Anxiety drug pregabalin killed my son – and hundreds more are dying from it

The drug that helped Alex Cottam turn his life around was also the one that ended up killing him.

Cottam, a 27-year-old software engineer, had been prescribed pregabalin to help him with the anxiety and depression that he had been battling with ever since his father James died 14 years earlier.

At first pregabalin helped him feel normal and thrive at work. But Cottam soon became reliant on its powerful effects, which led to dependency and the use of other prescription drugs. He died of an unintentional overdose two years after first taking pregabalin.

“It’s hard to imagine somebody’s whole life revolved around a pill, but it did,” said his mother, Michelle. “It completely changed him, it was like an obsession.”

Childhood photos of Alex, pictured with his father James in the image on the left

PHOTOS PROVIDED BY FAMILY, DESIGN BY CECILIA TOMBESI

An investigation by The Sunday Times has revealed that pregabalin has the fastest-rising death toll of any drug in the UK, based on figures compiled from official data across all regions. It is detected in a third of all drug-related deaths.

In 2012, pregabalin was indicated in nine fatalities. A decade later, in 2022, the number had risen to 779, with almost 3,400 deaths in the past five years.

Pregabalin is an anticonvulsant designed as a medication for epilepsy. In recent years, however, it has been prescribed for a wider range of uses, including for anxiety and nerve pain. In England in 2022, there were 8.6 million prescriptions for pregabalin, and many find that the drug improves their lives.

But some doctors believe the risks of the drug are not being properly considered, which is leading to dependency. They want to see more careful prescribing, research on how to taper patients off the drug safely, and specialised support for prescription-drug dependence.

Concerns about the use of addictive prescription drugs have come to the fore since the opioid crisis in the US. Between 1999 and 2021, almost 645,000 Americans died from an overdose involving an opioid.

In England, about one in four patients are prescribed dependency-forming drugs, defined by Public Health England as those associated with withdrawal symptoms. Yet while prescriptions for the majority of these drugs, such as benzodiazepines and opioids, are decreasing, those for pregabalin and antidepressants are on the rise.

When pregabalin first went on the market in 2004, sold by Pfizer, it was heralded as a wonder drug, a non-addictive alternative to opioids.

But slowly, reports of dependency and deaths began to emerge.

Following warnings from the Advisory Council on the Misuse of Drugs, pregabalin was made a class C drug in 2019, making its sale and possession without a prescription illegal.

A review by Public Health England the same year — the first into prescribed-drug dependence — concluded that more people were being prescribed pregabalin for longer. It called for a national helpline, regular reviews of prescriptions and alternatives to medicines.

Then, in 2021, the National Institute for Health and Care Excellence called for doctors to improve the safety measures they took when prescribing painkillers and dependency-forming drugs such as pregabalin.

Despite the warnings, prescriptions continue to rise. Today, pregabalin is no longer a first-line treatment for epilepsy but is mostly prescribed for nerve pain and anxiety.

Prescriptions are higher in more deprived areas, where chronic pain and anxiety is also more prevalent, according to NHS data. Doctors say because non-chemical interventions such as therapy are oversubscribed, pregabalin is often prescribed to patients with high levels of anxiety and distress.

‘He couldn’t live without it’

Alex Cottam had been an outgoing child with lots of friends. He enjoyed school and was a model pupil with perfect attendance.

But when he was 13, his father, James, died, and he began to struggle. He suffered depression and anxiety, but he threw himself into his studies and became head boy at Salford City Academy.

“I was really proud of him,” said Michelle. “He had a lot of self determination: if he wanted to do something, he would do it.”

Michelle Cottam believes her son, Alex, should never have been prescribed pregabalin, given his history of addiction

JAMES SPEAKMAN FOR THE SUNDAY TIMES

He went to college, but the change in environment worsened his social anxiety — he became withdrawn and started drinking. Determined to get his life back on track, he asked his GP for help and weaned himself off alcohol. He was still suffering anxiety, though, and at the age of 25 was prescribed pregabalin.

Initially, it helped boost his confidence. Life started looking up, and he got a job as a software engineer. Cottam described feeling “normal” again, but he was developing a tolerance to pregabalin and was increasing his dose to maintain this sense of normality. Michelle said: “Alex quickly became dependent on it. He couldn’t live without it.”

After a year, his GP told him during a monthly review that it was time to stop. But Cottam was petrified of living without the drug, and so he checked whether it was available online.

He found an internet pharmacy that posted him packets of pregabalin without a prescription. His addiction grew and he began ordering other prescription drugs, such as the painkiller tramadol.

Cottam’s addiction spiralled and over the space of two years he was admitted to hospital 12 times. He was found dead in his flat in Salford in 2021. The coroner ruled it was due to “an unintentional overdose” of pregabalin and three other prescription drugs.

“He had overcome every obstacle that had got in his way, but the pregabalin took such a strong grip on him that he just couldn’t see a way out,” said Michelle. “It’s such a waste. How many other lives will be affected if they carry on not advising patients that they might become addicted?”

At the inquest into his death, his mother cited an NHS document written for doctors, advising that careful consideration should be taken when prescribing pregabalin to patients with a history of addiction. She believes he should never have been prescribed the drug.

A framed picture of Alex in his mother Michelle’s living room

JAMES SPEAKMAN FOR THE SUNDAY TIMES

‘We’re supposed to do no harm’

Concerns about the use of pregabalin first came to the fore in Northern Ireland. The Troubles had left a generation struggling with mental health, and the “wonder drug” pregabalin was among those offered as a solution.

Now doctors in the rest of the UK fear rising numbers of patients are battling prescription-drug dependency, but official data is lacking. Unlike illegal drugs, addiction specialists say those suffering rarely seek out support, often because they do not realise they have a problem.

