Anju Soni
South London and Maudsley NHS Foundation Trust, UK
Title: A study of the use and misuse of gabapentinoids in prison, including their co-prescription with opioids
Biography
Biography: Anju Soni
Abstract
Introduction & Aim: The aim of this study was to establish the prevalence of the prescription of gabapentinoids in a category B men’s prison in London. In addition, the prevalence of co-prescription of gabapentinoids with opioids was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination. In the light of this study it was hoped to establish the standards for the prescription for gabapentinoids in prison. Gabapentinoids, especially Pregabalin, appear in practice to be increasingly used recreationally in prison. Compared to Gabapentin, Pregabalin has a higher potency, is more quickly absorbed and has greater bio availability making it more likely to be abused. The issue of dependence on Pregabalin and Gabapentin in prisons is under-recognized and leads to misuse, diversion of prescriptions and bullying in prisons. Perhaps reflecting the lack of awareness of the risks of misuse of and dependence on gabapentinoids, this study highlighted that it is often unclear from prison medical records when, where and why gabapentinoids were being prescribed.
Method: A retrospective, case-file based survey was undertaken in a category B prison for males (Capacity 1500 prisoners; Average turnover of prisoners up to 6000 per year), including to establish practice standards related to the prescription of gabapentinoids in the prison and determine the compliance with these.
Results: 109 cases were identified of prisoners having been prescribed gabapentinoids. Pregabalin was prescribed in 66 cases (61%) and Gabapentin in 43 (39%). In 72 cases (66%) the indication for the use of gabapentinoids was documented. In 30 of the cases (27%), gabapentinoids were prescribed for the licensed indication for neuropathic pain, but for a further 36 cases (33%) prescriptions were for unlicensed (off-label) indications, mainly for non-neuropathic pain. In 51 cases (47%), gabapentinoids were prescribed with Opioid substitutes such as methadone or buprenorphine and in 19 cases (17%) with antidepressants. In 38 of these cases (75%), there was no documentation in the records of the risks of such co prescribing nor had that such risks been discussed with the prisoners. In 13 cases (12%), there was documented evidence of prescribed gabapentinoids being concealed, or being diverted to the other prisoners.
Conclusion: For those prescribed gabapentinoids in prison, the indications for such use especially if off label should be reviewed, their use minimized and where relevant and available compared to NICE guidelines. Less harmful alternative drugs are often available. Initiation of gabapentinoids in prison should be avoided unless recommended by a specialist.
For patients who are also receiving Opioid substitutes or are abusing opiates, consideration should be given as to whether it is safe to continue on gabapentinoids, given the risks of misuse and death. Issues raised by the study are likely to apply to other prisons and secure forensic psychiatric facilities.