Abstract
Pregabalin, a gabapentinoid used for neuropathic pain and epilepsy, is increasingly misused, particularly among individuals with opioid use disorder (OUD). Its synergistic effects with opioids enhance euphoric sensation. Pregabalin misuse in OUD patients is driven by this enhanced euphoria and self-medication to control opioid withdrawal symptoms, and pregabalin is used as an opioid substitution. This increases the risk of respiratory depression and leads to severe withdrawal symptoms. This case series presents three individuals with comorbid OUD and high-dose pregabalin dependence, detailing their withdrawal symptoms, co-occurring substance use, and treatment intervention. Stricter regulations, prescriber awareness, and harm reduction strategies are essential to prevent such misuse.