Dr Maryse Lapeyre-Mestre is MD, PhD, qualified in Clinical Pharmacology, Public Health and Pharmacoepidemiology. She is Professor of Clinical Pharmacology, with a permanent position of Senior lecturer in pharmacology for the Health and Medicine Schools at the Toulouse University (South of France). Her areas of research include evaluation of long term effects of drugs and drug safety, with a particular interest in abuse and addiction to medications and determinants and outcomes of psychoactive drug use. As a member of the French Addictovigilance Network (FAN, https://addictovigilance.fr/ ), she is also scientific expert in charge of the potential of abuse assessment of gabapentinoids for the French Medicine Agency (ANSM).
Prescriptions of gabapentinoids – what should we learn from the insights of Malcolm Lader?
Gabapentinoids (gabapentin and pregabalin) were initially presented without any potential of abuse, but the commercial success of pregabalin in Europe and particularly in France since its marketing authorisation in 2004, has led to its wider use in non-validated indications (any category of pain, use for treating benzodiazepines withdrawal or alcohol or cocaine addiction). The first addictovigilance signals appeared in 2010, based on pharmacovigilance and toxicology data, showing an increase in the involvement of these two drugs in substance abuse-related deaths. In France, the first case of abuse with pregabalin was spontaneously reported in 2011, but data collected through the French addictovigilance system for the period 2010-2019 exhibit a marked increase of pregabalin misuse and abuse in France from 2018, with pregabalin representing more than one quarter of falsified prescriptions identified, difficulties for withdrawal, and hospitalisations. Pharmacoepidemiological studies indicate that gabapentinoids are drugs of abuse either on their own or in conjunction with other drugs, particularly opioids, and their use is associated with increased mortality. If we step back from these data, we realize that the situation is completely similar to that of benzodiazepines as highlighted by Sir Malcom Lader several years ago.
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