Across the UK, a new pharmaceutical drug is slowly taking over the market. The illicit use of pregabalin has emerged as a significant and rapidly evolving public health concern, with particular impact in areas marked by high deprivation, poly-substance use, and entrenched opioid markets such as Teesside, Middlesbrough. Originally licensed as an anticonvulsant and prescribed for neuropathic pain and generalised anxiety disorder, pregabalin has increasingly become one of the most popular ‘street’ drugs locally.
In response to the troubling increase in illicit use, the UK’s Advisory Council on the Misuse of Drugs (ACMD) recently called for evidence on the ‘misuse and harms of pregabalin and gabapentin’, with the aim of understanding how these medications are being prescribed and diverted into illicit markets.
The opinion of many professionals seemed to be that people who currently took illicit pregabalin had previously been prescribed it, but a survey carried out by Public Health Departments locally with 147 respondents in Teesside found that less than 5% of those taking illicit tablets reported continuing its use after a prescription was stopped, contradicting the official narrative.
For the past 12 years the North East of England has had the highest rates of drug related deaths in England and Wales, with local authorities areas in Teesside featuring as some of the worst affected. The 2024 Drug Related Death data indicates pregabalin was a factor in 617 deaths in the year. This figure remains smaller than other substances, like opiates or benzodiazepines, but is far higher than fentanyl and ketamine, which each figured in 60 deaths in that year yet get considerably more media attention and moves to promote awareness.
While these figures represent only deaths and not wider harms, and the work around ketamine and fentanyl is vital and needs developing, they raise an important question: are we ‘sleeping’ on the dangers of pregabalin?
For the past 15 years, drug-related deaths involving pregabalin have continued to reach record highs, as have the total number of drug-related deaths across substances, according to the National Programme on Substance Use Mortality (NPSUM) and shared with treatment providers like myself.
Over these 15 years, I have observed this rise of pregabalin while working in drug and alcohol services in the Tees Valley area, from a medication that was sometimes ‘diverted’ and used illicitly by a small group of people to one of the most widely sought drugs by many. Everyday I speak to people who tell me that pregabalin is the one thing they either “want” or “can’t function without”. In the last 12 months, I have been taking extra notice about what people tell me anecdotally regarding pregabalin. Why do they use it? How do they source it? And how safe do they feel it is?
Illicitly manufactured tablets are recognised locally as a major contributor to harm, with anecdotal evidence pointing to illicit pregabalin use featuring in up to 40% of local drug-related deaths. Another factor that exacerbates the harms is that pregabalin is often used in conjunction with other substances. A recent qualitative study looking at polydrug use in Middlesbrough found that 96% reported using pregabalin in combination with the prescribed sedative Zopiclone.
Another significant risk with illicit tablets is adulteration. While no specific studies exist for pregabalin, several recent investigations in the UK have found high levels of adulteration in tested samples of benzodiazepines and heroin. This means that the strength and potency of illicit tablets can vary widely.
While people can submit samples of street bought pregabalin to drug checking organisation WEDINOS for testing, the results only confirm the presence of other substances, not the potency or whether the dosage matches that stated on the packaging. While all tested samples were sold as pregabalin, some were found to be adulterated with cocaine, ketamine or dihydrocodeine, with others having no active compound at all.
A 2025 study of seized pregabalin in Saudi Arabia found significant variations in dosage both within and between batches of tablets. Some of those samples tested contained adulterants, including paracetamol and codeine. The study concluded that, “the presence of untraceable capsules suggests that they are counterfeit drugs randomly filled by unqualified illegal operators,” and that “results included either low drug amounts intended to mislead consumers or high concentrations beyond expected levels.” To truly understand the nature of illicit pregabalin in the UK, a nation-wide drug checking programme is needed.
Three kinds of pregabalin consumers
People who use pregabalin describe their use as broadly falling into three categories.
