Heroin users often abuse a wide variety of other drugs, the most common of which are benzodiazepines, amphetamine, antidepressants, methadone and ethanol. Recently concerns have been raised that the three prescription drugs gabapentin (1), pregabalin (2) and buprenorphine (3) are being diverted and abused. We retrospectively reviewed the case files of 82 heroin users who had died in central Scotland over 2 1/2 years and re-analysed blood samples for these three prescription drugs.
Gabapentin was detected in 23 cases (28%), of which only 3 were prescribed gabapentin, suggesting that the drug was being obtained illicitly. Health care providers were aware of this abuse in 7 of the cases. However, since gabapentin has “occasionally” been found in recent seizures of street heroin in Scotland (4), its detection in fatalities may not always indicate specific misuse of gabapentin. Pregabalin was detected in 6 cases (7%) of which only 1 was prescribed pregablin, indicating a lower level of illicit use than gabapentin. Buprenorphine was found in only 1 case and had been prescribed.
Medical practitioners prescribing gabapentin and pregabalin need to be aware of the potential for diversion of the drug for illicit use. Although we found no evidence of similar diversion of bupenorphine in this study of fatalities in our area, this may not be true of other parts of the UK.
Ian J Donald
Medical Student
Centre for Forensic and Legal Medicine, University of Dundee
Peter D Maskell
Lecturer in Forensic Toxicology
Centre for Forensic and Legal Medicine, University of Dundee
Giorgia De Paoli
Lecturer in Forensic Toxicology
Centre for Forensic and Legal Medicine, University of Dundee
Nitin Seetohul
Lecturer in Forensic Toxicology
Centre for Forensic and Legal Medicine, University of Dundee
Derrick J Pounder
Professor of Forensic Medicine
Centre for Forensic and Legal Medicine, University of Dundee
References
1. Smith BH, Higgins C, Baldacchino A, Kidd B, Bannister J. Substance misuse of gabapentin. Br J Gen Pract. (2012) 62: 406-7.
2. Millar J, Sadasivan S, Weatherup N, Lutton S. Lyrica Nights – Recreational Pregabalin Abuse in an Urban Emergency Department. Emergency Medical Journal (2013) 30:874.
3. Taikato M, Kidd B, Baldacchino A. What every psychiatrist should know about buprenorphine in substance misuse. Psychiatric Bulletin (2005) 29: 225-227.
Rapid Response:
Re: Opioids in the UK: what’s the problem?
Heroin users often abuse a wide variety of other drugs, the most common of which are benzodiazepines, amphetamine, antidepressants, methadone and ethanol. Recently concerns have been raised that the three prescription drugs gabapentin (1), pregabalin (2) and buprenorphine (3) are being diverted and abused. We retrospectively reviewed the case files of 82 heroin users who had died in central Scotland over 2 1/2 years and re-analysed blood samples for these three prescription drugs.
Gabapentin was detected in 23 cases (28%), of which only 3 were prescribed gabapentin, suggesting that the drug was being obtained illicitly. Health care providers were aware of this abuse in 7 of the cases. However, since gabapentin has “occasionally” been found in recent seizures of street heroin in Scotland (4), its detection in fatalities may not always indicate specific misuse of gabapentin. Pregabalin was detected in 6 cases (7%) of which only 1 was prescribed pregablin, indicating a lower level of illicit use than gabapentin. Buprenorphine was found in only 1 case and had been prescribed.
Medical practitioners prescribing gabapentin and pregabalin need to be aware of the potential for diversion of the drug for illicit use. Although we found no evidence of similar diversion of bupenorphine in this study of fatalities in our area, this may not be true of other parts of the UK.
Ian J Donald
Medical Student
Centre for Forensic and Legal Medicine, University of Dundee
Peter D Maskell
Lecturer in Forensic Toxicology
Centre for Forensic and Legal Medicine, University of Dundee
Giorgia De Paoli
Lecturer in Forensic Toxicology
Centre for Forensic and Legal Medicine, University of Dundee
Nitin Seetohul
Lecturer in Forensic Toxicology
Centre for Forensic and Legal Medicine, University of Dundee
Derrick J Pounder
Professor of Forensic Medicine
Centre for Forensic and Legal Medicine, University of Dundee
References
1. Smith BH, Higgins C, Baldacchino A, Kidd B, Bannister J. Substance misuse of gabapentin. Br J Gen Pract. (2012) 62: 406-7.
2. Millar J, Sadasivan S, Weatherup N, Lutton S. Lyrica Nights – Recreational Pregabalin Abuse in an Urban Emergency Department. Emergency Medical Journal (2013) 30:874.
3. Taikato M, Kidd B, Baldacchino A. What every psychiatrist should know about buprenorphine in substance misuse. Psychiatric Bulletin (2005) 29: 225-227.
4. SCDEA Report on the Quality of Diamorphine seized in Scotland 2010-2011 (2012) http://www.communityplanningaberdeen.org.uk/web/FILES/ADP/REP_20120328_d... (Accessed 11th Sept 2013)
Competing interests: No competing interests