BBCMisuse of prescription drugs widely used to treat anxiety, nerve pain and epilepsy has been linked to a surge in deaths, forcing the government to reassess how they are managed.
Illegally obtained pregabalin tablets – which typically cost just £1 a pop – have overtaken Spice as the “drug of choice” among Manchester’s homeless, the BBC reports.
We listened to just a fraction of those affected that day.
Ricky led us through the graffiti-ridden backstreets of Manchester to the spot where his mate Diego died.
When Ricky showed me the hallway where Diego spent his final moments, two days before Christmas 2022, the pain etched on his face is still incredibly raw.
An autopsy revealed that Ladislav Kavour (33-year-old Diego’s real name) had taken a fatal overdose of drugs.
Ricky, who has spent the past 10 years on the streets, has the names of his dead friends tattooed on his chest.
There is no doubt that Diego was taking pregabalin, a drug that was prescribed more than nine million times across England last year.
“Pregab is killing people,” he told me, his voice trembling.
“They’re taking it with heroin, but it’s too strong. I know a lot of people who have died. They go to sleep and don’t wake up.”
Pregabalin is a Class C drug, which means it is illegal to possess or supply to another person without a valid prescription.
It is considered a safe and effective drug when used as directed, NHS website It may 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 overdose, but it also tends to be combined with other drugs such as heroin and alcohol,” he said.
The Office for National Statistics has confirmed that over 90% of people who die from pregabalin poisoning also had other substances in their bodies.
And the situation across England and Wales appears to be getting worse.
In the five-year period ending in 2023, the use of pregabalin was listed on death certificates in 1,625 cases, nearly four times the number recorded in the previous five years.
maleA little further away we met another friend of Diego’s.
Lindsay is slim, with glassy eyes and scar-streaked arms. She reaches into her pocket and pulls out a blister pack of pills.
“Is this what you’re talking about? Pregab? That’s crazy.”
“That’s what happened with Diego. He loved to be cuddled, so one night he fell asleep in my arms. In the morning I looked down and he was pale.”
Lindsay says she still hasn’t forgotten the horror of that night and that she now has an addiction to pregabalin.
Another of Lindsay and Ricky’s friends who passed away was Sarah McDonough.
“She was at the bus stop taking a huge amount of Pregab on top of the methadone to try to ease the withdrawal symptoms and then choked on her own vomit,” Ricky recalled.
The official cause of death of the 31-year-old woman on April 1 was recorded as methadone intoxication, but the coroner acknowledged at the inquest that other drugs may have been present.
Just months earlier, Lee Greensmith, 48, died two days after Christmas after taking pregabalin in a Wigan hotel being used as a homeless shelter.
Michael Linnell, who runs Greater Manchester’s Drug Information System and advises on new and emerging trends nationally, said: “Pregabalin is an extremely dangerous drug and when used in combination with heroin in particular it enhances the effects, reduces tolerance and increases the likelihood of overdose.”
The Home Office investigation will consider whether measures designed to tackle misuse are sufficient.
Back in Manchester, Ricky told me that pregabalin tablets were “£1 a tablet” and offered, “If you want some, can I go and buy some now?”
He said most of the people he knows get their drugs from “street dealers” who source them online.
We found numerous dealers, including on the encrypted Telegram messaging app and on the dark web.
One UK seller promises first-class postal service and details their efforts to “avoid detection.”
In recent years, much has been written about another drug that has hit homeless communities hard: the synthetic cannabinoid “Spice.”
“This is better than pregab. It’s pregab that’s killing people,” says Ricky.
Between 2018 and 2023, new psychoactive substances such as Spice were involved in 887 fatal poisonings in England and Wales.
During the same period, in 1625, pregabalin was named.
Help Available
At a bus stop near the trendy Northern Quarter we found a collapsed mother and son, both homeless and both in desperate need of help.
Dino said his mother, Maz, who lay motionless under her sleeping bag, had grown up in an abusive home that had left her homeless and turned to drugs.
He says he’s with her because she’s “not feeling well at all.”
“She takes methadone,” Dino explains, “but if she can’t get methadone, she takes pregabalin tablets just to stop the withdrawal symptoms.”
“It keeps her from getting sick, but she’ll get a rattle. But then she’ll get worse.”
“She had a few drinks this morning. She just drank on the street. She can drink anywhere.”
Manchester City Council said it would monitor the use of pregabalin among homeless people, pointing to the “extensive support” available.
But a spokesman said, “There are limits to what we can do.”
“We can offer advice to minimise risks, but we cannot force vulnerable people with complex needs to accept help or stop taking harmful substances.”
Local authorities say they will continue to help police crack down on drug dealers who prey on the most vulnerable in society.
Finally, I found Adele leaning against a shop window on Market Street, wrapped in a blanket.
She says Manchester’s homeless community is being devastated by the effects of pregabalin abuse.
Echoing Ricky’s words, she added: “I know a lot of people who have died. People have grown up with each other on the streets so it’s very sad to see that.”
“People with addictions need more support.
“But no one really seems to care, and that’s the problem.
“Especially those on the streets.”
