Recreational Use of Pregabalin in Ukraine. Availability, Patterns of Use and Chemsex

Introduction: Substance use disorders pose significant public health challenges and are associated with a wide range of social and medical consequences. Pregabalin, a gabapentinoid, was approved by the U.S. Food and Drug Administration in 2004 for the treatment of specific medical conditions. Despite its initially limited indications, the drug achieved substantial commercial success, ranking among the top ten global pharmaceutical sales by 2017. Reports of addictive potential of pregabalin began to surface shortly after its market release in 2005. The first documented cases of misuse appeared in Europe in 2008, and by 2010, the clinical community had begun to recognize pregabalin use disorder. Since then, the prevalence of pregabalin misuse has increased across all age groups globally. Its recreational use contributes to the overall burden of both communicable and non-communicable diseases, intensifying existing public health threats. This study examines the phenomenon of recreational pregabalin use in Ukraine. The research focuses on its impact on the physical and mental health of users, as well as on their socio-economic well-being. The primary aim is to explore existing patterns of recreational use to inform harm reduction strategies and public health interventions. Methods: The inclusion criterion for the study was recreational use of pregabalin at the time of the study or a history of such use. The sample was formed by the snowball sampling method, data collection was conducted through semi-structured interviews, and analysis was performed using the phenomenological method. The Drugs Wheel model was used to classify psychoactive substances. Results: Substance users are not aware of the risks of recreational use of pregabalin. Pregabalin is available for recreational use in Ukraine through over-the-counter pharmacies. Patterns of recreational use of pregabalin in Ukraine are dangerous in terms of mental and physical health disorders and negative socioeconomic consequences. Pregabalin is used as a tool for chemsex, and users neglect harm reduction measures for risky sexual behavior during such contacts. The difficulty of quitting recreational pregabalin use has been documented, and adherence to the existing mental health care system is low. Discussion: Low awareness of the risks of recreational use of pregabalin among substance users creates a need for educational activities among target groups. Given the commitment of doctors to prescribing pregabalin and the lack of warnings about the negative consequences, it is imperative to educate healthcare professionals about the risks of such prescriptions. Since pregabalin is used as a tool for chemsex, and users neglect harm reduction measures for such contacts, it is advisable to provide them with access to harm reduction measures for risky sexual behavior. Given the difficulty of quitting recreational pregabalin use and the low adherence of substance users to the existing mental health care system, it is recommended to improve this system and introduce harm reduction programs. Keywords: anticonvulsants, pregabalin, chemsex, substance-related disorders, prescription drug abuse, public health, qualitative research, interviews as topic, Ukraine