Pregabalin: Prescription pill ‘destroys’ homeless community

Abuse of a prescription drug widely used to treat anxiety, nerve pain and epilepsy has been linked to a sharp rise in deaths, prompting a government review of how it is administered.

Illegally obtained pregabalin pills – which usually cost just £1 each – have overtaken Spice as the “drug of choice” among Manchester’s homeless, the BBC has been told.

We spent the day listening to some of those affected.

Ricky leads us through the heavily graffitied back streets of Manchester to the spot where his partner Diego died.

The pain etched on Ricky’s face as he shows me the door where Diego spent his last moments two days before Christmas in 2022 is still incredibly raw.

An investigation revealed that Ladislav Kavur, to use the real name of 33-year-old Diego, had consumed a fatal cocktail of drugs.

Ricky, who says he’s spent the last 10 years on the streets, has the names of friends he’s lost etched into his chest.

He has no doubt that Diego took pregabalin, a drug that was prescribed more than nine million times across England last year.

“Pregabs are killing people,” he tells me, his voice cracking.

“They take it with heroin but it’s too strong – I know a lot of people who have died. Went to sleep and didn’t wake up.”

Pregabalin is a Class C drug, which means it is illegal to either possess it without a valid prescription or give it to someone else.

Although it is considered a safe and effective drug when used as prescribed, according to NHS website it can be addictive for some users.

Professor Ian Hamilton, an addiction expert at the University of York, has another warning about pregabalin.

“Not only can it be fatal in terms of overdose,” he says, “but also people tend to use it with other drugs, including heroin and alcohol.”

Statistics Norway confirms that more than 90% of people who die from pregabalin poisoning have other substances in their system.

And the picture for England and Wales seems to be getting worse.

In the five years to 2023, pregabalin was cited on 1,625 death certificates – almost four times the number recorded in the previous five years.

Not far away I met another friend of Diego’s.

Thin, with hollow eyes and scarred arms, Lindsay reaches into her pocket and takes out a blister pack of pills.

“This is what you’re talking about?” Pregabs? They are bad, man.

“Diego had them. He fell asleep in my arms one night because he liked cuddling. In the morning I looked down and he was blue.”

Although still haunted by the horror of that night, Lindsay herself says she is addicted to pregabalin.

Another friend of Lindsay and Ricky who was supposed to die was Sarah McDonagh.

“She was at the bus stop, taking loads of pregab on top of methadone to help with withdrawal and choking on her own vomit,” Ricky recalls.

While the official cause of death on April 1 was listed as methadone poisoning, the coroner admitted at her inquest that other drugs were present.

Months earlier, 48-year-old Lee Greensmith died two days after Christmas after taking pregabalin in a Wigan hotel used as a homeless shelter.

Michael Linnell, who runs the Medicines Information System in Greater Manchester and advises nationally on new and emerging policies, says “pregabalin is a very dangerous drug, especially when used with heroin because it increases the effect and reduces tolerance, making overdose possible more likely”.

The review by the Ministry of the Interior will examine whether the measures intended to deal with its abuse are sufficient.

Back on the streets of Manchester, Ricky tells me that pregabalin pills are “one kilo a go” and offers to “go and get some now if you want?”

He says most people he knows get theirs from “street vendors” who have gotten them online.

We found a number of vendors, including on the encrypted Telegram messaging app and the dark web.

One UK seller promises first-class postal service and details the efforts he makes “to avoid detection”.

Much has been written in recent years about another drug that has hit homeless communities hard – the synthetic cannabinoid Spice.

Ricky says he would “rather take this than pregabs – it’s the pregabs that are killing people.”

From 2018 to 2023, new psychoactive substances such as Spice were involved in 887 fatal poisonings in England and Wales.

In the same period, pregabalin was mentioned in 1,625.

We crash at a bus stop near the trendy Northern Quarter and find a mother and son. Both are homeless, both are desperate for help.

Deano says his mom Maz, lying motionless under a sleeping bag, ended up on the street and turned to drugs after an abusive home life.

He says he’s with her because she’s “not well at all.”

“She’s on methadone,” Deano explains. “But if she can’t get methadone, she takes pregabalin pills just to stop withdrawals.”

“It keeps her from being sick – like rattling – but then it makes her worse.”

“She’s had a few this morning.” Just street photos. You can get them anywhere.”

Manchester City Council says it will monitor the use of pregabalin among homeless people and points to “huge help” available.

“There are limits to what we can do,” a spokesperson tells me, however.

“We cannot force vulnerable people with complex needs to accept help or stop taking harmful substances, although we can offer advice on how to minimize risk.”

The local government says it will continue to help police target drug dealers who prey on some of the most vulnerable members of society.

Finally I met Adele, wrapped in a blanket and leaning against a shop window on Market Street.

Manchester’s homeless community has been devastated by the effects of pregabalin abuse, she says.

Echoing Ricky’s words, she adds: “I know a lot of people who have died. People have grown up with each other on the street and it’s so sad to see.

“There just needs to be much more help for people with addictions.”

“But nobody seems to care and that’s the problem.

“Especially the ones on the street.”