The ‘self-medicators’ often do not consider themselves ‘drug consumers’ or identify any risks of taking illicit tablets. This group is driven by a frustration at having to pay online for something they believe should be on prescription from their doctor. Ordinarily, these individuals may be at lower risk of overdose and report that they “take as prescribed”, meaning they take what they believe a doctor would prescribe them. For this group, fluctuation in dosage is likely to be the main risk factor, given that it is impossible to confirm the dosage of illicit tablets without testing and doses indicated on packaging can be inaccurate.
As one ‘self-medicator’ told me, “the Lyrica or Mylan are normally ok”, showing trust in a brand name while simultaneously acknowledging that these too may not be genuine. ‘Self-medicators’ mostly use pregabalin to cope with mental health issues. A survey conducted locally found that over 40% of respondents reported commencing illicit tablet use to help their mental health. Individuals in this group rarely come into contact with traditional substance use services, saying that with no detox or substitute prescribing, treatment wouldn’t meet their needs.
The second group is what I call the ‘one substance for another’ group. Often registered with a drug treatment service, many have been prescribed substitutes for previous opiate use; their use of pregabalin and other medications is most often reported. Over recent years, people who use drugs have reported instability in the heroin supply with periods of ‘drought’ or variations in strength. This has been identified as a factor in the move to illicit tablet use, which are cheaper, more potent and easily accessible.
This group acknowledges that the tablets they take are often counterfeit: “sometimes we know they’re not right, they taste or look different”. Prices reflect this, and the cost varies depending on quantity purchased, but small amounts are priced at GBP£ 10 for 6 or 7 tablets branded and sold as genuine or GBP £10 for 10 when acknowledged as counterfeits. Many don’t have phones, internet access or debit cards so purchasing online is beyond their means. They acknowledge that “one day they are much stronger than they have been”. This group seems to be the most aware of the risks associated with illicit tablet use, which may be due to ongoing interactions with substance use services, and often disclose an expectation they will be sold low quality pressed pills.
The last group is the ‘alternatives generation’. Members of this group often view pregabalin as an alternative to alcohol or opiates, reporting similar effects of increased confidence and relaxation but feeling it is less harmful than alcohol and without the stigma of the ‘dirty drugs’ like heroin. “You feel just like you have had a few pints, no hangover,” one member explained.
Within this group, there is less awareness of the potential dangers of illicit tablets, which are still considered ‘safe’ due to the perceived pharmacological nature of the substance. Popularity has increased among those working offshore or in jobs where drug testing is the norm because pregabalin is not routinely screened for outside of specialist services. The risk of differing potencies within a ‘batch’ poses a high risk to this group, who often ‘binge’ use over a few days a week. Locally, in recent months suspected overdoses have occurred, where the individual was believed to only use pregabalin and no other substance.
Getting hold of pregabalin
Buying pregabalin online is relatively straightforward, no dark web needed. Put the correct search terms into your browser and you will find no shortage of online ‘pharmacies’ that can prescribe it. Pregabalin is advertised as a sleeping tablet, though that has never been its licensed use. Some online pharmacies even advertise availability without prescription in the UK, with next day delivery. Basic Google searches also bring up online stockists of pregabalin and Zopiclone without a website and contact information via WhatsApp only.
Even for those without online access, buying on the street is not difficult. Walk through areas of high deprivation locally and it is not uncommon to be offered ‘PG’s’ or ‘Z’ drugs. In areas of town with high numbers of hostels and bedsits, cars or individuals on bikes will slowly pass by while announcing their current ‘stock’.
People who use pregabalin often fly under the radar: many have little or no contact with support services or are prescribed opioid substitution therapy and therefore appear on reported data as opiate users. As a result, the harms associated with illicit pregabalin use are growing but remain a neglected topic of discussion.
Without access to drug checking services to test the strength and purity of illicit tablets, those using street-bought pregabalin are at increased risk. Uncertainty about dosage makes it difficult to gauge tolerance, increasing the likelihood of overdose, harmful drug interactions, and other adverse effects.
