Emma Phillips, 39, says she was given the nerve-pain drug Lyrica to help with her viral meningitis.
Viral meningitis is a painful inflammation of the spinal cord caused by an infection.
Lyrica is not indicated for its management.
But Ms Phillips, like many other Australians, was given it anyway.
She suffered from depression, but no mental health history was taken by her GP when he gave it to her. He did not warn her that Lyrica’s side-effects include depression and suicidal thoughts.
“I had severe changes in mental health. Severe. Severe. You are not the same person,” she says.
“It’s really, really scary. There’s a feeling of complete worthlessness. It makes you feel like you don’t deserve to be here. I was looking at my veins, I was looking at knives.”
Ms Phillips is one of tens of thousands of Australians put on Lyrica in recent years, as the drug has exploded into one of the country’s most popular medicines.
Lyrica is the brand name given to the drug pregabalin, which is sold by Pfizer.
That growth was fuelled in part by doctors seeking a safer alternative to opioids; Pfizer initially said Lyrica was not addictive, a claim that now appears to be wrong.
An investigation by The Age and The Sydney Morning Herald can reveal:
- In Victoria, there were 164 overdose deaths linked to the drug between 2013 and 2017, according to coronial data
- There have been 88 pregabalin-associated deaths in NSW since 2005, increasing at almost 60 per cent a year
- Health authorities have records of six suicides of patients taking the drug
- 86,000 Australians who have been prescribed the drug appear to be abusing it, according to one study. Yet many doctors consider it a ‘safe’ medicine to replace opiates.
- Pregabalin’s officially-listed side-effects include depression, blurred vision, confusion, and suicidal thoughts. Yet it is often given to people who have depression or a history of self-harm.
- Pregabalin’s use exploded after it was approved as a treatment for nerve pain. But later studies now have some experts fearing it may not work at all for as many as half the conditions it is being prescribed for.
Addiction and abuse
One of the first things Jacob Williams did after leaving jail was to see his GP for a Lyrica prescription.
Inside, his mother says, Lyrica is kept to low doses to stop prisoners abusing the drug.
But within a week of getting out, Mr Williams, 39, had a script for 300mg.
Doctors often prescribe it for back pain, which Mr Williams had.
Like many addicts, Mr Williams abused pregabalin because of its ecstasy-like high, but also because it significantly increases the power of opiates, when consumed together.
On April 8 last year, his partner heard him gurgle, and then stop breathing.
An autopsy later found a cocktail of drugs in his system, including potentially toxic levels of opiates and pregabalin.
“The Lyrica was supplied to him by a doctor,” his mother Jules Perrett said.
“He would take so much he had no idea as to what day it was let alone what he was doing. It did nothing for his nerve pain.
“This drug is dangerous when taken correctly and lethal when given to someone who suffers from substance abuse.”
In the emergency department of the Princess Alexandra Hospital in Brisbane, toxicologist Dr Katherine Isoardi sees pregabalin overdose cases come stumbling in – or wheeled in, comatose. Others are having seizures. More come every day, she says.
“It’s got so much abuse potential. We’re seeing people who are taking deliberate overdoses to harm themselves, but also people who are taking recreational doses to try to get high,” she says.
Many people who come through show clear signs of mental health issues and self-harm, she says. Dr Isoardi cannot understand why they keep being given pregabalin prescriptions.
“A lot of people think of it as a safe option. And I don’t think they appreciate you get tolerant, you get addicted, and it gets abused.”
When Pfizer launched Lyrica in Australia, it said the drug was likely not addictive because it did not bind to known opiate receptors.
It is becoming clear that is wrong. Lyrica is addictive – and that addiction can be deadly.
Almost half the pregabalin dispensed in Australia – two million scripts – is being used by just 15 per cent of the total group prescribed it, according to a study by the NSW Poisons Information Centre. This group of 86,000 appears to be abusing the drug.
Three-quarters of these high-risk users were also prescribed opioids.
A Canadian study, published in August, indicated pregabalin users had 1.7 times the risk of dying from an opioid overdose than opioid users alone – and high-dose users had 2.5 times the risk.
Between 2004 and 2016, there were 1158 reports of “intentional poisoning” – overdose – involving pregabalin made to the NSW Poisons Information Centre, increasing at 53.8 per cent a year.
And ambulance attendances involving pregabalin jumped more than tenfold in Victoria from 2012, according to a paper published in November.
“It was initially promoted as having a low abuse potential,” says Nicholas Buckley, a Professor of clinical pharmacology at the University of Sydney.
“But the warning signs were there almost from the beginning. It was reported to cause euphoria as a side-effect – that’s always a warning sign for abuse potential.”
A spokesman for Pfizer acknowledged “post-marketing reports of substance misuse and abuse”, but said the drug “does not bind to known targets of abuse such as opiate receptors”.
