{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:11:31Z","timestamp":1790626291268,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,5,7]],"date-time":"2019-05-07T00:00:00Z","timestamp":1557187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,23]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Due to the rise in their misuse and associated mortality, the UK government is reclassifying gabapentin (GBP) and pregabalin (PGL) to Class C controlled drugs from April 2019. However, it is impossible to gauge the extent of their use with current post-mortem toxicological screening, where GBP and PGL are only screened for if they are mentioned in the case documents. This study determines the prevalence of GBP and PGL, the potential extent of their under-reporting and poly-drug use in a post-mortem population. Between 1 January 2016 and 31 December 2017, 3,750 deceased from Coroners\u2019 cases in London and South East England underwent a routine drugs screen and a specific screen for GBP and PGL. The prevalence of both drugs was determined in the cohort and the subcategories of heroin users and non-heroin-users. The prevalence of both drugs was compared to tramadol (Class C drug). Case documents were reviewed to investigate the under-reporting of GBP and PGL and poly-drug use. Of 3,750 samples analyzed, 118 (3.1%) were positive for GBP, 229 (6.1%) for PGL and 120 (3.2%) were positive for tramadol. If routine analysis without additional screening of GBP and PGL had been performed in this cohort, GBP would have been under-reported by 57.6% (P &lt; 0.0001) and PGL by 53.7% (P &lt; 0.0001) in deaths. The most common drug group observed with GBP and PGL was non-heroin-related opioids at 60.2% and 64.6%, respectively. In total 354 deceased (9.4%) were heroin users. GBP was positive in 23 (6.5%) of these cases and PGL was positive in 69 (19.5%). The prevalence of PGL in heroin users (19.5%) was 4.1 times greater than in non-heroin users (4.7%) (P &lt; 0.0001). GBP and PGL are being significantly under reported in fatalities. Both drugs are extensively used with opioids. The prevalence of PGL in heroin users is highly significant.<\/jats:p>","DOI":"10.1093\/jat\/bkz036","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T11:07:31Z","timestamp":1555326451000},"page":"564-570","source":"Crossref","is-referenced-by-count":44,"title":["Misuse and Mortality Related to Gabapentin and Pregabalin are Being Under-Estimated: A Two-Year Post-Mortem Population Study"],"prefix":"10.1093","volume":"43","author":[{"given":"Limon Khatun","family":"Nahar","sequence":"first","affiliation":[{"name":"Toxicology Unit, Imperial College London, Charing Cross Campus, St. Dunstan\u2019s Road, London W6 8RP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology & Metabolism, Imperial College London, London W12 0NN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Paterson","sequence":"additional","affiliation":[{"name":"Toxicology Unit, Imperial College London, Charing Cross Campus, St. Dunstan\u2019s Road, London W6 8RP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,5,7]]},"reference":[{"key":"2019091012175079100_bkz036C1","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1021\/jm049762l","article-title":"Structure\u2013activity relationships of Pregabalin and analogues that target the \u03b12-\u03b4 protein","volume":"48","author":"Belliotti","year":"2005","journal-title":"Journal of Medicinal Chemistry"},{"key":"2019091012175079100_bkz036C2","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s40263-014-0164-4","article-title":"Misuse and abuse of pregabalin and gabapentin: Cause for concern?","volume":"28","author":"Schifano","year":"2014","journal-title":"CNS Drugs"},{"key":"2019091012175079100_bkz036C3","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/bcp.12277","article-title":"Misuse of the \u03b3-aminobutyric acid analogues baclofen, gabapentin and pregabalin in the UK","volume":"78","author":"Kapil","year":"2014","journal-title":"British Journal of Clinical Pharmacology"},{"key":"2019091012175079100_bkz036C4","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1007\/s00228-013-1578-5","article-title":"Pregabalin abuse among opiate addicted patients","volume":"69","author":"Grosshans","year":"2013","journal-title":"European Journal of Clinical Pharmacology"},{"key":"2019091012175079100_bkz036C5","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1159\/000321079","article-title":"Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data","volume":"80","author":"Schifano","year":"2011","journal-title":"Psychotherapy and Psychosomatics"},{"key":"2019091012175079100_bkz036C6","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.coph.2005.11.003","article-title":"The mechanisms of action of gabapentin and pregabalin","volume":"6","author":"Sills","year":"2006","journal-title":"Current Opinion in Pharmacology"},{"key":"2019091012175079100_bkz036C7","author":"Zovko","year":"2009"},{"key":"2019091012175079100_bkz036C8","year":"2014"},{"key":"2019091012175079100_bkz036C9","author":"Iversen","year":"2016"},{"key":"2019091012175079100_bkz036C10","doi-asserted-by":"crossref","first-page":"j4441","DOI":"10.1136\/bmj.j4441","article-title":"UK government to reclassify pregabalin and gabapentin after rise in deaths","volume":"358","author":"Iacobucci","year":"2017","journal-title":"British Medical Journal"},{"key":"2019091012175079100_bkz036C11","doi-asserted-by":"crossref","first-page":"k4364","DOI":"10.1136\/bmj.k4364","article-title":"Pregabalin and gabapentin become controlled drugs to cut deaths from misuse","volume":"363","author":"Mayor","year":"2018","journal-title":"British Medical Journal"},{"key":"2019091012175079100_bkz036C12","year":"2005"},{"key":"2019091012175079100_bkz036C13","year":"2018"},{"key":"2019091012175079100_bkz036C14","year":"2017"},{"key":"2019091012175079100_bkz036C15","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/1556-4029.13263","article-title":"Determining the toxicological significance of pregabalin in fatalities","volume":"62","author":"Elliott","year":"2017","journal-title":"Journal of Forensic Sciences"},{"key":"2019091012175079100_bkz036C16","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.forsciint.2016.05.033","article-title":"Pregabalin