|Year : 2019 | Volume
| Issue : 4 | Page : 393-397
Prevalence and risk factors of pregabalin misuse among patients with substance use disorder
Amgad A.M Gabr
Department of Psychiatry, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
|Date of Submission||14-Sep-2019|
|Date of Decision||17-Oct-2019|
|Date of Acceptance||17-Nov-2019|
|Date of Web Publication||14-Feb-2020|
Amgad A.M Gabr
Al Mokhaym Al Daem, Gameat Al-Azhar, Nasr City, Cairo Governorate, Cairo 11751, Egypt; Al Mokhaym Al Daem, Al Azhar Unversity, Nasr City Cairo, Egypt. Post Office No.11751
Source of Support: None, Conflict of Interest: None
Background Pregabalin use disorder is an alarming phenomenon demonstrated in many countries. Some countries classified it as a class C controlled substance in a schedule V controlled substance.
Aim The aim was to assess pregabalin use disorder among substance abusers, recognize psychiatric co-morbidity, and identify risk factors to start pregabalin abuse.
Participants and methods The study group included 400 Egyptian substance misusers. From addiction and psychiatric outpatient clinics in Al-Azhar University Hospitals in Cairo, Egypt, the participants were diagnosed using DSM V and interviewed using (SCID 1) and urine specimens screened for routine polysubstance and pregabalin by means of a mass spectrometer analysis.
Results The prevalence of pregabalin misuse disorder among all patients with substance misuse disorder was 30%. However, first substance is cannabinoids (hashish), with 83.75%, and then tramadol, with 43.75%. The prevalence of co-morbid psychiatric disorders was 45%. We found the use of pregabalin for sleep purpose 32.5% and for anxiety self-treatment 19.2% as the strongest predictors and risk factors for pregabalin abuse.
Conclusion Pregabalin misuse disorder is at the fourth rank among all substances misused in Egypt, with a percentage of 30%. The most common reason for pregabalin misuse is to have a good sleep, self-treatment of anxiety, peer pressure, and depression.
Keywords: polysubstance, pregabalin, substance abuse
|How to cite this article:|
Gabr AA. Prevalence and risk factors of pregabalin misuse among patients with substance use disorder. Al-Azhar Assiut Med J 2019;17:393-7
|How to cite this URL:|
Gabr AA. Prevalence and risk factors of pregabalin misuse among patients with substance use disorder. Al-Azhar Assiut Med J [serial online] 2019 [cited 2020 Jun 3];17:393-7. Available from: http://www.azmj.eg.net/text.asp?2019/17/4/393/278392
| Introduction|| |
Pregabalin is a centrally acting γ-aminobutyric acid (GABA) analogue used in the treatment of epilepsy, neuropathic pain, fibromyalgia, and some anxiety disorders. Off-label uses were for hypnotic-dependent insomnia , alcohol dependence, and withdrawal of benzodiazepines . It increases neuronal GABA levels by binding selectively to the α-2-δ subunits of voltage-gated calcium channels . Dependency of pregabalin is claimed to its antiglutaminergic effects, which are similar to other GABA-like substances such as benzodiazepines and alcohol . Pregabalin is widely used and was ranked as 30th most prescribed medications in the USA in 2011 . Although pregabalin is well tolerated, it associated with euphoria in ∼5% of all, and illicit use of pregabalin associated mainly with opioid misuse . Pregabalin was detected in 4.5% of the surveyed addictive patients in a nation-wide screen in Norway . The inadequate product labeling and lack of established abuse potential have led to a safety feeling among many physicians to prescribe it to recovering narcotic addicts and also owing to a cheap price and not being scheduled till now, especially as pregabalin was not genotoxic in rats in doses up to 2000 mg/kg . An increasingly alarming phenomenon of pregabalin misuse has been reported in the Middle East area, especially in the Gulf Area, as a result of multiple reports of abuse and dependence . Usages of pregabalin contributed mainly to its sedating and anxiolytic effect . Pregabalin use is largely considered safe by physicians. Dizziness, nausea, constipation, edema, and headache are reported as the commonest adverse effects . The most common symptoms of acute pregabalin overdose are central nervous system depression, nausea, vomiting, anorexia, tachycardia imbalance, delirium, blurred vision, amblyopia, confessional state, disturbance in attention, thinking abnormal seizures, and myoclonus . In a study describing 10 patients admitted to an emergency department in Belfast over a 1-year period with pregabalin abuse (patients with dosages ranging from 500 to 1400 mg), six patients had seizures, and two patients were admitted to the intensive care unit. However, the most common symptoms of its withdrawal include sweating, restlessness, hypertension, tremor, and pregabalin cravings. Montgomery et al.  reported a case that developed auditory hallucinations and suicidal ideation in addition to sweating, anxiety and tachycardia with withdrawal. According to the pregabalin manufacturer, till now, no specific recommendations for the management of an acute withdrawal syndrome exist, just gradual tapering. This study aimed to detect the prevalence of pregabalin dependency among substance abusers, to recognize comorbid psychiatric disorders, and to identify risk factors to start pregabalin abuse.
| Participants and methods|| |
This was a cross-sectional study carried out for a period of 12 months (1 November 2017 till the end of October 2018). The study group comprised 400 Egyptian participants. Their age ranged between 18 and 60 years old, and both men and women included. They fulfilled the criteria for substance use disorder according to DSM V criteria. They were selected from addiction and psychiatric outpatient clinics in Al-Azhar University Hospitals in Cairo.
