A CRACKDOWN on prescription painkillers in the wake of rising overdose deaths would be "disastrous" for patients in Scotland who rely on them to control chronic nerve pain, an expert has warned.
The Home Office has announced plans to reclassify gabapentin and pregabalin as Class C controlled drugs, placing them in the same category as benzodiazepines, anabolic steroids, and tramadol. This means GPs will face strict limits on the quantity they can prescribe at any one time. It follows fears that the pharmaceuticals were being over-prescribed and putting patients as risk of addiction, as well as their burgeoning popularity on the black market.
Read more: Gabapentin and pregabalin cited in quarter of Scots overdose deaths
Both pharmaceuticals are recommended for the relief of neuropathic pain, caused by damage or disease affecting the nervous system.
Professor Blair Smith, Scotland's clinical lead for chronic pain and an advisor to the Scottish Government, said the move could jeopardise patient care.
Prof Smith said: "There are not all that many drugs that are effective against neuropathic pain, but gabapentin and pregabalin are among the most effective.
"Yet every so often - and it seems to happen with disappointing regularity - there's another drug withdrawn from GPs' armoury that they can prescribe for pain. Another obstacle could make the options for people with neuropathic pain even more limited."
Prof Smith said research he had been involved with in Tayside found that around 17 per cent of patients suffering neuropathic pain considered it "worse than death".
The Herald previously revealed that gabapentin was linked to 154 of the 997 drug deaths in Scotland in 2016, while its sister drug pregabalin was mentioned on 71 death certificates. Both have become increasingly popular on the black market, especially in Scotland, with illicit use soaring among prisoners and heroin addicts.
It is not clear that they played any direct role in drug users' deaths, however, as coroners are required to list all drugs discovered in an individual's bloodstream - not only those considered a cause of death.
Prof Smith added: "I think [reclassification] might be a bit premature because they're still collecting the evidence on how harmful pregabalin and gabapentin are. There's certainly plenty of evidence that it's misused, but the evidence for these drugs themselves to cause the drug deaths is not there.
"The other thing is that there is a tendency for these drugs to be prescribed for non-neuropathic pain just in the hope that they might work, even though the evidence for that is limited.
"So if they were prescribed more rationally, with sufficient caution, then they're not harmful and can provide a lot of benefit to people who really need them. It would be disastrous if they were withdrawn completely. "
A Bristol University study in May was the first to link a substantial increase in the prescription of pregabalin and gabapentin – up ten-fold between 2004 and 2015 – to a spike in overdose deaths in England and Wales during the same period. There were warnings that the drugs had "significant potential for dependence", even when not abused with opioids.
Around one in five people in Scotland - around 800,000 - are living with some degree of chronic pain, although fewer will have neuropathic pain.
Heather Wallace, the Edinburgh-based chair of Pain Concern, said gabapentin was a "turning point" for her 20 years ago after botched surgery left her with nerve damage.
She said: "It was a real, real struggle. I used to have a lot of days where I had to lie down, and other days when I was slumped in the settee. It was quite depressing.
"The extraordinary thing about neuropathic pain is that ordinary painkillers don't work. It's not as though you can take a paracetamol or an anti-inflammatory and deal with it. Even the strong opiates do nothing for a lot of people. But gabapentin and pregabalin do work. I'm still in pain - it's just that it's down to a level where I can do things."
Mrs Wallace returned to work, but has never increased the daily dose of gabapentin.
She said it was unfair if patients with neuropathic pain lose out because others are misusing the drugs.
She said: "Something has changed, but it's not the medication that's changed - it's society and the way it's being abused. I've got my condition for the rest of my life, so either the doctors want to take me back to being someone who spends half my life lying down, or they let me work and have a normal life."
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