Lucy Pallot had never experienced the lows of depression and anxiety until she started taking pregabalin.

Key points: Lyrica is now the most prescribed pain medication on the PBS, but there are calls for nationwide monitoring after reports that it may cause depression and anxiety

Lyrica is now the most prescribed pain medication on the PBS, but there are calls for nationwide monitoring after reports that it may cause depression and anxiety More than 4.1 million subsidised scripts for pregabalin were written in Australia last financial year

More than 4.1 million subsidised scripts for pregabalin were written in Australia last financial year Its manufacturer Pfizer said the safety of its medicine has been demonstrated in robust clinical trials

Sorry, this audio has expired Health experts call for tighter controls on Pregabalin pain medicine

"I would never even think about suicidal thoughts and that was the only thing we can pin it to, is the Lyrica. That's all," Ms Pallot, 25, from Bairnsdale in Victoria's east, said.

She was taking what is now the most commonly prescribed subscription medication for pain in Australia, pregabalin, which is sold under the brand name Lyrica.

Doctors issued 4.1 million scripts for the drug last year.

Ms Pallot, along with a growing number of health professionals and other patients, is now questioning whether pregabalin is being incorrectly prescribed to make up for inadequate specialist healthcare in regional Australia.

In 2017, Ms Pallot, who has type 1 diabetes, was working in a beauty salon in Melbourne when she went to a doctor complaining of restless legs.

"The doctor who prescribed it to me didn't do any tests. She just said 'take this, it will help you sleep'," she said.

"[It was if the doctor said] medicate yourself, and if it gets worse, have more."

So that is what Ms Pallot did.

She upped her daily dose from 25 milligrams to 250 milligrams, and within eight months she was addicted and critically ill.

Lucy Pallot had to uproot her life and move back in with her parents after suffering an addiction to pregabalin. ( Supplied )

She weighed just 49 kilograms, suffered blurred vision, and had the heart rate of an 80-year-old.

"I ended up losing about 35 kilograms in three months and I was put in hospital for about four to five weeks in ICU in Melbourne because I had anorexia," Ms Pallot said.

"There were times I would be rocking. I was fully, mentally unwell.

"And I had this brain fog where I would try to say something but the words wouldn't come out."

Regional GPs in avoiding opioids turn to pregabalin

Figures supplied by the Federal Government show more than 4.1 million subsidised scripts for pregabalin were written in Australia last financial year at a cost to taxpayers of $113 million.

A total of 1.4 million of those scripts were administered in regional Australia.

Pfizer says pregabalin is an important treatment for thousands of Australians living with debilitating nerve pain and epilepsy. ( ABC Gippsland: Sarah Maunder )

It is now the most commonly prescribed medication for pain on the Pharmaceutical Benefits Scheme (PBS) and the sixth most prescribed drug overall, according to the PBS Expenditure and Prescriptions Report 2018-19.

The indication for pregabalin is neuropathic pain, or fibromyalgia, but head of neurology at St Vincent's Hospital in Melbourne, Professor Mark Cook, said it was being incorrectly prescribed to treat different pain suffered by people living in regional areas.

"Over the months I would see hundreds of people taking pregabalin, most of the time for pain, so you see people who've had ankle injuries or surgery to their abdomen, for instance, who are being prescribed pregabalin," he said.

"There's been a lot of publicity about the dangers of opioids and so pregabalin is a bit of a stop gap, [it] is being used to fill a need.

"I see people who are using pregabalin inappropriately as an acute pain killer, they think that pregabalin is something you would take like Panadeine Forte, for instance.

"It is not, it is a drug to dampen the excitability of nerves and reduce pain from neuropathic injuries. It's not something you take for acute pain relief."

Experts advise patients not to change their medication without consulting their doctors first.

Professor Cook said regional GPs were turning to pregabalin in towns and centres where expert chronic pain management services are scarce.

"When people have got chronic severe pain, people will try anything. And pregabalin is one that comes to mind for many general practitioners," Professor Cook said.

Drug 'fantastic' if used correctly

Gippsland GP David Monash said pregabalin was a "fantastic" drug when used for what it was designed for.

"It's the best drug we have on the market for neuropathic pain," Dr Monash said.

"It's fantastic for the treatment of pain for shingles, for example. However, it has a very small margin of safety which means that if you actually use it in excess quantities it becomes toxic.

"The other thing that's happened of course, in Australia, is that all the combined drugs — paracetamol, codeine, combined drugs that people used to buy over the counter — have all now become prescription or unavailable.

"So once again, that's also further restricted the medications that GPs have to treat patients with minor levels of arthralgia.

Dr Monash said pregabalin was in high demand in prisons.

"The margin between safety and toxicity, which is life threatening with pregabalin, is very small. We have to stress that to the community," Dr Monash said.

