Pregabalin in the news

[SmilingAlbert]

Avas and others:

Don't worry -

From what I've read on the far reaches of the interweb, to get the effects that these people are looking for involves taking very high quantities of the stuff (far more than the highest recommended dose), in combination with a bunch of other stuff.

I suspect the majority of deaths are when taken in combination with heroin, which is extremely dangerous on its own (so easy to overdose) , let alone with other things.

This page suggests that even 8000mg wouldn't be enough on its own to harm anyone:

http://www.rxlist.com/lyrica-drug/ov...ndications.htm

Albert

[MyNameIsTerry]

Hanshan,

Is it this farce of a report you are referring to?

https://www.google.co.uk/url?sa=t&so...MpHiJXDjSk_rdw

The majority of that report is dedicated to bashing pregabalin. The earlier graphs show a greater number of deaths from individual forms of SSRI's and hypnotics (please no one be triggered by this, the factors are not explained and will by like any post mortem, there will have been reasons other than the medication but I'm pointing to them to show the author's obvious bias against pregabalin) and its ridiculous to highlight a single digit figure and ignore some several times higher. The answer could be that the % mortality to numbers prescribed is higher but I don't recall seeing that and without it its meaningless.

The author then goes on to explain these are largely accidental (which I'm sure happens with all prescription medications) and that pregabalin had been safely used to taper off those dependent on Benzodiazapenes... an at risk group!

I wonder how much this 'so called' professor got paid to publish this garbage and by whom?

I think he must be a believer in some form of 20/80 rule as opposed to the rest of the planet.

[hanshan]

Hello Terry,

No, it's not that report, but one a year later, presumably by the same people, as the institution and slides are the same.

[MyNameIsTerry]

Is it this one?

https://www.google.co.uk/url?sa=t&so...5QxRv4os6VTYYA

Statistically insignificant at approx 0.3% of overall mortality.

They claim 48% to be drug abusers with another 10% being accidental poisoning... but where have the rest gone? What are they trying to hide?

[hanshan]

Hello Terry,

Yes that's the one. The report is so poorly expressed, with statistics all over the place and vague terms like "PGB findings", it's hard to pin them down on anything. The methodology is exceptionally vague, and the aims of the study aren't stated.

But in slide 5, they state:

"In PRG or GBP poisonings, forensic pathologist had determined the underlying cause of death as drug poisoning with PRG or GBP as the main finding"

I take this to mean that the forensic pathologist had found that death was primarily due to pregabalin overdose.

And slide 10 clearly indicates deaths due to pregabalin rising each year to a high of 22 in 2012, as opposed to two deaths due to methadone.

With all due respect to the Finnish forensic pathologist, I find it hard to believe that 22 people died from pregabalin overdose in Finland in 2012.

Unlike CNS depressants like alcohol and opiates which can rapidly cause death in overdose, there are reports of people taking 15 times the maximum dose of pregabalin at one time without ill effects.

I suspect that those 22 deaths were actually primarily due to overdose of alcohol or opiates, and the person had also taken pregabalin.

[MyNameIsTerry]

Slide 6 says:

• Poisonings in other cases than abuse cases were rare
• All abuse cases included additional psycholeptics and/or
alcohol
• Opioids were involved in 90% of the abuse cases

This just takes me back to the missing 42%. If they weren't abusers and they weren't poisonings then what were they? The fact they are not defined makes me consider them to be lacking a strong link.

If you look at the previous paper, which perhaps spawned this one, it defined the meaning of abuse and poisoning. It also defined and separated where the post mortem found a strong link which reduced the figures further.

In an environment with peer reviewing I would expect these studies to be heavily criticised.

---------- Post added at 00:18 ---------- Previous post was at 00:05 ----------

The graph slide is a typical case of what I have always been taught or used in my business roles. A rising trend vs. all others falling becomes meaningless when those falling are still far higher.

Its also interesting to see codeine being higher, considering it's so easy to obtain.

---------- Post added at 00:23 ---------- Previous post was at 00:18 ----------

Slide 15 of the first paper states:


Typically abused pregabalin was detected together
with an opiate (15/19 in 2007)

Pregabalin is known to have a booster effect with
opioids

Accidental poisoning was the most common cause of
death among the abusers (13/19 in 2007)

So, for me, both papers just find that this is only an issue when combined by abusers.

[hanshan]

Hello Terry,

I agree with what you say about peer review heavily criticising this study.

It demonstrates a few truisms. The first is that if you haven't much to say and it's the bleeding obvious anyway, then dress it up with confusing statistics and irrelevant information.

The second truism is that an excellent way of confusing people is to move back and forward between quantities and percentages. Preferably put them together in the same table. Don't let people know what the percentage is a percentage of. To confuse people even more, give percentages of percentages (47.4% of group A... of these, 12.4%...).

If I can clarify this presentation..

