8, 9, 10
1, 2, 3, 4, 5, 6, 11
1, 2, 5, 6, 8, 10
Drugs of abuse
1, 2, 3, 6, 7, 8, 9, 10
1, 2, 6
Synthetic hashish (Joker)
1, 5, 9, 10, 7
3, 4, 6, 7, 9
1, 2, 5, 6, 7, 10
5, 6, 7
1, 2, 4
Duration of drug abusee
1, 2, 3, 10
> 5 years
4, 6, 7, 8, 9
7, 9, 10
4, 5, 11
1, 2, 3, 6, 8
9, 10, 11
1, 2, 8, 6
3, 4, 5, 7
Pregabalin and Other Drugs
Only one participant was taking pregabalin on its own with no previous history of drug abuse and observed,I began with natural hashish. Afterwards, I started with marijuana and other sorts of medical pills like Xanax®, tramadol, Oxicane®, and Roxy®. The last thing I used was Lyrica®. I tried Joker, but Lyrica® is more difficult to stop than the Joker because I used to take large quantities (Participant 1, 22 years old, male).
The majority of participants were first introduced to pregabalin from a friend or colleague. More than half of them (n = 9/11) experimented for the first time with friends when using other drugs.I used to take pills named Galica® and no other drugs. This material itself will lead you to take other drugs just like weed! If I stayed using this drug, I would have ended up trying other types of drugs. That is why I came here for treatment (Participant 11, 19 years old, male).
Two participants tried it first as an alternative to tramadol or benzohexol.From my friends, as I was already a Joker [synthetic cannabinoid] and hashish addict, we used to always take drugs as a group and they (his friends) told me this (pregabalin) was better than Joker. They meant because it is a medical substance (Participant 10, 27 years old, male).
For two participants, the first use of pregabalin was in the context of treatment for addiction. One participant used it as he viewed the drug as a legal substitute for another drug, and another used pregabalin as treatment for synthetic cannabinoid withdrawals.I knew it (pregabalin) by an Emeriti friend who used to take it, as an alternative to tramadol. Tramadol is a controlled drug, but these are not and any pharmacy would sell them. I usually take big quantities and I came here to the center on Thursday evening after taking one whole packet of Lyrica® 14 pills (Participant 4, 42 years old, male).I learned about it (pregabalin) through my friend. He advised me to try and I liked it. It gives a good mood like the mood of Baltane® (benzhexol). First, I took two pills and they changed my mood, and the next day I demanded more (Participant 7, 35 years old, male)
Several participants commented that the lack of detection of pregabalin in urine screening methods was a motive for use.Now, the idea prevailing among the addict community is that pregabalin can treat addiction, so we thought that it would be legal and normal. We knew it was used for disc treatment, and later on, we came to know that some countries use it for the treatment of addiction. But I took it as a substitute for other materials (Participant 6, 22 years old, male).This happened by accident. Someone told me it (pregabalin) would treat Joker powder addiction, and I took it. It treated the agitation of the powder only for two days and then it became useless on the third day (Participant 9, 35 years old, male).
Others commented on its legal status and easy route to access.In general, we concentrated on Lyrica® as it doesn’t appear in the urine and we were afraid of antinarcotics department personnel. That’s why we liked Lyrica® (Participant 4, 42 years old, male).
Better than Joker and other materials as it is a legal drug (Participant 10, 27 years old, male).
The Pregabalin Effect
The main perceived positive outcomes of pregabalin use centered on its effect in making users sociable and talkative with others.At first, I felt sluggish, sleepy, fatigue, with leg pain and shaky hands and many other things happened like foggy eyes but mainly I felt sleepy. The second time you take it (Lyrica®: pregabalin) you feel very active, you want to work, just like the action of Captagon. You feel active and have dry mouth, your hands peel, the body feels dehydrated, and you feel you want to drink something sweet or like Redbull (energy drink). Also, I have reached the stage of cheerfulness with the feeling of happiness which is well-being. Now on continuous taking of Lyrica®, one starts to forget and mingles between the subjects when talking to someone (Participant 3, 20 years old, male).I can’t describe it, you feel relaxed, too lazy, and it (pregabalin) makes you sleepy. When you stay awake you will go on eating and talking profusely, you became too social. When you take three pills 150 mg, you can talk to anybody without interruption probably for 2 hours (Participant 2, 23 years old, male).
The majority appeared to take this one step further in attempting to reach intoxication.It made me change the way I treat people; I became very kind and social which is very far from my personality. Mainly, I had the energy to talk non-stop without knowing where all these words came from (Participant 11, 19 years old, male).
