Reclassification of Pregabalin in the UK: Has It Made a Difference in Deaths?

The UK government reclassified pregabalin to class C controlled substance from 1 April 2019 due to the rise in pregabalin-related deaths (1); has the change in classification made a difference?

The Toxicology Unit at Imperial College London conducts toxicology analyses on behalf of Coroners throughout London and the Southeast, handling ∼3,000 cases a year. In response to the growing concern over the misuse of pregabalin reported by Public Health England in 2014 (2), pregabalin was analyzed in all postmortem cases (aged 16 years and over) between 1 January 2016 and 31 December 2017. The prevalence for pregabalin was significant, at 6.1%, in the postmortem population; these data were published in the Journal of Analytical Toxicology in 2019 (3).

It is now 3 years since the reclassification, but has this change been reflected in what is being observed in deaths? Investigating the prevalence data for pregabalin, on the same postmortem population, between 1 January 2020 and 31 December 2021 showed a prevalence of 6.3% (n = 4,977 postmortem cases). This potentially indicates no significant impact in deaths related to pregabalin since the reclassification.

In the England (UK), between 2016 and 2017, the prescriptions for pregabalin were 5.5 and 6.3 million, respectively (4, 5). Since the law has changed, the prescribing of pregabalin has been still increasing and has risen to 8.4 million for the financial year 2021–2022 (6).

Our findings suggest that reclassification of a prescribed drug may not influence what is being observed in deaths; the prescribing of the drug needs to be regulated to see any positive outcome.