New prescribing controls come into force for pain relieving drugs | 19 March 2019

 

Dr Charles Shepherd, Hon. Medical Adviser, ME Association.

Gabapentin (trade name = Neurontin) and Pregabalin (trade name = Lyrica) are two drugs that are normally used to treat epileptic seizures. They are sometimes prescribed for people with ME/CFS who have moderate to severe pain, especially nerve (neuropathic) pain.

Feedback from people with ME/CFS who have used these two drugs indicates that, as with many pain-relieving drugs, there are mixed benefits – with some people finding them of great help while others experience unpleasant side-effects that outweigh any positive improvements.

In October 2018, the UK Government announced that both drugs were to be reclassified to what are called Class C controlled substances from April 2019 – which is now only two weeks away.

The switch in classification follows a recommendation from the Advisory Council on the Misuse of Drugs that they should become controlled drugs and be placed under Schedule 3 of the Misuse of Drugs Regulations 2001 and Class C of the Misuse of Drugs Act 1971.

This is because while both drugs are successfully used for treating neuropathic pain, seizures and anxiety, illicit use has increased in recent years.

Under the new classification, pharmacists will not be able to accept electronic prescriptions for gabapentin and pregabalin, although this may be mitigated in the future if the Electronic Prescribing System (EPS) can be used to prescribe controlled drugs electronically instead.

Prescriptions of gabapentin and pregabalin will also be limited to 30 days’ treatment/supply, and repeat prescriptions will not be issued. Any prescription received must be dispensed within 28 days.

Below is the most up to date information on the roll out of EPS, and the effect on prescribing controlled drugs, that has been issued by NHS Digital:

“The national roll out of controlled drugs in EPS for TPP SystmOne and Vision is now complete. All GP practices in England using either of these systems are now able to prescribe controlled drugs electronically.”

“The EMIS Web roll out will start on 25 March 2019 and take place over two weeks.”

“We are working closely with Microtest to confirm dates for a pilot with its Evolution system. Further updates will be published soon.”

“Processing prescriptions for Schedule 2 & 3 Controlled Drugs (CDs) electronically using EPS will make the process safer and more secure.”

“The change in classification is expected to prompt a decline in the use of these drugs as prescribing, dispensing, and collecting them becomes more onerous for doctors, pharmacists, and patients.”

Responding to the original announcement, Ash Soni, president of the Royal Pharmaceutical Society (RPS), said, “These restrictions are designed to improve safety, and from that perspective will be recognised as a positive step by pharmacists.”

But he emphasised that patients must be made aware of the changes so that they understand the new requirements for prescriptions, particularly regarding the time limits for dispensing and restrictions in prescribed quantity.

“It is likely that there will be some reduction in the prescribing of these drugs and pharmacies will need support in managing their stock holding to ensure they meet patient demand, without ending up with significant stocks that go out of date,” Soni added.

“Misuse of the gabapentinoids, often in combination with opioids, is becoming more prevalent and recognised in specialist drug and alcohol services”, said Graham Parsons, RPS spokesperson on misuse of drugs and chief pharmacist of the charity Turning Point.

“It is always a fine balance when drugs are reclassified. Prescribers must always be cautious that the pendulum does not swing too much in the other direction leading to patients with a genuine clinical need being denied evidenced-based pharmacotherapies.”

Source: The Pharmaceutical Journal.

Concerns

If you are using either drug and are at all concerned that these new restrictions might impact on your health, then please discuss the changes with your GP in the first instance and in advance of your next repeat prescription.

Feedback

We would like to hear about your experience of these drugs. Do you find them helpful? For what symptoms in particular? Are you concerned about this reclassification and what it might mean?

Please leave your comments on the website below or join our discussion on social media (Facebook and Twitter).

If you experience any difficuly in continuing to obtain a supply following this reclassification, please let us know via email (title your email ‘Drug Reclassification’).


More information

The ME Association has information leaflets from Dr Charles Shepherd covering all aspects of the use of gabapentin and pregabalin. We also offer a review of pain and pain relief options in ME/CFS and symptom management options more generally.

These can each be purchased and downloaded from the website shop or ordered for postal delivery.


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