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Volume 211 - Issue 10

Management of pregabalin and gabapentin prescribing and use in NSW prisons

Authors:  Gary Nicholls, Peter Samios and Stephen Hampton

Med J Aust 2019; 211 (10): 474-474.e1. || doi: 10.5694/mja2.50398
Published online: 18 November 2019
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To the Editor: The editorial by Murnion and Conigrave1 and the article by Crossin and colleagues2 on the dangers of misuse of pregabalin are a timely warning to all prescribers. The black market utility (based on testimonies) and frequent misuse of pregabalin is well known both academically and to prescribers in prison environments.3,4

Harm relating to gabapentinoid use is noted to be increasing globally. A 2017 case–control study showed a dramatic increase in relative risk of death with opioid and gabapentinoid versus opioid alone.5 People leaving prison are at a higher risk of opioid overdose death, partly because of loss of tolerance.6,7 This will likely be compounded by inappropriate gabapentinoid prescribing.

In New South Wales prisons, the Justice Health and Forensic Mental Health Network sees many patients who present seeking pregabalin and other prescription drugs in our health clinics. Patients often enter custody using high doses of medications prescribed in the community, including gabapentinoids, benzodiazepines and opiates. The Network applies a multidisciplinary team approach between primary care, pharmacy, and drug, alcohol and mental health services for these complex patients. Furthermore, clinicians undertake regular medication reviews of patients; medications that are not indicated are deprescribed to reduce potential harm to patients.8,9

The Network has developed management guidelines around gabapentinoid use, including regular review of prescriptions by general practitioners and the clinical director. Off‐label use is discouraged. Pregabalin is always a supervised medication, and dose limits and deprescribing programs are in place to limit availability if not indicated.

Alternate medications for the management of diagnosed neuropathic pain are effective and may pose less risk in prison environments.8,9 Gabapentinoid drugs are not used as an alternative to opiate pain medications in NSW prisons. Patients are assessed and given appropriate medications according to the quality and safe use of medicines approach, and medication charts are regularly audited to ensure safe prescription of medications. There has been an overall reduction in actual gabapentinoid prescribing in NSW prisons in recent years.

We encourage all Australian prescribers to ensure care around prescribing of gabapentinoid and other medications, especially for complex patients with drug and alcohol misuse and polypharmacy issues.

Authors

  • Gary Nicholls1,2
  • Peter Samios1
  • Stephen Hampton1
  • 1. Justice Health and Forensic Mental Health Network, Sydney, NSW
  • 2. UNSW Sydney, Sydney, NSW

Correspondence: Gary.Nicholls@health.nsw.gov.au

Competing interests

No relevant disclosures.

Acknowledgements

Primary care clinical staff at Justice Health and Forensic Mental Health Network.

References

Linked content

  • MJA Editorial: Pregabalin misuse: the next wave of prescription medication problems

  • MJA Research: Pregabalin misuse‐related ambulance attendances in Victoria, 2012–2017: characteristics of patients and attendances

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