Non-narcotics Lyrica, Neurontin overprescribed, add to opioid epidemic, doc says

Two non-narcotic painkillers that are being overprescribed nationwide hit Long Island’s streets months ago in an unusual addition to the opioid epidemic, a local expert in substance-abuse treatment warned Wednesday upon publication of a New England Journal of Medicine report.

Doctors writing in the journal said an explosive number of prescriptions are being dispensed for the drugs — pregabalin, sold under the brand name Lyrica, and gabapentin, marketed under the name Neurontin.

Those physicians, Christopher Goodman and Allan Brett of the University of South Carolina, cited the potential for misuse as doctors nationwide — facing tighter prescribing rules for narcotics — have sought non-narcotic methods of chronic pain control. The medications are two of the most widely prescribed drugs nationwide, according to data in the journal.

Both medications already are sold on the black market on Long Island at prices of $10 to $20 per pill, said Dr. Jeffrey Reynolds, chief executive of the Family & Children’s Association in Mineola.

“These drugs are being sold and traded on the streets just as opioids are,” Reynolds said. “This is a very local issue, and we have known about it for at least a year.”

Tighter drug-prescribing regulations in New York have meant fewer opioid pills, such as hydrocodone and fentanyl, are in the hands of drug pushers, he added. With a less abundant supply of narcotics, addicts have found that pregabalin and gabapentin — which act on a key chemical in the brain — make the opioid effect last longer.

The non-narcotic pills can have a sedative effect on patients, but not on addicts, Reynolds said.

The use of the two drugs emerged after New York shifted to electronic prescribing last year, eliminating traditional paper pads. The state was one of only three at the time to require e-prescribing of controlled substances, a move that helped eliminate the number of opioid pills in the illicit drug trade.

Before the changeover to electronic prescribing, local drug peddlers stole thousands of pads and wrote their own orders for opioid medications, police have said.

Pregabalin and gabapentin, nevertheless, are an important part of pain management because they address a number of syndromes, doctors said.

“For years, both medications have been relied upon to help relieve patients of diabetic neuropathic pain, which is a complication of the underlying disease,” said Dr. Minisha Sood, an endocrinologist and assistant professor of medicine at Hofstra Northwell School of Medicine in Hempstead.

Neuropathic pain is a chronic condition caused by damaged nerves in the extremities, particularly the hands and the feet, she said.

Pregabalin and gabapentin are chemically related, Sood said, adding that she is aware that prescriptions for the drugs have increased. She added, however, that she does not overprescribe either medication and treats patients at the lowest possible dosages.

While gabapentin has a role in diabetic neuropathic pain, pregabalin is routinely used for fibromyalgia, a disorder typified by widespread musculoskeletal pain, sleep and mood disturbances, and overwhelming fatigue.

Outside of its use in pain control, gabapentin once was commonly prescribed for epilepsy, but that use has waned as more effective drugs have emerged, said Dr. Fred Lado, director of epilepsy for the Northwell Health system’s central and eastern regions.

“Both gabapentin and pregabalin have side effects,” Lado said. “They can cause weight gain and people can experience toxicity at very high doses.”