Is Pregabalin a Narcotic? What You Need To Know

Many people ask whether pregabalin qualifies as a narcotic drug due to concerns about dependency and abuse potential, and if the substance falls under controlled substance regulations. Prescribers frequently recommend pregabalin for conditions like diabetic neuropathy, fibromyalgia, and generalized anxiety disorder, but its mechanism of action differs quite a bit from traditional narcotics.

What is Pregabalin?

Pregabalin is a prescription medication that belongs to a class of drugs called anticonvulsants or anti-seizure medications.[1] The Food and Drug Administration (FDA) first approved pregabalin in 2004 under the brand name Lyrica. This medication works by binding to calcium channels in the nervous system, which reduces the release of certain neurotransmitters that carry pain signals and cause seizures.

Prescribers commonly recommend pregabalin for several medical conditions. The medication effectively treats nerve pain caused by diabetes, shingles, or spinal cord injuries. Pregabalin also helps control partial seizures in adults with epilepsy and reduces symptoms of fibromyalgia and generalized anxiety disorder.

The medication comes in capsule and oral solution forms, with typical doses ranging from 75 mg to 600 mg per day.[2]Prescribers usually start patients on lower doses and gradually increase the amount based on response and tolerance. Pregabalin requires a prescription and carries specific warnings about potential side effects and withdrawal symptoms.

Common Conditions Treated By Pregabalin

Prescribers recommend pregabalin for various neurological and pain-related conditions that can impact quality of life:[3]

• Diabetic peripheral neuropathy: Nerve pain in the hands and feet caused by diabetes complications.
• Postherpetic neuralgia: Persistent nerve pain following a shingles outbreak.
• Fibromyalgia: Chronic widespread muscle pain and tenderness throughout the body.
• Partial onset seizures: Seizures that begin in one area of the brain, used as additional therapy in adults.
• Generalized anxiety disorder: Excessive worry and anxiety that interferes with daily activities.
• Spinal cord injury pain: Nerve pain resulting from damage to the spinal cord.

How Does Pregabalin Work?

Pregabalin works by binding to specific calcium channels in the central nervous system, which reduces the release of neurotransmitters that carry pain signals and cause seizures.[4] This anticonvulsant medication affects voltage-gated calcium channels containing the alpha-2-delta subunit. This mechanism helps explain why pregabalin effectively treats neuropathic pain conditions like diabetic neuropathy, postherpetic neuralgia from shingles, and fibromyalgia. The Food and Drug Administration (FDA) approved pregabalin as both an antiepileptic drug for partial seizures and as a treatment for chronic pain conditions.

The medication’s effects on calcium channels in the CNS create its therapeutic benefits but also contribute to common side effects like drowsiness, weight gain, and dry mouth.[5] Physical dependence can develop because pregabalin alters normal neurotransmitter function, which explains why withdrawal symptoms occur when people stop taking the drug abruptly.

Is Pregabalin a Controlled Substance?

Pregabalin is classified as a Schedule V controlled substance under the Controlled Substances Act.[6] The Drug Enforcement Administration placed pregabalin in this category in 2005 due to reports of abuse and dependence potential. Schedule V represents the lowest level of control for substances that have accepted medical uses but still carry some risk of abuse.

This classification means pregabalin prescriptions have specific legal requirements. Pharmacies must track pregabalin dispensing through prescription monitoring programs in most states. Prescribers can submit pregabalin prescriptions electronically or in writing; depending on state laws and pharmacy policies, phone-in prescriptions for Schedule V substances may be permitted. Schedule V prescriptions like pregabalin can be refilled as authorized by the prescriber, and federal law does not impose a six-month expiration limit; however, some states or insurers may impose such limits.

The controlled substance status reflects pregabalin’s potential for misuse, particularly at higher doses. Some people abuse pregabalin for its sedating effects or combine it with other substances to enhance euphoric feelings. However, pregabalin’s Schedule V classification indicates a much lower abuse potential compared to opioids, benzodiazepines, and other higher-scheduled medications.

Pregabalin vs. Opioids: Key Differences

Pregabalin and opioids treat pain through entirely different mechanisms in the central nervous system. Pregabalin binds to calcium channels and reduces neurotransmitter release, making it particularly effective for neuropathic pain conditions like diabetic neuropathy and postherpetic neuralgia. Opioids work by binding to opioid receptors in the brain and spinal cord, blocking pain signals and producing euphoric effects. This explains why pregabalin excels at treating nerve pain while opioids work better for acute injury-related pain.

The abuse potential and legal classifications of these medications reflect their different risk profiles. Opioids like codeine, morphine, and oxycodone carry much higher abuse potential and are classified as Schedule II controlled substances with strict prescribing requirements. Pregabalin holds a Schedule V classification, indicating lower abuse potential but still requiring prescription monitoring. Physical dependence can develop with both medication types, but opioid withdrawal symptoms tend to be more severe and dangerous than pregabalin withdrawal symptoms.

Side effect profiles also distinguish these two medication classes significantly. Common side effects of pregabalin include dizziness, drowsiness, weight gain, dry mouth, blurred vision, and peripheral edema. Rare but serious side effects may include respiratory depression, especially when combined with CNS depressants. At the same time, opioids commonly cause constipation, respiratory depression, and sedation.[7] Pregabalin carries FDA warnings about suicidal thoughts and severe allergic reactions, whereas opioids present greater risks of overdose and respiratory failure. Both medication types require careful medical supervision, but opioids demand more intensive monitoring due to their higher potential for fatal complications.

Pregabalin and Abuse

Pregabalin carries a risk of abuse and dependence, notably when people take doses higher than prescribed or use the medication recreationally. Some people misuse pregabalin for its sedating and euphoric effects, which become more pronounced at elevated doses. People with histories of substance abuse face increased risk for pregabalin misuse, and combining pregabalin with alcohol or opioids creates dangerous interactions that can lead to respiratory depression.

Signs of pregabalin abuse include taking larger doses than prescribed, obtaining multiple prescriptions from different prescribers, or experiencing cravings for the medication. Physical dependence can develop even with prescribed use, leading to withdrawal symptoms when stopping abruptly. These symptoms may include anxiety, insomnia, nausea, sweating, and in severe cases, seizures.

Treatment For Pregabalin Abuse

Treatment for pregabalin abuse typically involves medically supervised tapering to prevent dangerous withdrawal symptoms. Healthcare professionals may recommend addiction counseling, support groups, or residential treatment programs depending on the severity of the abuse. People who struggle with pregabalin dependence should never attempt to quit without medical supervision due to the risk of severe withdrawal complications.

Getting Help for Pregabalin Dependence

People who develop pregabalin dependence should seek professional medical help rather than attempting to quit on their own. Abruptly stopping pregabalin can trigger dangerous withdrawal symptoms, including seizures, severe anxiety, and insomnia, that require medical supervision. Treatment typically begins with a medically supervised tapering schedule that gradually reduces the dose over several weeks or months. Addiction professionals can provide medications to manage withdrawal symptoms and monitor for complications during the detox process.

Comprehensive treatment for pregabalin dependence often includes addiction counseling, support groups, and behavioral therapy to address the underlying causes of substance abuse. Many treatment programs offer both inpatient and outpatient options depending on the severity of the dependence and the person’s individual circumstances. Mental health support is essential as well, since pregabalin dependence often co-occurs with anxiety disorders, chronic pain conditions, or other substance abuse issues.

Recovery programs help people develop coping strategies for managing pain and anxiety without relying on pregabalin while building a strong foundation for long-term sobriety.