Impact of gabapentinoids’ reclassification policy and COVID-19 on gabapentinoids’ utilization pattern and their associated mortality in Scotland and Northern Ireland: a segmental regression analysis

Abstract

Background: Gabapentinoids are commonly used for neuropathic pain but are increasingly linked with misuse/mortality. In 2019, the UK reclassified them as Schedule 3 controlled drugs. The onset of the COVID-19 pandemic created additional uncertainty regarding their utilisation. We aimed to examine the impact of reclassification and COVID-19 on gabapentinoid utilisation and related mortality in Scotland and Northern Ireland (NI). Research design/methods: A population-based, cross-national study was conducted using prescribing datasets (April/2018–February/2025). Utilisation was measured as total items dispensed per 1,000 inhabitants and defined daily doses per 1,000 inhabitants/day. Gabapentinoid-related mortality data were analysed in parallel. Segmented regression assessed changes in trends following the 2019 reclassification and two COVID-19 lockdowns. Results: Overall utilisation was higher in Scotland than NI. In Scotland, pregabalin prescribing significantly increased over the study period, while NI demonstrated a decline, largely attributable to formulary restrictions. Neither reclassification nor pandemic lockdowns were associated with statistically significant changes in prescribing patterns. Mortality rates showed no significant correlation with utilisation in either country. Conclusions: Gabapentinoid utilisation does not appear to have been significantly affected by the reclassification or by COVID-19. Cross-national differences underscore the influence of formulary guidance, highlighting the need for harmonised policies/patient-level research to inform safe prescribing.

Rights

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.

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DOI

https://doi.org/10.1080/17512433.2025.2587174

Repository URI

https://strathprints.strath.ac.uk/94673/