Lyrica is a synthetic medication designed to mimic the structure of the inhibitory neurotransmitter GABA. Because of its effects on GABA and other neurotransmitters, Lyrica may be a potential drug of abuse.
What Is Lyrica?
Lyrica (pregabalin) is a synthetic medication that was designed to mimic the chemical structure of gamma-Aminobutyric acid or GABA, the major inhibitory brain neurotransmitter. Like its sister drug gabapentin (better known by the brand name Neurontin), it is approved for the treatment of seizures and certain types of pain, such as pain associated with diabetes, shingles, and fibromyalgia.
Although its mechanism of action is not understood, it is believed to enhance the functioning of GABA in the brain, thus reducing brain activity associated with seizures, pain, withdrawal symptoms from drugs, and other issues. In this manner, it is similar to other types of central nervous system depressants like benzodiazepines and even alcohol.
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Lyrica and gabapentin are often collectively referred to as gabapentinoids due to similarities in their chemical structure, uses, and suspected mechanism of action.
Is Lyrica a Controlled Substance?
Medications containing pregabalin are controlled substances that are listed in the Schedule V classification by the U.S. Drug Enforcement Administration (DEA).
Because of this classification, Lyrica (and all pregabalin products) are considered to have a mild to moderate potential for abuse. Prolonged use may lead to physical dependence in some individuals.
At the time of this writing, gabapentin is not classified as a controlled substance by the DEA, but some states like Michigan have classified it as a controlled substance within the state.
Is Lyrica Abused?
When gabapentinoids were initially developed and marketed, it was believed these drugs would have a low potential for abuse and would be used as medicinal drugs that could treat several different issues. A growing body of research evidence suggests that pregabalin products can be drugs of abuse.
Much of the early research suggests that abuse of pregabalin products like Lyrica often occurs by grinding up the pills and snorting them or mixing the ground pills with water and injecting the solution.
Those who abuse these drugs use much higher doses than the doses that are used for therapeutic reasons.
Abuse With Other Drugs
Initial research found that individuals who had opioid use disorders or who abused other drugs, including benzodiazepines or synthetic cannabinoids, were abusing gabapentinoid drugs along with their substance of choice.
For example, an article published in 2016 in the journal CNS Drugs reviewed a large number of research studies (17 preclinical studies, 19 clinical research studies, and 13 epidemiological studies) and 19 case reports. They found that the majority of the reports of abuse indicated that pregabalin was most often part of a polysubstance abuse issue in the research subjects, particularly with opioid abusers.
The evidence suggested that the effects on GABA and glutamate (the excitatory neurotransmitter that pregabalin inhibits) accounted for the euphoria that abusers claim high amounts of the drug brings them.
Other Psychological Disorders and Pregabalin Abuse
A systematic review of literature published in the journal Drugs in 2017 included 59 studies that consisted of case reports, epidemiological research studies, and clinical studies. Findings indicated that increasing numbers of individuals were self-administering higher than recommended doses of gabapentinoids to achieve expected psychological effects (euphoria).
The most likely group of individuals who abused these drugs were those with opioid use disorders or people with mental health disorders.
Pregabalin vs. Gabapentin
A study published in the journal Research in Social and Administrative Pharmacy in 2018 further reviewed the literature for abuse, misuse, dependence, and overdose events associated with pregabalin and gabapentin.
Findings indicated that abuse of these drugs was more likely to occur in younger men.
Pregabalin was more likely to be abused than gabapentin.
What Are the Effects?
According to the aforementioned research studies, individuals who abuse Lyrica report that they experience euphoria that is dose-dependent (greater feelings of euphoria with higher doses) and dissociative effects.
Dissociative effects are psychotic-like experiences that include feeling like you are being detached from your body, feeling as if things around you are not real, or feeling as if you can transcend time and space.
These feelings occur at high doses, or when the drug is injected or snorted, especially when pregabalin is mixed with other drugs.
Based on the above-mentioned research findings, several factors may increase the risk that someone will abuse Lyrica.
- Younger males may be more likely to abuse pregabalin than other groups.
- Individuals with a history of some other substance use disorder are more likely to abuse Lyrica, particularly those with a history of opioid use disorder.
- People with a previous history of some other mental health disorder appear to be more likely to abuse pregabalin.