Measurements and questionnaire
After obtaining oral and written consent from each participant, the study was developed according to the standard in quality improvement system in ministry of health and population in Egypt. The participants were evaluated using a semistructured interview sheet that gathered general data as well as drug habits of the patients (the type of drug, the route of administration, the dose, etc.); a structured clinical interview for DSM V Axis I disorders (SCID-I), which is used to diagnose psychiatric disorders; urine screening for routine substance abuse and for pregabalin, which is not a routine investigation to detect the prevalence of pregabalin dependency among substance abusers; and possible risk factors, such as demographics, comorbid psychiatric disorders, family history of addiction, and self-medication to start pregabalin abuse.
The protocol was approved by the Ethics Committee of the institutions of the research, and a written informed consent was collected and signed from the patient and control group. The consent was in accordance with the ethical standards of the Helsinki Declaration, 2004.
Data were summarized as mean and SDs, and qualitative data were summarized as numbers and percentages. The SPSS software, version 11.0.1 (SPSS Inc., Chicago, Illinois, USA), was used for statistical analysis.
| Results|| |
The study was conducted on 400 patients who came to the outpatient addiction clinics of three hospitals. The study was conducted as previously shown in the method. Regarding the sociodemographic characteristic of patients with pregabalin use disorder, we found that the main age of onset of start pregabalin use disorder was 30.18±12.73 years, ∼80.8% of the sample were males and 19.2% were females, ∼23% had positive family history of psychiatric disorders, and the percentage of positive family history of substance abuse was 25% ([Table 1]). The prevalence of cannabinoids was 83.75%, tramadol was 43.75%m followed by pregabalin in 30%, sedative and hypnotics in 48.75%, alcohol in 19.5%, heroin in 6.5%, cocaine in 9.8% ([Table 2]). Overall, 54 (45.0%) patients had comorbid psychiatric disorders as follows: three (5.6%) persons had schizophrenia and other psychotic disorders, 35 (46.8%) persons had anxiety disorders, five (9.3%) persons had depressive disorders, six (11.1%) persons had bipolar and related disorders, three (5.6%) persons had somatic symptoms and related disorders, and two (3.7%) persons had other diseases (feeding and eating disorders, sleep-wake disorders, and sexual dysfunctions) ([Table 3]). The results of risk factor of pregabalin misuse show 12.5% of patients started pregabalin abuse for its pleasurable effect (to improve mood), 32.5% of patients for sleep purpose (improve initial insomnia), 19.2% as self-medication to relieve anxiety, 11.7% for pain relief, 10.8% as self-medication to relieve depression, 7.5% owing to peer pressure, and 5.8% owing to other purposes ([Table 4]). Uses of pregabalin for treatment insomnia and anxiety were high potential risk factor for pregabalin abuse ([Table 5]).
|Table 1 Sociodemographic characteristic data of pregabalin-dependent patients|
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|Table 4 Prevalence of psychiatric disorders in pregabalin-addict patients|
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|Table 5 Logistic regression analysis independent predictors of pregabalin addiction|
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| Discussion|| |
The recent national survey of substance misuse revealed an incidence of 9.6%, and the prevalence among students was 1.48%, and the most common substance was cannabinoid followed by tramadol . However, a global report by the United Nations Office on Drugs and Crime (2012) estimated that 6–8% of the Egyptian used cannabis . We do not know of any earlier study that estimated the prevalence of pregabalin use disorder in Egypt. In the present study, cannabinoid was the main substance in 83.75% of the subjects, tramadol in 43.75%, and pregabalin in 30%, with a total number of 54 patients. Concerning the sex, most patients with pregabalin use disorder were males (80.2%) whereas females represented 19.8%, as male sex and concurrent substance abuse were reported as possible risk factors by Gahr et al. .
The low numbers of women in the sample may be because of shame and fear of stigma or may be owing to the low number of substance use disorder in women. The increase in the number of male patients over female patients in this study is consistent with the WHO global survey  that supports the finding that estimated attributable burden owing to illicit use of drug is 0.8% for males and 2% for females.
The study shows that 53.3% of patients were single, 36.7% were married, 5% divorced, and 5% widowed. Approximately 45.8% of our cases are from middle socioeconomic level, 28.3% were from high socioeconomic level, and 25.8% from low socioeconomic level. Approximately 25% of our sample had positive family history of substance abuse and 23.3% had family history of psychiatric disorders. The mean age of onset of drug abuse was 32.02 years. Fifty-four (45%) patients of our sample had comorbid psychiatric disorders (SCID I), which is consistent with the study conducted by Schjerning et al. . We can explain this by the fact that in some cases the substance used as a self-medication helps resolution of the symptoms together with the rewarding effect of the substance.The most possible risk factors to start Pregabalin misuse is sleep purpose followed by self-treatment of anxiety, which is consistent with Aracil-Fernandez et al. , who reported the most common cause of pregabalin use is owing to its sedating and anxiolytic effect. Many studies have found that chronic drug intake is associated with a psychiatric manifestation ranging from dysphoric withdrawal symptoms, depression, impulse control symptoms, anxiety, psychotic symptoms (paranoid delusions and hallucinations), and suicidal and self-injurious behavior. These psychiatric disorders occur in addition to tolerance, withdrawal, and intoxication symptoms of the different types of drugs . Psychiatric manifestations co-occurring with substance dependence are considered as the long-term consequences of neurobiological adaptations and dysregulation owing to prolonged drug use , or owing to common genetic and environmental factors .
| Conclusion|| |
Pregabalin misuse disorder is at the fourth rank between all substances misused in Egypt, with a percentage of 30%. The prevalence of pregabalin misuse disorder in males is more frequent than females. Pregabalin misuse is more prevalent among young people than in older age. The most common reason for pregabalin abuse is to have a good sleep, for self-treatment of anxiety, peer pressure, and depression. Egyptian community needs more attention from family, educational, and health institutes for prevention and treatment of pregabalin abuse.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]