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Pregabalin abuse is under-recognized in Türkiye, with 15-18% of urine samples testing positive annually. Expanding drug screening panels to include pregabalin is crucial to address this diagnostic gap and improve substance use disorder treatment.

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Area of Science:

  • Clinical Biochemistry
  • Forensic Toxicology
  • Pharmacology

Background:

  • Pregabalin, used for neurological and psychiatric conditions, shows increasing abuse potential.
  • Standard urine drug screening in Türkiye excludes pregabalin, despite its psychoactive effects and misuse.
  • This gap leads to under-recognition of pregabalin abuse.

Purpose of the Study:

  • To assess the prevalence of pregabalin abuse using biochemistry laboratory data.
  • To highlight the necessity of including pregabalin in routine toxicological screening.
  • To introduce the concept of 'incomplete negativity' in toxicology reporting.

Main Methods:

  • Retrospective analysis of urine drug screening results from 2019-2024.
  • Validated liquid chromatography-tandem mass spectrometry method for over 140 substances, including pregabalin and gabapentin.
  • Statistical comparison of pregabalin concentrations between single-use and polydrug groups.

Main Results:

  • Pregabalin detected in 15-18% of urine samples annually, sometimes surpassing methamphetamine detection.
  • Positive cases frequently linked to probation services and addiction treatment centers.
  • Higher pregabalin concentrations observed with co-detected substances (cannabis, methamphetamines), but a significant subgroup used pregabalin solely, leading to false negatives.

Conclusions:

  • Pregabalin abuse is under-recognized due to screening limitations.
  • Including pregabalin in routine drug panels is feasible and urgently needed.
  • The concept of 'incomplete negativity' emphasizes the need to revise national toxicology practices and expand screening panels.