council Decision 2005/387/JHA; Annex 2 – New psychoactive substances reported to the EMCDDA and Europol for the first time in 2009 under the terms of Council. Available at: http://www.emcdda.europa.eu/html.cfm/index33227EN.html. Accessed 1 Sept 2017.
- 43.Health and Social Care Board. Advice for prescribers on the risk of the misuse of pregabalin and gabapentin. 2015. Available at: http://niformulary.hscni.net/Formulary/Adult/PDF/PregabalinAndGabapentinRiskOfMisuseAdviceHSCBWebVersion.pdf. Accessed 1 Sept 2017.
- 44.Home Office and the Health Service Executive. A consultation on proposals to schedule pregabalin and gabapentin under the Misuse of Drugs Regulations 2001. 2017. Available at: https://www.gov.uk/government/consultations/pregabalin-and-gabapentin-proposal-to-schedule-under-the-misuse-of-drugs-regulations-2001. Accessed 1 Sept 2017.
- 45.World Health Organization. Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment. 2017. Available at: https://www.whocc.no/filearchive/publications/2017_guidelines_web.pdf. Accessed 1 Nov 2017.
- 48.Bazazi AR, Zelenev A, Fu JJ, Yee I, Kamarulzaman A, Altice FL. High prevalence of non-fatal overdose among people who inject drugs in Malaysia: correlates of overdose and implications for overdose prevention from a cross-sectional study. Int J Drug Policy. 2015;26(7):675–81.CrossRefPubMedGoogle Scholar
- 59.Health Service Executive. Connecting for Life, Irelands National Strategy to Reduce Suicide 2015–2020. 2015. Available at: https://www.healthpromotion.ie/hp-files/docs/HME00945.pdf. Accessed 1 Sept 2017.
- 60.World Health Organization. Practice manual for establishing and maintaining surveillance systems for suicide attempts and self-harm. 2016. Available at: http://apps.who.int/iris/bitstream/10665/208895/1/9789241549578_eng.pdf. Accessed 1 Sept 2017.