Gabapentin and pregabalin are collectively known as gabapentinoids.1 They are licensed as an anti-epileptic, for neuropathic pain and generalised anxiety disorder.2 Since their market introduction (gabapentin 1993; pregabalin 2004) they have risen to become one of the most commonly prescribed medications in a number of countries. One of the theories for the rise in prescribing is the increase in off-label prescribing, i.e. being prescribed for conditions other than that licensed for, such as other pain disorders.

Of concern is that when gabapentinoids are used alongside opioids, there may be an increased risk of respiratory depression, overdose, and death. When first released onto the market, these medications were thought to have a low risk of misuse or dependence; however, ever since there has been a growing recognition of those associated risks. There has been an increased reporting of misuse or dependence to various agencies, and an increase in the number of overdose deaths where they are implicated often in combination with opioids, specifically heroin and methadone. In 2019, the United Kingdom (UK) authorities reclassified gabapentinoids as Schedule 3 (Class C) controlled drugs.

An Irish study by Griffin et al.1 assessed suicide risk following hospital attendance with self-harm. This is an important Irish study as it calculated the risk of suicide among those with a history of hospital-presenting self-harm using national-level data.

Background

Self-harm can be defined as intentional self-injury or poisoning, irrespective of motive.1 There are many ways people can intentionally harm themselves, including poisoning with tablets or toxic chemicals, misusing alcohol or drugs, or cutting or burning their skin.