A recent inquest has highlighted concern amongst medics as to the prescription of a drug used for the treatment of neuropathic pain and anxiety.

Pregabalin is a drug that studies show has potential for abuse. Fatalities involving pregabalin overdose as the sole agent are rare. The evidence is that most cases involve the co-administration of other drugs and sometimes cardiac complications. In some cases pregabalin can act synergistically with drugs that act as central nervous system depressants and this can be fatal, particularly where coronary artery disease may also feature.

The Coroner of Inquests of the Isle of Man recently heard a case whereby the person's post mortem blood specimen showed a concentration of 145 mg per litre of pregabalin indicating excessive ingestion of this drug. The Coroner heard expert medical evidence from pathologists and forensic toxicologists as to how pregabalin can act together with other drugs to depress the central nervous system. Thus pregabalin when mixed with drugs such as codeine, morphine, diazepam, zopiclone, buprenorphine and ingested ethanol can act synergistically to enhance the toxic effects on the cardiorespiratory system. In some cases this can be compromised by pre-existing significant coronary artery disease.

The inquest heard that in a 2014 study published by Forensic Science International all medico-legal deaths in Finland in the period 2010 to 2011 were studied to assess the effect of pregabalin. This was in the light of there being increasing concern about the abuse potential of pregabalin. In the two year study period, pregabalin was found in 316 post mortem cases. However opioids were also found in over 91% of pregabalin abuse cases. But there were no pregabalin mono-intoxications, in all cases other drugs which depressed the central nervous system were involved. The report concluded that there was no longer any doubt that pregabalin should be considered and classified as a benzodiazepine like drug with considerable abuse potential. This point appears to be illustrated by the expert evidence heard in the recent Isle of Man inquest.

Advocate John T Aycock has extensive inquest and clinical negligence case experience. He is a member of the Medico-Legal Society.

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