Background: Pregabalin, also known by a brand name of Lyrica, is a prescription only gamma-aminobutyric acid (GABA) analogue and licensed for a range of medical conditions, e.g. chronic pain, generalised anxiety and epilepsy. In recent years, pregabalin has attracted clinical and research attention due to an increase in its association with overdose fatalities. Individuals with opiate use and those in opioid agonist treatment are an identified at risk group for problematic pregabalin use and overdose. As such, research focusing on pregabalin use in individuals accessing opioid agonist treatment is highly relevant.

Aim: This study aims to add to the evidence based on diverted pregabalin use in the OAT cohort in Ireland.

Methods: Fifteen semi structured interviews were conducted and analytically coded using thematic analysis with software programme NVivo12.

Results: Individuals on OAT may use Lyrica to self-regulate negative emotions; Lyrica use in this population is embedded in a polydrug use culture of “tablet taking”; participants illustrated concerning reports of inappropriate prescribing and described psychiatric symptoms occurring during withdrawal.

Conclusions: We report here on the first study in Ireland investigating the experiences of individuals who access opioid agonist treatment (OAT) and reported current or recent pregabalin use. Increased pharmaco-vigilance amongst medical practitioners is warranted when prescribing Lyrica to individuals with vulnerabilities such as a history of problematic drug use. Trauma informed interventions in addition to pragmatic harm reduction information for polydrug users to prevent cross tolerance, dependence and overdose deaths should be part of the healthcare and policy response.

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