Fentanyl-like drug that causes concern in Spain

Amid the global fentanyl crisis, another drug called gabapentin is gaining popularity in Spain and causing concern among the Spanish and American medical communities.

Nearly a year ago, the United States Food and Drug Administration (FDA) warned that the drug was set to top the list of most prescribed drugs in many states in December 2022.

In May, gabapentin was the fifth most prescribed drug in the entire United States.

Originally prescribed in Spain to treat epilepsy and neuropathic pain, gabapentin, typically a non-opioid, is used primarily for its sedative effects and relief of chronic pain.

This sedative aspect has led to a 50% increase in demand in Spain over the past four years. The dilemma arises when most consumers resort to off-label use, ignoring its potential side effects.

What is gabapentin?

Gabapentin, a synthetic homologue of the natural brain neurotransmitter GABA (gamma-aminobutyric acid), acts as a tranquilizer, calming anxiety and reducing seizures.

Along with pregabalin, these two gabapentinoids are currently marketed in Spain for the treatment of epilepsy, neuropathic pain, diabetic neuropathy and postherpetic neuralgia. These are also prescribed for generalized anxiety disorder.

Due to its non-addictive properties, many organizations and companies have endorsed gabapentin as an alternative to opioids for chronic pain, an epidemic that has plunged the US into an unprecedented health crisis due to fentanyl overdoses.

Consumption growth in Spain

According to a report by the Spanish Agency for Medicines and Health Products (AEMPS), the consumption of gabapentin and pregabalin increased by 17% between 2008 and 2016.

Recent data from consulting firm HMR shows that sales have increased by 50% over the past four years, with more than one million containers sold in October alone.

Furthermore, a recent investigation published in Gaceta Sanitaria, the scientific journal of the Spanish Society of Public Health, showed that half of consumers take it for non-approved purposes.

The same trend is visible in the US, where the FDA has expressed concern. “Our assessment shows that prescriptions for these drugs have increased, as has their abuse.”

Gabapentin and pregabalin are often used off-label for conditions such as low back pain, fibromyalgia, migraine, and restless legs syndrome.

These drugs produce an addiction-like state, known colloquially as “Budweiser drugs”, which leads to their recreational use and subsequent health problems.

Side effects

Health officials report adverse side effects such as weight gain and respiratory depression, as the FDA had previously warned.

Serious blood disorders, possible congenital heart defects in the fetus, and other pregnancy-related complications have been identified associated with pregabalin. Therefore, its consumption is not recommended during pregnancy.

In response, the United Kingdom classified gabapentinoids as controlled substances in 2019.

In an article in El País, Francisca González, a pharmacovigilance expert at the Spanish Society of Family and Community Medicine (SEMFYC), said that the sharp increase in demand has its origin in the increase in restrictions on benzodiazepines and other drugs such as opioids.

“When you remove it on one side, it usually turns on the other side. And many times, given the persistence of pain, they are combining several, which can lead to more problems,” he warned.

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