Dr Caroline Watson, a prison GP and the chairwoman of the Royal College of General Practitioners’ secure environments group, said dependence on medication needed to be better recognised by doctors.

She added: “We’re supposed to do no harm. So if you are prescribing something without good clinical indication, without good monitoring and follow-up, you’re not doing the job you need to be doing.”

Coroners have also been raising concerns.

In January, an assistant coroner in Bedfordshire, Séan Cummings, issued a “prevention of future death” report after 59-year-old Joy Ebanks died from an overdose of pregabalin and another prescription painkiller, oxycodone. Cummings quoted research that questioned the effectiveness of pregabalin and highlighted that dependence on it “was increasingly recognised as a problem”. It followed a similar warning by a coroner in north London in October.

‘I knew I had to stop taking it’

While patients are increasingly aware of the risks of addiction to painkillers, pregabalin is little-known amongst the general public.

When Debbi Lou, 45, a nurse from Mexborough, South Yorkshire, damaged her lower spine in a car accident, she was initially given morphine patches. Aware of the risks of opioids, she told her GP she was reluctant to keep using them.

Instead, she was prescribed pregabalin. She said: “It absolutely knocked my socks off. But after a month, the euphoric feeling settled down, and I could feel my anxiety coming back tenfold. That’s when I started using them as they weren’t prescribed.”

To maintain the effects of the drug and keep her symptoms at bay, Lou began to increase her dosage, leaving her in the lurch before her next prescription. Her side effects — dizziness, fatigue and memory problems — became severe. One day she forgot to pick up her six-year-old daughter from school.

“I knew I had to stop taking them,” said Lou. “If my memory was getting me to a point where I forget about my own kid, there was a problem.”

Lou says she was not made aware of the potential for dependence and withdrawal when she was first prescribed pregabalin.

“You’ll be shaking, you can’t sleep, can’t eat, there’s vomiting, diarrhoea, anxiety. You really feel like you’re dying,” she said. “Once it’s in your body and you’ve built up a dependency, you feel uncomfortable if you’ve not got it. It’s not a choice any more.”

After months of struggling with withdrawal, Lou has been pregabalin-free for a year and is working as a nurse on a drug and alcohol support team. “It’s just like oxycodone and opiates, people have underestimated the damage that can be caused,” she said. “I trusted my doctor. That trust has been broken.”

‘Doctors are selling cars without brakes’

Because pregabalin creates euphoria, it has become popular with recreational drug users, earning the nickname “Budweisers” or “Buds” because of its alcohol-like effect on the body. Its street price, about £2 for a 300mg pill, makes it a much cheaper alternative to alcohol and other traditional drugs.

Last week, the Peaky Blinders actor Paul Anderson, 48, was fined after pleading guilty to possession of drugs, including pregabalin.

And with the rise in its use, both legal and illegal, have come social problems.

Court records show dozens of people being arrested for possession of pregabalin and charged with stealing the drug from pharmacies. In one case, a 37-year-old from Kingston upon Hull pleaded guilty to theft of 15 boxes of pregabalin from a medical centre. He was sentenced to 16 weeks in jail.

Doctors interviewed by The Sunday Times described how they were met with aggression when they tried to take a patient off pregabalin; one said they had been threatened with legal action, another had a computer monitor thrown at them, and one was physically restrained by a patient and told they would not be let go until they prescribed the drug again.

And in prisons, doctors have been raising the alarm about dependency since the drug was first approved.

Dr Iain Brew, who has spent decades working in prisons and community drug treatment services in northern England, first raised concerns with Public Health England about pregabalin in 2010.

“When barbiturates drugs first came out, doctors thought ‘great, a way of helping people cope with life’. They got over prescribed and a lot of people died. Then benzodiazepines came out, and everyone got prescribed them, and it became apparent there was addiction, then sleeping pills, and everyone got addicted again. It’s happening again with pregabalin,” said Brew, who believes this pattern will continue to repeat without considered action.

While he believes there is a place for these drugs, for example during end-of-life care, he wants closer scrutiny over the way they are prescribed and greater support provided to patients to come off the drugs when possible.

He said: “We don’t want these drugs to be banned, we just don’t want them being abused and killing patients.”

An all-party parliamentary group on prescription-drug dependence has called for stronger regulation of pharmaceutical companies to ensure risks are better researched before a drug’s approval.

It also wants patients to be told about dependency risks when prescribed the drug, and greater support for those battling dependence.

“How can there be rising deaths from pregabalin and a huge explosion of prescriptions, with all these troubles, and yet doctors are using this drug to treat anxiety?” said Dr Mark Horowitz, a clinical research fellow at the NHS, who researches how to safely take patients off their medication.

“Doctors are selling cars without brakes,” he added. “It boggles the mind when a drug is showing all these dangers to then use it in a wider variety of people.

“To have trouble with pregabalin, you don’t need to do anything naughty with it, you just have to take it as prescribed by your doctor. The opioid crisis in America was not caused by people being naughty, it was caused by people following their doctor’s orders.”

A spokesman for the Department of Health and Social Care said in a statement that the best course of treatment was a decision for GPs, and referred to an independent review commissioned by the government to reduce overprescribing and explore alternatives to medication. They added that the MHRA was cracking down on the illegal sale of prescription drugs.

The NHS provides the following information about stopping taking pregabalin: when you stop taking pregabalin, you’ll need to reduce your dose gradually to avoid withdrawal symptoms. Do not stop taking pregabalin without talking to your doctor.

If you are concerned about dependence on prescription or other drugs, talk to your GP. If you’re having trouble finding the right sort of help, call the Frank drugs helpline on 0300 123 6600. They can talk you through all your options.