Patterns, Risks, and Clinical Challenges of Pregabalin Misuse in Patients With Opioid Use Disorder: A Case Series

TL;DR

Pregabalin misuse is rising among opioid users due to enhanced euphoria and self-medication, leading to severe health risks.

Contribution

Highlights pregabalin's role as an opioid substitute and its associated clinical risks through case studies.

Findings

Pregabalin misuse is driven by enhanced euphoria and opioid withdrawal self-medication.

High-dose pregabalin dependence leads to severe withdrawal and respiratory depression risks.

Stricter regulations and harm reduction strategies are needed to address this growing issue.

Abstract

Pregabalin, a gabapentinoid used for neuropathic pain and epilepsy, is increasingly misused, particularly among individuals with opioid use disorder (OUD). Its synergistic effects with opioids enhance euphoric sensation. Pregabalin misuse in OUD patients is driven by this enhanced euphoria and self-medication to control opioid withdrawal symptoms, and pregabalin is used as an opioid substitution. This increases the risk of respiratory depression and leads to severe withdrawal symptoms. This case series presents three individuals with comorbid OUD and high-dose pregabalin dependence, detailing their withdrawal symptoms, co-occurring substance use, and treatment intervention. Stricter regulations, prescriber awareness, and harm reduction strategies are essential to prevent such misuse.