(1) In the two years 2010 and 2011, 13,766 Finns had post-mortem toxicology assessments
(2) Of these 13,766 toxicology assessments, 316 cases (2.3% of 13,766) revealed the presence of pregabalin.
(3) Based on other information, these 316 cases were divided into two groups: legal users (164) and non-legal users (152)
(4) Of the legal users, 3 people (0.95% of 316) were found to have died primarily of pregabalin overdose (in combination with other drugs). Of the non-legal users, 29 people (9.2% of 316) were found to have died primarily of pregabalin overdose (in combination with other drugs).
(5) This figure of 32 deaths over two years attributed primarily to pregabalin can be seen in the graph in slide 10: 2010 - 15 deaths, 2011 - 17 deaths.

I hope that's not too hard to follow. I have avoided emotive terms like "poisoning" and "abuser".

As stated in my earlier post, my main concern is with the Finnish forensic toxicologist saying pregabalin was the primary cause of death when combinations of other drugs (alcohol / opiates / no mention of benzodiazepines) were present.

Another flaw in this study is that although it talks about opioids, only prescription opioids are mentioned. There is no mention of heroin or illegal morphine, for example. Were they included in the toxicologist's assessment? Why aren't they in the graph?

[hanshan]

You can find the original DrugScope report with its special section on pregabalin/gabapentin here:-

http://www.drugscope.org.uk/Media/Pr...rends-2014.htm

I wrote to Drugscope pointing out that their report did not in any way balance the report by describing any possible positive effects of pregabalin.

I received a reply from Harry Shapiro, Director of Communications and Information at DrugScope, disassociating his organisation's report from medical uses of pregabalin.

Okay, but it does impact on us - eg the doctor who tells us it is "addictive".

While I don't support "letter-bombing", you may care to write to Mr Shapiro telling him of your experience of pregabalin. His email is:-

HarryS@drugscope.org.uk

My point is that attacking the non-legal / non-medical users may be attacking an easy target, but it also negatively affects the legitimate users.

[MyNameIsTerry]

Ah, the beauty of the 'out of scope' section.

Those who believe that this covers them when it comes to peer reviewing or justifying your findings to your senior managers are quite naive as they don't have the luxury of not considering the wider impact. I've seen many a project draft torn to pieces by peers and binned in frustration by senior managers when they haven't prevented the right people from getting their opinions known.

Its clear to see in the case of the reports Albert posted that the same is occurring. An isolated drug worker creates shock and rather than conduct research, it just sparks an overreaction putting GP's under scrutiny for something they should already be doing and their reaction 'may' be to put the wagons in a circle to protect themselves.

If the world worked on isolated shock stories, society would be a very sterile place with freedom of speech the first casualty.

That project could easily have added a clause to state that there was no intended study of non abusers hence no assumption should be made that patterns & findings map to other user categories. I always thought the medical community worked on the basis that until it was proved to be working in a suitably conducted trial with favourable peer reviews, it wasn't accepted as an indicator to recommend or change? Perhaps this is only the case when refusing to believe a new treatment, alternative or natural treatment or therapy could work?

As for the drug worker issue, yes it warrants further research to determine if this is a common or emerging pattern, but until then isn't this little better than anecdotal evidence? Of course, thats only considering it from an abuser angle.

---------- Post added at 09:57 ---------- Previous post was at 09:37 ----------

There are some study and survey references on this substance misuse website:

http://recoveryreview.net/2014/07/ga...abalin-misuse/

I notice the majority in one survey were using without a prescription. This is something I expect will be found in many of these studies but they have conveniently decided to either not consider it or omit it from their findings.

If it's black market, it's already going to be class B substance so complaining about it is hardly going to stop it now substance misusers know what they can do with it.

I also notice that one of these studies also references the user of non abusers in earlier drug trials due to the very reasons being discussed by the dig worker.

If it were addictive, surely a drug trial would expose that? They would have had to clarify the withdrawal proceed.

---------- Post added at 09:59 ---------- Previous post was at 09:57 ----------

Also Hanshan, I think you broke down the statistics in that paper in an accurate , easily understandable way.

---------- Post added at 11:45 ---------- Previous post was at 09:59 ----------

There is a BMJ article here written by a GP that seems to echo the opinions of the drug worker:

http://www.bmj.com/content/347/bmj.f6747

I haven't read the article but given the author's comments and the responses both supporting & challenging it, I would assume it to match the nature of the articles Albert posted.

It is interesting that all the same flaws mentioned in this thread appear in the comments, either exposed in the author's responses, by the challengers or by the motives & care settings of the supporters.

I noted a chemist highlighting cost frequently and those in prison or abuse settings towing the party line.

One supporter, in a prison setting, even mentions addiction in non abusers which I think is's disputable given the potential errors in determining this when others are raising issues relating to record keeping by GP's!

[Avasmummy_x]

I just hate it when they publish stuff like this.