Australia’s experience with pregabalin offers an encouraging, but carefully qualified, signal for policymakers confronting misuse of the commonly prescribed medicine. A study published in The BMJ found that both use of pregabalin and overdose calls in Australia peaked in 2018 and subsequently declined. The timing overlapped with high-profile reporting on harms, tighter prescribing restrictions, boxed warnings and real-time prescription monitoring.
The findings do not establish that any one intervention caused the fall. But the researchers say the pattern may help inform responses in other countries, where concerns about misuse, dependence and harm linked to the drug have grown.
A medicine with benefits and risks
Pregabalin is a gabapentinoid used to treat epilepsy, nerve pain and anxiety disorders. Its use has increased in recent years, alongside evidence of misuse, dependence and associated harms in Europe, the United States, Asia and Australia.
The study notes that concerns are not confined to Australia. In the United Kingdom, one-third of substance-use deaths involve a gabapentinoid, predominantly pregabalin, and deaths involving gabapentinoids more than doubled between 2018 and 2022. Reports elsewhere have prompted countries to consider or introduce restrictions and other interventions.
That context makes the Australian trend notable. Rather than examining a single policy in isolation, the researchers assessed changes across a period in which public awareness, prescribing rules, product warnings and monitoring all shifted.
What the researchers examined
The team analyzed Australian dispensing claims and poison-center data from 2016 through 2024. Their analysis focused on three events: widespread media coverage of pregabalin harms in December 2018, tighter prescribing restrictions introduced in April 2020, and boxed warnings introduced in February 2021.
Across the study period, 3,441,851 pregabalin prescriptions were dispensed to 227,864 people. The poison center recorded 4,871 calls involving pregabalin overdoses.
Use and overdose calls both peaked in 2018 before declining. The researchers identified three points at which dispensing fell significantly: December 2018, the month associated with high-profile press coverage; May 2020, the month after tighter prescribing restrictions began; and December 2021, after the boxed warnings and the introduction of real-time prescription monitoring.
Lower than the earlier trend projected
Compared with the historical trend projected by the researchers, pregabalin prescriptions were 25% lower than expected. Calls for intentional poisoning were 47% lower than expected.
Those figures are associations, not proof that the public-information campaign, prescribing changes or warnings directly produced the declines. Other factors could have contributed, and the study cannot disentangle the effect of each measure. Still, the alignment of several interventions with a sustained change in trend is the central result.
The study’s significance lies less in identifying a single fix than in showing what a layered response can look like. Public discussion can increase awareness of a medicine’s harms; prescribing restrictions can alter access and clinical practice; boxed warnings can make risks more prominent; and prescription monitoring can give prescribers more information. Australia introduced these measures over several years rather than all at once.
What the results do and do not say
The findings should not be read as a reason to deny appropriate treatment to patients who benefit from pregabalin. The study concerns population-level dispensing and overdose-call trends, not whether every individual prescription was appropriate or whether the drug is unsafe in all circumstances.
Nor do the results show that a reduction in dispensing automatically equals a reduction in harm. The poison-center data provide an additional indicator because calls involving intentional poisoning also fell relative to the earlier projected trend. Yet the authors remain explicit that their analysis cannot demonstrate a direct causal link.
That restraint matters. Pregabalin serves several clinical purposes, while misuse and overdose are serious concerns. A policy response must balance access for people with legitimate medical needs against measures intended to reduce preventable harm.
A possible model for other countries
For health systems facing rising pregabalin-related concerns, the Australian data offer a real-world case study rather than a final verdict. The combined measures were followed by lower dispensing and fewer intentional-poisoning calls than the prior trend would have suggested.
The researchers describe the outcome as promising and say it may help shape comparable interventions elsewhere. Further work will be needed to assess how durable the decline is, which elements contributed most, and whether similar approaches work in different health systems.
For now, the study adds evidence that misuse prevention need not rely on a single lever. Australia’s results point to the potential value of pairing clearer public information with prescribing safeguards, warnings and monitoring—while maintaining attention to the needs of patients who rely on the medication.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