- Those who abuse Lyrica are more likely to grind up the medication and snort it, or mix it with a liquid and inject it than to use it orally.
Thus, any individual who uses a pregabalin product like Lyrica for any reason and has one or more of the above risk factors should be monitored closely regarding their use. For instance, medical personnel should administer the medication directly to individuals who use Lyrica to manage the symptoms of opioid withdrawal.
- Regularly using Lyrica without a prescription
- Mixing Lyrica with other drugs, such as opioids or alcohol
- A frequently runny nose or nosebleeds from snorting the drug
- Track marks from injecting the drug
- Attempting to get multiple prescriptions for Lyrica
- Lots of empty prescription bottles for Lyrica
- Drug paraphernalia, such as syringes or devices for grinding the pills
Clinical signs of drug abuse include frequent nonmedical use of the drug, problems controlling use, spending significant time using or trying to get the drug, and significant dysfunction or distress associated with the drug.
Does Abuse Lead to Physical Dependence?
Research suggests that chronic abuse of pregabalin can produce significant tolerance to the drug.
Multiple case studies suggest there is a withdrawal syndrome that occurs in some chronic abusers who abruptly discontinue use. The treatment for withdrawal symptoms is most often to administer pregabalin on a tapering schedule instead of discontinuing it abruptly.
Treatment for Lyrica Abuse
The approach to treating someone who has abused Lyrica follows the approach for individuals who abuse opioids or benzodiazepines.
- Because co-occurring mental health issues may be present, the first step is to fully assess the individual in terms of their physical, psychological, and social functioning.
- Next, the assessment results are used to develop a treatment plan that follows the empirically based protocol for substance use disorder treatment. The program is individualized to suit the needs of the person.
- A medical detox program would most likely be the first step of formal treatment. The person would usually be given Lyrica on a tapering schedule to avoid withdrawal symptoms.
- A formal substance use disorder therapy program (with group and individual therapy) is the foundation of ongoing treatment.
- Other behavioral interventions would be used, including peer support groups, alternative forms of therapy like music therapy, and other services as identified in the treatment program.
- Medications would be used as needed to assist in the treatment of any co-occurring disorders identified in the assessment and treatment plan.
- Co-occurring psychological disorders and substance abuse issues would be treated simultaneously.
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Length of Time in Treatment
The length of time the individual will spend in different aspects of their recovery program will depend on the person’s situation.
- Medical detox from pregabalin can be performed entirely in a week for some individuals. For others, it may take several weeks.
- Participation in substance use disorder therapy will last for several months or longer.
- Attendance at peer groups such as 12-step meetings should be considered an ongoing process for most individuals.
- Medication-assisted treatment (MAT) will vary in length, depending on what is being addressed and the individual’s response to the medication.
Typically, the longer a person remains in therapy, peer groups, and other supportive activities, the better their long-term outlook is.
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(January 2019). Michigan Lists Pain Drug Gabapentin as Controlled Substance. WXYZ Detroit. Retrieved February 2019 from https://www.wxyz.com/news/michigan-lists-pain-drug-gabapentin-as-controlled-substance
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(March 2017). Abuse and Misuse of Pregabalin and Gabapentin. Drugs. Retrieved February 2019 from https://link.springer.com/article/10.1007/s40265-017-0700-x
(June 2018). Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: an analysis of the Food and Drug Administration Adverse Events Reporting System (FAERS). Research in Social and Administrative Pharmacy. Retrieved February 2019 from https://www.researchgate.net/profile/Kyle_Hultgren/publication/326055678_Reports_of_gabapentin_and_pregabalin_abuse_misuse_dependence_or_overdose_An_analysis_of_the_Food_And_Drug_Administration_Adverse_Events_Reporting_System_FAERS/links/5b47522b0f7e9b4637cf12bb/Reports-of-gabapentin-and-pregabalin-abuse-misuse-dependence-or-overdose-An-analysis-of-the-Food-And-Drug-Administration-Adverse-Events-Reporting-System-FAERS.pdf
(September 2017). Manifestations of Pregabalin Withdrawal. Journal of Psychiatry. Retrieved February 2019 from https://www.omicsonline.org/open-access/manifestations-of-pregabalin-withdrawal-2378-5756-1000418.pdf