The drug had been demonstrated to be safe and effective, and was registered for use in more 130 countries, the spokesman said.
They pointed to Health Department advice to doctors to vet patients for prior substance abuse before prescribing pregabalin.
But this does not seem to be happening.
Experts said doctors seemed unaware of how addictive the drug could be, or that it can be abused.
The study by the Poisons Centre, led by Dr Rose Cairns, found that two-thirds of people who overdosed already had a pre-existing history of substance abuse when their doctors prescribed them pregabalin.
But in Australia Lyrica is a Schedule 4 drug, meaning it can be freely prescribed by doctors.
“The TGA is finalising an investigation into the misuse of pregabalin in Australia, and will refer the issue to the Advisory Committee on Medicines, prior to implementing any regulatory action in Australia,” a Health Department spokeswoman said.
Suicide risk for some
Lyrica’s listed side-effects note that it doubles a patient’s risk of suicidal thinking or behaviour versus a placebo, to one case in every 530 people who use the medication.
But almost 80 per cent of the overdose victims in Dr Cairns’s study had been diagnosed with depression and 68 per cent had a history of suicidal thoughts.
The Health Department has recorded seven suicide attempts, and six suicide deaths, suspected to be linked to pregabalin.
Of the first 50 people who went on pregabalin at one Gold Coast pain clinic in 2013 – just after the medicine had been added to the PBS – three reported the sudden onset of suicidal ideas.
Tony Hall, a pharmacist at that clinic, had been giving out Lyrica for years – in much lower doses.
“It was either suicidal ideation or extreme anger. The doses Pfizer wanted us to give were completely wrong. We start them on 25mg once a day, or then twice a day. Pfizer were telling us to start on 75mg. Pain specialists have been saying for years we want a dose lower than 25mg – this is a toxic medicine, it has lots of side effects.”
When a patient complained to their GP about depression or suicidal ideation, the GP would often blame it on the pain and increase the Lyrica dose, Mr Hall says.
When Professor Chris Maher was running an independent trial on pregabalin at the University of Sydney, he almost had to stop over concerns for the safety of some of the volunteers.
“Some of the people in the trial said to us – ‘I don’t know what this medicine is, but … I have never had thoughts like that before’,” he says.
“The GPs were sold the line by Pfizer that this is a safe medicine, get them off opiods and onto this. It’s a horrible medicine. The side-effects are confusion, drowsiness, disorientation, falling, suicidal ideation,” Professor Maher says.
Leona Solley, 55, describes a “loss of empathy” which she links to the Lyrica her GP gave her for tingling and burning in her feet and fingertips. The drug made her feel foggy, disconnected from her husband and children. It sharply increased her anxiety.
“I got to the stage where I was thinking ‘is it worth carrying on’, I don’t know if I can keep living like this’,” she says.
When she tried to quit, she suffered from what she says were withdrawal symptoms for six weeks.
“About five days after my last dosage, it was as though something was crawling under my skin and under my scalp. I had to cut all my fingernails because I was scratching myself so hard I was physically bleeding.”
Drug’s use explodes
More than four million subsidised pregabalin scripts were written in 2017-18, up from 36,242 in 2011-12.
Pregabalin went from a drug no one had heard of to one of the most-used medications in Australia, within a few years.
During that time, it was listed on the PBS and Pfizer embarked on an expensive effort to educate doctors and specialists about the drug.
In 2012-13, subsidised pregabalin prescriptions increased by 788 per cent, then again by 459 per cent the next year.
Many of those prescriptions appear to have been written for back pain.
“A lot of people are prescribed pregabalin for chronic low back pain, not neuropathic pain. It won’t be effective for them – they are exposed to all the harms with no benefit,” says Dr Bridin Murnion, a pain specialist at the University of Sydney.
In 2012 Pfizer paid a $US1 billion fine after the Department of Justice alleged it promoted four drugs, including Lyrica, for conditions that they were not medically indicated for – and paying doctors kickbacks for prescribing them.
Dr Harry Nespolon, president of the Royal Australian College of General Practitioners, says it is very difficult to directly link Lyrica to addiction or suicide, and the drug was markedly less dangerous than the opioids it often replaced.
“These sorts of [overdose] deaths are avoidable in inverted commas. But these are not simple patients. There are lots of things going on in their lives.”
There is now evidence pregabalin does not help even those people who have nerve pain.
In a study published in the New England Journal of Medicine in 2017, University of Sydney Associate Professor Christine Lin and her colleagues showed pregabalin was no more effective than a placebo for treating sciatica.
Pfizer disputes those results.
“It does not work,” Professor Lin says. “And we know it has side-effects.”
Doctors consider sudden withdrawal from pregabalin to be unsafe. If you are considering changing your dose, you are advised to see a doctor.
Consider all natural options before going for any pain medicine or other addictive drug. Pain that is chronic can be naturally controlled. ~NaturalAddictionNews.com