Reclassification of anticonvulsants: shifting the problem elsewhere?

Gabapentin and pregabalin are routinely and widely prescribed anticonvulsant medicines licenced to treat conditions such as epilepsy, the management of neuropathic pain and generalised anxiety disorders (ACMD, 2016).

Statistics spanning several years have highlighted some worrying and harmful effects, with either gabapentin or pregabalin appearing on 64 death certificates in 2014 alone.  Some of these cases suggest that combining either pregabalin or gabapentin with illicit or ‘street’ drugs such as heroin can cause respiratory failure (Hamilton & Sumnall, 2019).

Increasing concern led the Advisory Council on the Misuse of Drugs (ACMD) to recommend that both gabapentin and pregabalin be controlled under the Misuse of Drugs Act (1971) as Class C substances (ACMD, 2016), and a further addendum to this advice was added in October 2018 (ACMD, 2018).  Based on the ACMD’s recommendations, the UK government implemented reclassification changes which came into force in the UK on 1 April 2019, making both gabapentin and pregabalin “Schedule 3 Controlled Drugs without Safe Custody” (NHS England, 2019).

Implications for practice and wider society have included the requirement of a handwritten prescription that cannot be dispensed through repeat dispensing, and hefty fines and prison sentences for illegal possession or supply of these medications, as with all Class C substances.

All this is having an impact on care homes, where managers will need to plan ahead, to ensure that residents who are prescribed these medications do not experience any disruption in supply. One potential problem is that there is a risk that handwritten prescriptions will not be collected, particularly if other medications being collected are prescribed electronically. As gabapentin and pregabalin are now only prescribed for a maximum of 28 days, this has become a monthly concern, which is further exacerbated as emergency supplies of these medicines are no longer permitted (NHS England, 2019).

The mandatory requirements for gabapentin and pregabalin are now the same as for tramadol, which was reclassified in 2014.  However, many sources have highlighted that similar restrictions with the supply of tramadol caused the shift to the illicit use of gabapentin and pregabalin, albeit reducing the number of tramadol-related deaths, and warn that the problem is likely to move onto other medicines (Martin, 2019).

 

Guest blogger Vickie Wylde RGN,
former care home manager

References

Advisory Council on the Misuse of Drugs (ACMD), (2016, 2018) Advice on the anticonvulsant drugs pregabalin and gabapentin.
https://www.gov.uk/government/publications/advice-on-the-anticonvulsant-drugs-pregabalin-and-gabapentin

Hamilton I, Sumnall H. (2019) Prescription drugs pregabalin and gabapentin have been reclassified- but it won’t stop problem use. The Conversation.
https://theconversation.com/prescription-drugs-pregabalin-and-gabapentin-have-been-reclassified-but-it-wont-stop-problem-use-114403

Martin S. (2019) Gabapentin and pregabalin become class C drugs. Medical Xpress. https://medicalxpress.com/news/2019-04-gabapentin-pregabalin-class-drugs.html

NHS England. (2019) Handling of gabapentin and pregabalin as Schedule 3 Controlled Drugs in health and justice commissioned services: letter from Kate Davies.
https://www.england.nhs.uk/publication/handling-of-gabapentin-and-pregabalin-as-schedule-3-controlled-drugs-in-health-and-justice-commissioned-services/