The vast majority of participants described noticing that smoking cigarettes increased and was more satisfying when using pregabalin.At first it makes you sleepy, and then it elevates your mood and boosts your energy. But when you start to take 5–6 pills at once, you don’t feel sleepy, you feel active and energetic (Participant 5, 22 years old, male).
I smoke one packet a day, but when I take it (pregabalin), I smoke 3–4 packets non-stop (Participant 1, 22 years old, male).Smoking is more satisfying with Epigab®. I smoke three and a half packets instead of two when I take Epigab® (Participant 5, 22 years old, male).
Poly-pharming and Pregabalin Intoxication
Drinks like energy drinks, Coca Cola®, sweet tea, and coffee were commonly mixed with pregabalin to enhance its stimulant outcomes as described by all participants.When taking Lyrica® with hashish, they boost each other’s effect (Participant 3, 20 years old, male).
Other participants described mixing pregabalin with different drugs like tramadol, Lexotanil®, synthetic cannabinoid (Joker), alprazolam, and Captagon in order to potentiate its effect.I learnt something from an Emirati, that if you drink Coca Cola® which includes carbon dioxide in it along with Lyrica® it increases its effect. Coca Cola® is well-known combination with Lyrica®. If you search the internet you see, for example, whoever takes Lyrica® always drinks a large Coca Cola® with it to reach its effect faster. The reason is that it contains sugar, and sugar always boosts the effect of Lyrica® (Participant 1, 22 years old, male).
Some described the combination with alcohol as dissociative.I was taking it (pregabalin) with the Prazin®, Saliba (clonazepam), and Kemadrin®. They made me confused, but at the same time they gave me a good mood. Also, I started to forget events immediately and talk to myself. Everything I took made me dissociated and unaware of the things around me (Participant 7, 35 years old, male).
Many participants described how pregabalin use in poly-drug-taking episodes contributed to cognitive impairment and detachment from worries and concerns.Drinking alcohol along with pregabalin will lead to a disaster. I tried it and I hit a wall. That is why I came here to the center (Participant 5, 22 years old, male).With a can of beer and within 5 minutes, the action sets in. I lose consciousness. Sometimes when awake, I find myself in the police detention room, yet I had no idea what I have committed (Participant 7, 35 years old, male).
Experiences of severe dissociation and overdose as a result of the compounding effects of poly-substances used with pregabalin were common.It (pregabalin) impaires my thinking and makes me feel like I don’t understand what people are saying; it rambles my thoughts (Participant 7, 35 years old, male).It (pregabalin) dissociates you from reality, you would feel normal, happy without any worries (Participant 1, 22 years old, male).
I came to the center on Thursday. I was taking Lyrica® strip and Joker powder and passed out for four days and woke up yesterday morning. The nurse told me that he tried to talk to me, but I had no reaction or response and since I came here I am not able to sleep (Participant 4, 42 years old, male).I went to the university and met an addict who persuaded me to take marijuana. Then I went home and on the roof, it happened with me for the first time, I had an overdose and slept on the ground. I didn’t know what happened as I also took Lyrica® with it (Participant 1, 22 years old, male).
Trajectories, Patterns, and Routes of Administration
Repeated dosage within drug-taking episodes was common.I take it (pregabalin) every other day because if I took it daily nothing will happen (Participant 1, 22 years old, male).
Participants described using personal experience and experimentation with dosage and intervals of use to boost the effect and elongate its duration. Most used it only by swallowing the capsule. Others experimented with insufflation or by pouring the capsule contents directly into the mouth.I began with Lyrica® 75 mg; then I started to increase it to 150 and sometimes 300 like Epigab® 300. I used to take 3–4 pills till I went into deep sleep. If I took it in the morning, I usually took 2–3 pills and at night 2 pills, then 150 and thereafter 300 (4–5 pills), and so on. The highest dose I reached was the last time, I took a complete strip of 14 pills (300), not all at once, but on the same day (Participant 2, 23 years old, male).I started with Lyrica® at a dose of 300 mg. First, I used to take 3–4 pills, then one strip. The highest dose I took was 28 pills of Lyrica®, at one time, I mean two strips (Participant 8, 29 years old, male).
I used to take it (pregabalin) with a glass of water and sometimes I tried to open it and put the drug in my mouth right away. I tried to sniff it once, but it had no effect (Participant 1, 22 years old, male).At first I used to swallow pregabalin pills; then I started to take it by chewing, suckling, and then swallowing it. Later on, I started to open it and pour the powder in my mouth (Participant 11, 19 years old, male).