concentrations in post-mortem blood\u2014a two year study","volume":"266","author":"Eastwood","year":"2016","journal-title":"Forensic Science International"},{"key":"2019091012175079100_bkz036C17","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.drugalcdep.2018.01.018","article-title":"Prevalence of gabapentin in drug overdose postmortem toxicology testing results","volume":"186","author":"Slavova","year":"2018","journal-title":"Drug and Alcohol Dependence"},{"key":"2019091012175079100_bkz036C18","doi-asserted-by":"crossref","first-page":"j5312","DOI":"10.1136\/bmj.j5312","article-title":"Misuse of gabapentin and pregabalin may be underestimated","volume":"359","author":"Nahar","year":"2017","journal-title":"British Medical Journal"},{"key":"2019091012175079100_bkz036C19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.forsciint.2014.04.028","article-title":"Profiles of pregabalin and gabapentin abuse by postmortem toxicology","volume":"241","author":"H\u00e4kkinen","year":"2014","journal-title":"Forensic Science International"},{"key":"2019091012175079100_bkz036C20","first-page":"339","article-title":"Abuse of pregabalin\u2013results of the postmortem toxicology from 2010 to 2012","volume":"80","author":"Lottner-Nau","year":"2013","journal-title":"Toxichem Krimtech"},{"key":"2019091012175079100_bkz036C21","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s40263-016-0359-y","article-title":"A decade of gabapentinoid misuse: an analysis of the European Medicines Agency\u2019s \u2018Suspected Adverse Drug Reactions\u2019 Database","volume":"30","author":"Chiappini","year":"2016","journal-title":"CNS Drugs"},{"key":"2019091012175079100_bkz036C22","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1111\/add.13843","article-title":"Risk to heroin users of polydrug use of pregabalin or gabapentin","volume":"112","author":"Lyndon","year":"2017","journal-title":"Addiction (Abingdon, England)"},{"key":"2019091012175079100_bkz036C23","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1111\/add.13324","article-title":"Gabapentin misuse, abuse and diversion: a systematic review","volume":"111","author":"Smith","year":"2016","journal-title":"Addiction (Abingdon, England)"},{"key":"2019091012175079100_bkz036C24","author":"Iversen","year":"2013"},{"key":"2019091012175079100_bkz036C25","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.jchromb.2004.10.036","article-title":"Screening and semi-quantitative analysis of post mortem blood for basic drugs using gas chromatography\/ion trap mass spectrometry","volume":"813","author":"Paterson","year":"2004","journal-title":"Journal of Chromatography B"},{"key":"2019091012175079100_bkz036C26","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1258\/0004563001899744","article-title":"Analysis of urine for drugs of abuse using mixed-mode solid-phase extraction and gas chromatography-mass spectrometry","volume":"37","author":"Paterson","year":"2000","journal-title":"Annals of Clinical Biochemistry"},{"key":"2019091012175079100_bkz036C27","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.scijus.2010.09.005","article-title":"The United Kingdom and Ireland Association of Forensic Toxicologists: forensic toxicology laboratory guidelines (2010)","volume":"50","author":"Cooper","year":"2010","journal-title":"Science & Justice"},{"key":"2019091012175079100_bkz036C28","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/jat\/bkx019","article-title":"Validated method for the screening and quantification of baclofen, gabapentin and pregabalin in human post-mortem whole blood using protein precipitation and liquid chromatography\u2013tandem mass spectrometry","volume":"41","author":"Nahar","year":"2017","journal-title":"Journal of Analytical Toxicology"},{"key":"2019091012175079100_bkz036C29","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1213\/00000539-200007000-00035","article-title":"Gabapentin enhances the analgesic effect of morphine in healthy volunteers","volume":"91","author":"Eckhardt","year":"2000","journal-title":"Anesthesia & Analgesia"},{"key":"2019091012175079100_bkz036C30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/j.0013-9580.2004.455003.x","article-title":"Pregabalin pharmacology and its relevance to clinical practice","volume":"45","author":"Ben\u2010Menachem","year":"2004","journal-title":"Epilepsia"},{"key":"2019091012175079100_bkz036C31","doi-asserted-by":"crossref","first-page":"732","DOI":"10.7326\/M18-1136","article-title":"Pregabalin and the risk for opioid-related death: a nested case\u2013control study","volume":"169","author":"Gomes","year":"2018","journal-title":"Annals of Internal Medicine"},{"key":"2019091012175079100_bkz036C32","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1056\/NEJMp1704633","article-title":"Gabapentin and pregabalin for pain\u2014is increased prescribing a cause for concern?","volume":"377","author":"Goodman","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"2019091012175079100_bkz036C33","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s40263-015-0303-6","article-title":"Abuse potential of pregabalin","volume":"30","author":"Schjerning","year":"2016","journal-title":"CNS Drugs"},{"key":"2019091012175079100_bkz036C34","year":"2017"}],"container-title":["Journal of Analytical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jat\/advance-article-pdf\/doi\/10.1093\/jat\/bkz036\/28564874\/bkz036.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jat\/article-pdf\/43\/7\/564\/29335220\/bkz036.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,16]],"date-time":"2022-09-16T00:02:19Z","timestamp":1663286539000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jat\/article\/43\/7\/564\/5486351"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,7]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,5,7]]},"published-print":{"date-parts":[[2019,8,23]]}},"URL":"https:\/\/doi.org\/10.1093\/jat\/bkz036","relation":{},"ISSN":["0146-4760","1945-2403"],"issn-type":[{"value":"0146-4760","type":"print"},{"value":"1945-2403","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,9]]},"published":{"date-parts":[[2019,5,7]]}}}