It sounds more like a horror story than a relevant piece of information: “This painkiller is responsible for thousands of deaths,” was the headline in a recent tabloid. More than 3,400 people are said to have died in Great Britain as a result of taking the two painkillers Pregabalin (trade name: Lyrica) and Gabapentin (Neurontin). Newspaper reports there contain shocking descriptions of several individual fates – of people who mostly died after overdosing on the drugs or taking a fatal drug cocktail that also contained one of the two substances in question.
The numbers go back to statistics published in January 2024 by the “Office for National Statistics”, a type of British Federal Statistical Office. Accordingly, more than 3,000 people died from drugs known as gabapentinoids in England and Wales from 2018 to 2022. The medications are primarily used as a supplement to treat severe anxiety, neuropathic pain and epilepsy, so they are not run-of-the-mill remedies like those taken for headaches, sciatica problems or after a night of drinking. In the brain, gabapentinoids modulate the release of activating messenger substances, which is why dizziness and sleepiness can occur as side effects. Are the latest death toll numbers a reason to issue massive warnings about the substances?
In only two cases were the drugs considered the sole cause of death
The answer is complex. It can be found, among other things, in one Specialist article in British Journal of Clinical Pharmacologywhich was published in 2022 and in which 3,051 deaths are analyzed became. In more than 92 percent of those who died, they had also taken opioids. However, doctors only prescribed these strong painkillers together with pregabalin or gabapentin in a quarter of the cases. The blood levels of gabapentinoids measured after death were in the therapeutic or even subtherapeutic range for almost all of the fatalities; was therefore by no means life-threatening. In only two of the cases was the drug concentration in the blood so elevated that the drugs were considered the sole cause of death.
Another striking feature was that only a little more than a third of the patients took medication based on a doctor’s prescription, meaning that in the other cases the medication had apparently been obtained illegally. “Gabapentinoids alone very rarely lead to death,” the experts concluded. However, when interacting with opioids, they can lead to fatal consequences, which is why “physicians and patients should be aware of this interaction,” as the article emphasizes. The Office for National Statistics warns in its latest annual report that the number of deaths caused by the misuse of multiple drugs (“polydrug use”) has increased significantly. The death certificates are increasingly listing “medications such as benzodiazepines and gabapentinoids along with heroin and other opiates”.
“This is probably a case of misuse and an unfavorable interaction,” says Martin Härter from the Center for Psychosocial Medicine at the University Hospital Hamburg-Eppendorf. “We often see clinically patients with polytoxicomania who also take pregabalin,” says psychiatrist Thomas Pollmächer from the board of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). “It’s often not about the intended use of pregabalin, but about the sometimes addictive abuse of this sedating substance.”
In Germany, pregabalin, which was approved in 2004, has been among the top 20 drugs with the highest sales for years. However, the Drug Commission of the German Medical Association (AkdÄ) already decided in 2011 German medical journal Warned that the substance can be addictive and abused. Something similar was reported by the Swedish Medicines Agency in the same year. In 2020, the AkdÄ warned again that pregabalin had the potential for addiction. “It is true that addicted patients are predominantly affected (particularly those who consume opioids). In rare cases, dependency is also reported in patients who are not otherwise addicted,” says a commission report. The potential danger has been known for some time, but all experts agree that greater attention should be paid to it, especially in the care of drug addicts and addicts, as well as for prevention.