He said that with any anti-epileptic drug and most anti-depressants and anti-psychotics, doctors needed to watch some patients closely after commencing them on those drugs because there was an increase in suicidal thoughts.

'Where the hell did that thought come from?'

Sale registered nurse Nicky Semmler, 34, was prescribed Lyrica for nerve pain in 2017.

A ruptured disc at the base of her spine flared up again in 2019 causing "shooting, unrelenting pain".

"Within a week of being on it I experienced very disturbing thoughts," she said.

Nurse Nicky Semmler was put on Lyrica after injuring her back and said the drug gave her "disturbing" and "suicidal' thoughts. ( ABC Gippsland: Kellie Lazzaro )

Mrs Semmler said she was driving along a windy, hilly road to watch her husband compete in a trail run at Tarra Bulga when she had the first suicidal thought.

"I thought 'holy hell, where did that come from? I have my daughter in the car, I'm not depressed, I don't want to end my life, where did that come from?'"

Twenty-four hours later, Mrs Semmler said she catastrophised a very minor incident at a supermarket and had a rare and huge fight with her husband.

"I was in Aldi and had spent more than $100 on groceries but didn't know the PIN to my husband's card. He wouldn't answer the phone and when I got home I just went crazy at him," she said.



"In the shower after that I thought … I could just disappear down the drain and not be a bother to anyone."

Mrs Semmler said she immediately realised that her suicidal ideation was abnormal and she stopped taking pregabalin.

As a nurse, Mrs Semmler said she had seen a steady increase in the number of patients presenting at hospital on Lyrica.

"When I first started my nursing career we rarely used it, never saw it, and it certainly wasn't something we considered as an option for pain relief," she said.

"I think there is just not enough information regarding it.

"Doctors and pharmacists need to monitor pregabalin, track it, and follow up the people who are using it because it has a massive potential to be abused."



Some states begin tracking its use

Queensland is one of the first Australian states to list pregabalin on its real-time prescription medication monitoring program, Q-Script, to be operational by mid-2020.

The Monitored Medicines Steering Committee, comprising medical and pharmaceutical representatives and the Coroners Court of Queensland, endorsed the recommendation that pregabalin be monitored along with other schedule eight substances including codeine, gabapentin, and benzodiazepines.

A spokesman for Victoria's Department of Health said the medications listed on Victoria's SafeScript program had been guided by an expert advisory group.

"Pregabalin, also known as Lyrica, is not one of the medications monitored through the program," the spokesman said.

"However, if new evidence is provided that suggests pregabalin should be added, it would be considered."

Dr Shalini Arunogiri from the Turning Point Alcohol and Drug Centre in Melbourne agreed pregabalin scripts should be monitored in real time to make it harder for people to go 'doctor shopping' for the drug.

"We have Safescript in Victoria, a program clearly looking at real-time monitoring of benzodiazepines, but at this stage it doesn't actually include pregabalin," Dr Arunogiri said.

Data compiled by the Therapeutic Goods Administration database of adverse events shows pregabalin was linked to 150 overdose deaths since it was listed on the PBS in 2013.

Ninety-six of those were fatal overdoses where no other drug was involved.

There were 978 official reports of adverse side effects, and 86 people who were taking pregabalin reported suicidal ideation.

Drug manufacturer Pfizer said the conditions pregabalin was indicated for can be chronic, debilitating, and have a significant impact on the quality of life of patients and their families.

"The efficacy and safety of these medicines have been demonstrated in a large number of robust clinical trials among thousands of patients in the approved indications," the company said in a written statement.

'I thought it was safe'

Lucy Pallot moved back in with her parents in Bairnsdale to recover and suffered panic attacks, sweats, and anxiety as she withdrew from the drug.

"I have never seen my Dad cry until I went through this," she said.

Lucy Pallot spent a month in hospital in intensive care after becoming addicted to Lyrica. ( ABC Gippsland: Sarah Maunder )

Ms Pallot now runs her beauty and eyelash business from a room at her parents' house and is looking forward to the birth of her first daughter next month.

Her new treating GP, whom she considers a valued family friend, has referred her to specialists in Melbourne for ongoing care.

"I met my partner when I was probably at my lowest and we're having a baby, so life's really good now," she said.

"But I still do have serious mental illnesses which I blame on Lyrica and I always will.

"I will always tell everyone 'do not take it because it will change your life'.

"I didn't even have neuropathy or nerve damage so I was prescribed something I didn't even need.

"They didn't tell me the side affects. [The doctor] just said 'it will help you sleep and if the pain gets worse up your dose'.

"I thought it was safe. They didn't tell me what was in it."

In its statement, drug manufacturer Pfizer said: