A study of the reasons for prescribing and misuse of gabapentinoids in prison including their co-prescription with opioids and antidepressants

• Pages: 67-77
• Published date: 27 August 2019
• DOI: https://doi.org/10.1108/IJPH-01-2019-0004
• Date: 27 August 2019
• Author: Anju Soni,Pamela Walters
• Subject Matter: Health & social care

A study of the reasons for prescribing and

misuse of gabapentinoids in prison

including their co-prescription with opioids

and antidepressants

Anju Soni and Pamela Walters

Abstract

Purpose –Electronic medical case files of male prisoners in a category B prison in London were studied to

establish a prevalence during an eight-month period of the use of and the reasons for prescribing

gabapentinoids in pri son and also to establish prescribing st andards in prison and compliance with th ese.

In addition, the preval ence of co-prescripti on of gabapentinoids wit h opioids and antidepre ssants,

particularly tricyclic antidepressants such as amitriptyline, was also assessed in light of the increased risk of

respiratory depression resulting in death when these drugs are used in combination. The paper aims to

discuss these issues.

Design/methodology/approach –A retrospective, SystmOne case-file based survey was undertaken

searching by SNOMED CT supplemented by examination of free text, in a category B prison for males

(Capacity 1,500 prisoners; Average turnover of prisoners up to 6,000 per year), to establish practice

standards related to the prescription of Gabapentinoids in the prison and determine compliance

with these.

Findings –In total, 109 cases were identified of prisoners having been prescribed gabapentinoi ds,

pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent)

prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases

where the indications were documented. In 51 cases (47 per cent) gabapentinoids were pre scribed

with an opioid substitute. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to

other prisoners.

Practical implications –The initiation of gabapentinoids in prison should be avoided. For prisoners who are

also receiving opioid substitutes or are abusing opiates, it may be unsafe to continue on gabapentinoids.

Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed

community mental health and primary care as well.

Social implications –Risk of dependance on gabapentinoids including risk of mortality when taken with

opioids and opioid substitutes.

Originality/value –This is an original study conducted at a category B prison in London.

Keywords Offender health, Opioid substitution therapy, Drug dependence, Prison medicine,

Gabapentinoids, Licensed indications

Paper type Research paper

Introduction

Gabapentin was originally licensed in the UK in 1997 and Pregabalin in 2004 for the treatment of

epilepsy and neuropathic pain. Pregabalin is also indicated in the treatment of generalised

anxiety disorder (GAD).

Gabapentinoids produce psychological effects similar to benzodiazepines and alcohol and also

have additional euphoric effects.

Received 16 January 2019

Revised 16 June 2019

28 June 2019

14 July 2019

Accepted 24 July 2019

Anju Soni is Forensic

Psychiatrist and

Pamela Walters is Clinical

Director, both at the South

London and Maudsley NHS

Foundation Trust, London, UK.

DOI 10.1108/IJPH-01-2019-0004 VOL. 16 NO. 1 2020, pp. 67-77, © Emerald Publishing Limited, ISSN 1744-9200

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