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Gabapentinoids: has reclassification really solved the problem?

BMJ 2020; 368 doi: (Published 13 January 2020) Cite this as: BMJ 2020;368:m114

Linked Opinion

Reclassifying pregabalin and gabapentin only moves the problem onto other drugs

  1. Elisabeth Mahase
  1. The BMJ

The government’s reclassification was expected to reduce prescribing of gabapentinoids, but Elisabeth Mahase finds that a lack of support for GPs and patients is limiting its impact

In October 2018, the UK government announced that it would be reclassifying gabapentin and pregabalin1—known collectively as gabapentinoids—after experts pointed out the rising numbers of deaths linked to the drugs.

Gabapentinoids—which are indicated for the treatment of epilepsy, peripheral and neuropathic pain, and generalised anxiety disorder in adults—were officially reclassified as class C controlled substances in April 2019. Reclassification has made it illegal to supply pregabalin and gabapentin through repeat dispensing, and pharmacists now need to dispense the drugs within 28 days of a prescription being written. Doctors must also hand sign prescriptions.2

In the UK, the rate of patients newly treated with gabapentinoids in primary care tripled between 2007 and 2017, according to research published in JAMA.3 By 2017, 50% of gabapentinoid prescriptions were for an off-label indication and 20% had a co-prescription for opioids.

Prescribing numbers still rising

Reclassification …

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