According to a recent report published by the United Nations Office on Drugs and Crime (UNODC), it is emerging that pregabalin trafficking in the Niger and other parts of West Africa is fast becoming a major concern for the region.

The report highlights that the Sahel has had to contend with trafficking rings surrounding not only pregabalin but also pharmaceutical opioids like tramadol, as well as cocaine and cannabis resin.

These four substances have been classified in the report as the most internationally trafficked drugs seized in the region.

About pregabalin

Pregabalin is a gabapentinoid used in the management of diabetic peripheral neuropathic pain, partial-onset seizures, postherpetic neuralgia, fibromyalgia, and neuropathic pain with spinal cord injury.1

This drug functions as a gamma-aminobutyric acid (GABA) analogue, binding to the alpha-2-delta subunit of voltage-gated calcium channels and decreasing calcium influx and neurotransmitter release.

This enables the drug to produce antinociceptive, anticonvulsant, and anxiolytic effects and to also treat a variety of off-label indications.

In pain management, particularly chronic low back or radicular pain, there has been an observed increase in off-label management despite a lack of evidence of the efficacy of the same.2

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Pregabalin in the Niger and parts of West Africa

The Republic of the Niger, at 480,000 sq mi, is the largest country in West Africa and has had its fair share of pregabalin trafficking seizures.

See the table below for a summary of some pregabalin seizures in the country and other parts of the region.

Country	Year	Quantity of pregabalin seized	City
Republic of the Niger	2021	150,000 tablets	Agadez
		300,000 capsules	Zinder
	2022	158 tablets	Agadez
		112,514 capsules	Maradi
		30,000 capsules	Zinder
	2023	390,000 capsules	On-transit pick up vehicle
Togo	2022	5,974,500 tablets	Port of Lomé
Nigeria	2022	150,000 tablets
Algeria	2022	20,180 tablets

Table showing the number of pregabalin seizures in the Niger and other countries in Africa

Why pregabalin?

The key motivator for those who abuse pregabalin is a feeling of euphoria.

Additionally, studies have shown that those who take the drug for recreational purposes have been quoted as describing the feelings they experience as sedation, dissociation, relaxation, contentment, numbness, uninhibited behavior, improved sociability, empathy, or audio/visual hallucinations.3

Other studies have shown that many misuse pregabalin by self-medicating with the intention of fighting anxiety or managing pain.4

It has also been reported to be used to heighten the effects of other substances, such as opioids.

Effects of misuse

Pregabalin carries a risk of dependence, an aspect that may introduce the classic addiction-related issues.

In addition, drug-drug interactions, particularly with medicines such as methadone or morphine, could lead to death due to breathing complications.

Looking at the numbers in England, Scotland, and Wales, for example, there were a total of 808 deaths related to pregabalin in the year 2022 alone.5

Australia had 824 deaths related to the same drug.

And there are an estimated thousands of unreported deaths globally.

Legislation/Regulation

Compared to the US and some European countries where pregabalin has been listed as a high-risk potent drug in their laws, the case is not the same as in the Niger and other African countries.

This means the handling and distribution of this drug are not under stringent guidelines.

Due to this circumstance, traffickers are able to evade domestic laws, and it is more challenging for law enforcement to look into and apprehend those involved in the trafficking of pregabalin.

Conclusion

Pregabalin is a key medicine, and doctors would argue that it can’t be completely eliminated from standard therapy. However, this doesn’t mean stakeholders should sit idly by as actions that promote misuse and abuse thrive.

Trafficking of this medicine as well as pharmaceutical opioids is both a global and African problem.

It is therefore important to implement strategies that will limit the enablers of this practice.

The UNODC report highlights corruption and money laundering as the main enablers of this practice, as well as the lack of proper laws that would inhibit misuse and abuse of the same.

It may be time to step up efforts in the fight against pregabalin trafficking.

Almost as much as that exerted in the fight against cocaine, cannabis, and opioid trafficking.

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References

1.       Lyrica (pregabalin) dosing, indications, interactions, adverse effects, and more. Accessed May 6, 2024. https://reference.medscape.com/drug/lyrica-cr-pregabalin-343368

2.       Folia. CBIP. Accessed May 6, 2024. https://www.cbip.be/fr/articles/query?number=F47F02B

3.       Patterns of gabapentin and pregabalin use and misuse: Results of a population‐based cohort study in France – Driot – 2019 – British Journal of Clinical Pharmacology – Wiley Online Library. Accessed May 6, 2024. https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.13892

4.       Servais L, Huberland V, Richelle L. Misuse of Pregabalin: a qualitative study from a patient’s perspective. BMC Public Health. 2023;23(1):1339. doi:10.1186/s12889-023-16051-6

5.       Death registrations related to Gabapentin or Pregabalin, England and Wales: 2018 and 2022 – Office for National Statistics. Accessed May 6, 2024. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/adhocs/1765deathregistrationsrelatedtogabapentinorpregabalinenglandandwales2018and2022