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Heroin Addiction and Related Clinical Problems: 2020, 22, N6 (pages: 39 - 48)

Is the Non-Medical Use of Pregabalin Related to Reward/Relief Craving Coupled to an Unbalanced Opioid System?

Della Rocca F., Cosentino V., Carbone M.G., Maremmani A.G.I., and Maremmani I.

Summary: Background: Pregabalin is an antiepileptic drug belonging to the gabapentinoid family used for antinociceptive, anticonvulsant and anxiolytic purposes. In recent years, a growing body of observational studies and surveys has been highlighting the increasingly common recourse to a non-medical use of pregabalin. Young subjects with a past or current history of substance use disorder, mainly arising from the taking of opiates appear to be at risk of developing the non-medical use of pregabalin. The pathogenetic mechanism underlying this phenomenon is unclear. Case Report: In the present paper, we describe the case of a 25-year-old male who was hospitalized in the 2nd Psychiatric Unit of Psychiatry at the University of Pisa for a non-medical use of pregabalin. We speculated on the reasons why the patient developed a pregabalin use disorder. Was pregabalin being used to gain a ‘primary' reward or as a ‘booster' to enhance the effects of other substances? Alternatively, was it being self-administered to achieve relief from withdrawal symptoms caused by other substances, or for pain management? Conclusions: This paper adds to the growing body of literature suggesting that pregabalin has a non-medical use potential. When prescribing pregabalin, clinicians should consider completing a risk assessment for non-medical use, especially in patients with a Substance Use Disorder history. Therefore, pregabalin off-label prescriptions should be carefully considered.