Drug abuse crisis grips Pakistan as their sale go unregulated

ISLAMABAD: The unchecked misuse and abuse of three commonly available medicines including Tramadol, Gabapentin, and Pregabalin have raised alarm bells in Islamabad and beyond, prompting urgent calls for these drugs to be regulated as controlled substances.

The growing trend, flagged by the Quality Control Board Islamabad, highlights a social and health crisis as these medications, originally intended for pain relief and neurological disorders, are increasingly being misused, particularly by younger populations, it emerged on Monday.

In a detailed communication to the Drug Regulatory Authority of Pakistan (DRAP) and provincial drug control institutions, Islamabad Quality Control Board (QCB) Secretary Shabbir Ahmed urged the need to include these drugs in Schedule G of the ICT Drug Sale Rules 2013 and respective schedule of provincial drug sale rules. This categorisation would mandate their sale under strict supervision, ensuring prescriptions and record-keeping measures are in place.

Reports from field surveillance and drug inspectors reveal an alarming increase in the sale and misuse of Tramadol, Gabapentin, and Pregabalin. These drugs, often treated as over-the-counter (OTC) medications, are easily accessible to potential abusers, enabling widespread addiction.

Pregabalin, initially designed to treat epilepsy, neuropathic pain, and anxiety, is now being used recreationally for its sedative and euphoric effects. Its misuse has been linked to severe health consequences, including respiratory depression, overdose, and even death, especially when combined with other substances like opioids or alcohol.

The QCB secretary noted the need for immediate action to safeguard public health. “These drugs have immense abuse potential and are now being misused at alarming rates. Strict regulations and controlled access are necessary to curb this growing menace,” he stated in his letter.

Global trends also underscore the severity of the problem. In Saudi Arabia, the UAE and Jordan, misuse of Pregabalin has skyrocketed, with significant seizures of illegal stockpiles reported in recent years. For instance, in March 2023, UAE authorities intercepted 2.75 million Pregabalin pills being smuggled by an organised crime syndicate.

The QCB in its 53rd meeting held on May 30, 2023, reviewed alarming statistics and expert findings, including published studies highlighting the abuse potential of these drugs. A 2023 study in the Journal of the College of Physicians and Surgeons Pakistan (JCPSP) further confirmed the escalating misuse of Gabapentinoids in rural Pakistan.

The QCB emphasised that Tramadol is already listed under Schedule B of the ICT Drug Sale Rules, requiring a prescription. However, its misuse persists due to inadequate enforcement. Gabapentin and Pregabalin, on the other hand, remain unregulated, amplifying their potential for abuse.

The board has directed DRAP and provincial health departments to evaluate the status of these drugs in other countries and submit their recommendations. In many regions, including the UK and EU, these medications are classified as controlled substances, requiring strict oversight to prevent misuse.

The misuse of these medications is not just a health crisis but also a social issue. Pregabalin, often referred to as the “new Valium” due to its tranquilising effects, has found popularity among young adults, many of whom are unaware of its addictive potential.

In many countries of the world, the use of Pregabalin and Gabapentin have surged by 60 percent between 2008 and 2018, with the drugs implicated in hundreds of poisoning cases. A similar pattern is emerging in Pakistan, where their overuse is leading to dependency, withdrawal symptoms, and in severe cases, death.

Families and communities are bearing the brunt of this crisis, as addiction disrupts social structures and contributes to unemployment, crime and mental health issues. Experts warn that the problem is likely to escalate unless immediate action is taken to regulate these drugs and educate the public about their risks.

The QCB has recommended that Tramadol, Gabapentin, and Pregabalin be placed under Schedules B and G of the ICT Drug Sale Rules, ensuring their sale is restricted to pharmacies under a licensed pharmacist’s supervision. This step would align Pakistan’s regulations with international best practices and help mitigate the growing misuse.

In the meantime, authorities have called for stricter monitoring of pharmacies and online platforms selling these medications. Public awareness campaigns are also needed to highlight the dangers of misuse and encourage individuals to seek help if they are struggling with addiction.As the crisis unfolds, all eyes are on DRAP and provincial health authorities to take decisive action.