Addressing Gabapentinoids' Access Challenges in Saudi Arabia Under New Prescription Regulations: An Expert View

Gabapentinoids, notably gabapentin and pregabalin, are crucial for managing neuropathic pain in conditions like diabetic neuropathy and specific types of cancer-related pain where opioids are ineffective or undesirable. However, the misuse potential of pregabalin has led to stricter regulatory controls in many regions, including Saudi Arabia. This expert opinion presents insights from multidisciplinary experts about the impact of these regulations on clinical practice, patient care, and misuse patterns in Saudi Arabia. Pregabalin's rapid onset of action and probable euphoric effects make it more prone to misuse, especially among younger individuals and those with a history of substance abuse. Gabapentin, in contrast, has a lower abuse potential. Experts discussed the implementation of the National Platform for Narcotic Drugs and Psychotropic Substances (Raqeeb) in Saudi Arabia, a system designed to monitor prescriptions of controlled substances. While effective in curbing over-prescription, it has also introduced unintended challenges. Physicians, fearing scrutiny, often hesitate to prescribe gabapentinoids, leading to delays in treatment and greater reliance on less appropriate alternatives. Moreover, stigma associated with controlled substances has further discouraged patients from seeking treatment, resulting in undertreated pain and a diminished quality of life. This expert opinion highlights the need for a more balanced approach to gabapentinoid regulation. It advocates for improved physician education on the management of neuropathic pain, and public awareness initiatives to curb misuse, reduce stigma, and promote the safe use of medications. Refining the Raqeeb platform could alleviate administrative burdens while ensuring robust oversight. Finally, adopting a risk-stratified approach to prescription would allow close monitoring of high-risk patients for substance abuse while ensuring that low-risk patients maintain access to essential treatments. Addressing these challenges would enable healthcare authorities to prevent abuse while ensuring effective pain relief for patients with legitimate medical needs.