Dependence and Withdrawals
Many described awareness of dependence and the all-consuming nature of seeking and using pregabalin.Regarding the negative consequences, I only knew it (pregabalin) would harm the kidneys, and then I came to know about other consequences during the treatment. It impacts the nerves, genitalia, brain, kidney, increase/decrease heart beats, and would raise blood pressure. But the addictive effects I knew about them from my friends (Participant 3, 20 years old, male).
The negative effects of dependent use centered on the loss of relationships and overall social functioning.The worst part is that I lost everything. I no longer have confidence in myself. My whole thinking was devoted to the idea of getting money to buy Lyrica® (Participant 2, 23 years old, male).I used to make different excuses to get money. For example, I would say I had to pay for university transport fare or fill up my car in addition to other things (Participant 3, 20 years old, male).
The majority of participants reported withdrawal symptoms when attempting to self-detox and discontinue pregabalin use and described mental health difficulties in achieving cessation.I started to lose the people around me. You sit with the people out of obligation not because you want to, which makes you feel lonely (Participant 10, 27 years old, male).You keep staring at the blank wall for hours. You lose track of time. You can sleep for hours and even days without waking up (Participant 7, 35 years old, male).
Others described a myriad of physical and mental conditions such as exhaustion, headaches, anxiety, depression, joint and muscle pains, shivering, lethargy, and avoidance of social interaction when attempting to reduce and cease use. These withdrawal symptoms contributed to users administering pregabalin again.Every time I quit I develop a sort of social phobia, nightmares, and fear. Seriously, I can’t. I must take it (pregabalin) to get relief. Also, I had suicidal thoughts which made me want to take it again, and it caused me sexual dysfunction as well (Participant 1, 22 years old, male).
Two participants reported that when experiencing pregabalin withdrawal symptoms, they self-medicated with other drugs to alleviate symptoms.I felt shivering, headache, body ache, and heavy knees, but mostly it is the shivering that bothered me. All these symptoms made me want to take it (pregabalin) again (Participant 7, 35 years old, male).I literally avoided talking to people even on the phone and I became inactive. I also suffered from headache, depression, shaky hands, and muscle ache, especially here (pointing to his knee). My mother told me that I sweated a lot during sleep and my temperature got high as well. After three days of quitting Lyrica®, I suffered from insomnia (Participant 11, 19 years old, male).
I felt exhausted, moody, and avoided dealing with people. To alleviate these symptoms, I used to take Lexotanil®; it helped me to get rid of symptoms (Participant 5, 22 years old, male).
Sourcing of Pregabalin
The majority of participants were not aware of a street name for pregabalin products and usually requested it by its brand name like Lyrica® or Galica®. In contrast, three participants described the street name of Lyrica® or Epigab® as Lulu, Laleze, and the trip and were using these names among themselves.He (his friend) told me this is from the pharmacy without a prescription. Any pharmacy can sell it to you, and I went to the pharmacy he mentioned and bought it (pregabalin) (Participant 7, 35 years old, male).
The majority of participants described easy access and availability of pregabalin products in community pharmacies. Six participants got pregabalin by requesting a specific brand name or by the pharmacist himself/herself offering to give an alternative substitute. A minority of participants described some community pharmacies as refusing to sell the product or advising him that the drug was listed and required a prescription. Some pharmacists advised on alternative drugs.We used to call Epigab® the “trip”, because as they say it takes you in a trip to another world (Participant 5, 22 years old, male).
One participant described preferring to secure pregabalin in the morning when the owner or the responsible pharmacist was not available. In addition to that, he reported a difference in the price of the drug every time that he requested it from a pharmacy. Three of the participants described asking for a prescription from a physician.Not all pharmacists would sell it (pregabalin). Some would refuse and explain it was listed and needed a prescription so I go and look for another pharmacy (Participant 11, 19 years old, male).Many pharmacists sell it. I used to always buy Lyrica® from a specific pharmacy. Sure the pharmacist knows it’s for non-medical purposes because I used to buy it frequently and all he needed was money. Sometimes, he would say that the drug was out of stock, but he had other alternatives. That’s how I came to know about Epigab® and Regab® (Participant 2, 23 years old, male).
In the UAE, they usually ask for a prescription but here [Jordan] no. I used to visit the doctor to obtain a prescription to buy it. I give him 100 dinars (500 dirhams) for the prescription. He is an Indian doctor, and he didn’t refuse to give me the prescription. But here [Jordan] it is normal, I can buy it from any pharmacy (Participant 8, 29 years old, male).I tried to secure a prescription from a doctor, but not from my side from another person’s side. My friend got me a prescription from a doctor that he knows. He is a private doctor (Participant 11, 19 years old, male).