Lyrica Nights–recreational Pregabalin Abuse in an Urban Emergency Department

Abstract

Objectives & BackgroundSince ‘legal highs' emerged as drugs of abuse in the UK, Emergency Physicians have battled to keep up with the latest drug craze. Whilst many of these drugs present with recognisable toxidromes, the effect of new compounds or medications cannot be readily predicted. In Belfast, we have witnessed a recent increase in the number of patients presenting after recreational abuse of Pregabalin (Lyrica). Patients, state that the medication induces a state similar to drunkenness, hence the street name ‘Budweiser's’. To our knowledge this is the first case series detailing the recreational abuse of Pregabalin, a drug which has become popular in primary care.MethodsWe conducted a one year review of all patients presenting to our department after recreational drug abuse. Those who admitted to Pregabalin usage were identified and case notes were reviewed.ResultsBetween 02/12–02/13, 10 patients presented to our ED following recreational Pregabalin abuse. All were aged between 20 and 35 years of age. Dosages ranged from 500–1400 mg. Six patients presented with seizures (5 of which were ‘first' seizures). Two patients required intubation and ventilation and were admitted to the ICU. In total, nine patients were admitted for a minimum of 24 hours, whilst one patient discharged against advice.ConclusionEmergency Physicians should be aware of the current use of Pregabalin as a recreational drug. Patients are either taking tablets whole or cutting and snorting them. 60% of patients in this case series presented to the ED with seizures and 20% required ICU admission. We recommend that patients who present with potential Lyrica toxicity should be admitted for observation with the treating physician being mindful of the potential for seizure activity.

Disproportionality Analysis for the Assessment of Abuse and Dependence Potential of Pregabalin in the French Pharmacovigilance Database

“…Euphoria was already described in pre-marketing studies [29]. ''Real-life'' experience revealed that it was used in order to potentiate the effects of methadone [28], or for drunkenness-like effects (''Budweiser's'' effect) [27]. Furthermore, drug-dependent patients are at risk of pregabalin dependence, as it is sometimes used off-label to help drug discontinuation, for instance discontinuation of benzodiazepines [31].…”

“…The disproportionality analysis found no significant association between pregabalin or amitriptyline and abuse or dependence, whereas this association was significant with clonazepam. From now on, there is strong evidence highlighting the abuse potential of pregabalin in the real-life setting [9,[24][25][26][27][28][29][30]. Several psychoactive effects of pregabalin explain the risk of recreational misuse and thus its abuse and dependence potential.…”

Opioid-Sparing Drugs (Ketamine, Gabapentin, Pregabalin, and Clonidine)

“…In one case series [ 37 ], sixty percent of patients presented to the ED with seizures and 20 % required ICU admission. Plasma, serum or blood concentrations of pregabalin may be measured to monitor therapy or to confi rm a diagnosis of poisoning in hospitalised patients.…”

Pregabalin addiction in a case with synthetic cannabinoid use

“…Intubation and ventilation were required in 2 patients while seizures were observed in 6 patients (26). GABAergic effect and stimulant properties of pregabalin are considered to play a role in the abuse of the drug (27).…”