Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data.

Between January 2008 and August 2010, qualitative Google searches of 203 websites have been carried out in 8 European languages (English, German, Spanish, Italian, Dutch, Norwegian, Finnish, Swedish) using key words such as ‘legal highs’, ‘research chemicals’, ‘online pharmacy’, ‘Lyrica’, ‘pregabalin’, and ‘online pharmacies’. Out of these, 108 websites were monitored on a regular basis, i.e. daily (n = 21), weekly (n = 32), or monthly (n = 55), depending on relevance; the remaining 95 websites were not considered here to be relevant. To obtain material relating to gabapentin and clonazepam, the Google search was carried out in English, with 52 websites examined and 32 identified as relevant. Links from the above websites/forums, and other related material were followed as well. The SW London/St. George’s Ethics Committee granted the study permission. Pregabalin was described as an ‘ideal psychotropic drug’ for recreational purposes to achieve specific mindsets, including: alcohol/GHB/benzodiazepine-like effects mixed with euphoria; to achieve entactogenic feelings and DXM-like disassociation, and to cope with opiate/opioid withdrawal ( table 1 ). A YouTube video [17] showing pregabalin versus gabapentin experimentation was also identified. Misuse of pregabalin mostly seemed to occur orally, but intravenous, rectal (‘plugging’), and ‘parachuting’ (emptying the content of the capsule into a pouch) self-administration techniques were also reported. Time of onset of the effects ranged between 10 min and 2 h, depending on the route of administration. Tolerance may reportedly develop fairly rapidly, and wear off quickly after drug cessation. Similarly, gabapentin seemed to possess both heavy sedative (‘... it’s like I’m on a fully-sedated opiate buzz ...’) and psychedelic (‘... I feel a disassociation much like DXM ...’; ‘... 1,200 mg has me in an off buzz slightly reminiscent of MDMA ...’) effects. Interestingly, however, one user argued that ‘pregabalin outshines gabapentin. Far less dosage to achieve the same recreational high ...’. Similarly to pregabalin, drug tolerance could reportedly develop very rapidly. Conversely, clonazepam was reportedly inducing either sedation (at 1–2 mg) or stimulation (at more than 8 mg). Clonazepam was typically co-administered with different sedatives and/or psychedelics. Pregabalin, gabapentin and clonazepam were commonly offered for sale on the web, without the need of a prescription. Pregabalin experimenters might be profiled here as individuals with a history of recreational polydrug misuse [17, 29] . Pregabalin dosages most typically reported were clearly in excess (e.g. up to 5 g) of the maximum level (e.g. 600 mg) [30, 31] which is clinically advisable. If pregabalin is perceived by misusers to be a valid substitute for most common illicit sedative drugs, this may be a reason for concern. One could wonder about the anxiolytic properties of pregabalin, gabapentin and clonazepam as potential mediators for misWith online pharmacies, prescription drugs may be more widely accessible [1–3] . In particular, preliminary online information pertaining to both pregabalin purchase availability and its recreational misuse potential has been recently identified [4] . Pregabalin is a prescription drug licensed to treat generalized anxiety disorder, partial epilepsy, and neuropathic pain. Since its misuse potential is reportedly low [5–7] , we aimed here at formally analyzing both anecdotal online reports of pregabalin misuse and its online purchase availability levels. Pregabalin data were compared with related clonazepam and gabapentin online information. In fact, pregabalin is structurally related to gabapentin [8] , and shares some therapeutic indications with clonazepam. Chouinard et al. introduced both clonazepam [9] and later gabapentin [10] in psychiatry, in order to reduce withdrawal and rebound symptoms associated with other antianxiety agents [11] . However, both clonazepam [12–14] and gabapentin [15, 16] possess an identified abuse potential, at least in selected populations. Received: May 26, 2010 Accepted after Revision: September 7, 2010 Published online: January 4, 2011