The Royal Pharmaceutical Society (RPS) has recommended that pregabalin and gabapentin be placed under Schedule 3 of the Misuse of Drugs Regulations 2001, but be excluded from requirements for safe custody and storage. The Society also calls for the medicines to remain available through emergency supply.
In its response to a UK Government consultation on a proposal to schedule the medicines, which closed on 22 January 2018, the Society recognised that pregabalin and gabapentin are subject to abuse and dependence but said there was no evidence that community pharmacies were at particular risk of gabapentinoid theft. Therefore, introducing a requirement for safe custody of the medicines would, the RPS said, introduce excess burdens on community pharmacies, hospitals and care homes.
Furthermore, the Society argued that “the potential introduction of safe custody requirements … will have a significant impact on the operation of pharmacies and dispensaries in many settings, both private and NHS.”
Instead, it said, it believed that reclassifying the drugs would bring benefits through a “reduction in prescribing by ensuring it is prescribed appropriately and according to current guidelines … Controlled drugs cannot be added to repeat prescriptions, neither can they currently be sent via electronic prescription systems, where those systems are in use.”
The Society also said it hoped that patient feedback had been sought on this matter: “We would not want to see any unintended negative consequences for patients that rely so heavily on these medicines”. However, the RPS did welcome the fact that placing pregabalin and gabapentin under Schedule 3 would make non-prescribed possession of the drugs a criminal offence.
The prescription-only medicines are used for long-term conditions including epilepsy, neuropathic pain and fibromyalgia.
According to data published in Addiction in 2017, the number of pregabalin and gabapentin prescriptions increased from 1 million in 2004 to 10.5 million in 2015. Misuse of the drugs, either alone in higher-than-prescribed doses or to potentiate the action of opiates, has been reported to be on the increase. According to the Office of National Statistics, in England and Wales in 2016 pregabalin was mentioned on the death certificate of 111 people, and there were 59 deaths in which gabapentin was mentioned.