Prescription drug's misuse 'ravaging' city's homeless

The misuse of a prescription drug widely used to treat anxiety, nerve pain and epilepsy has been linked with a sharp increase in deaths and prompted a government review into how it is controlled.

Illicitly obtained pregabalin pills - typically costing just £1 each - have overtaken Spice as the "drug of choice" within Manchester's homeless population, the BBC has been told.

We spent the day listening to just some of those affected.

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

The pain etched on Ricky's face when he shows me the doorway in which Diego spent his final moments two days before Christmas in 2022 is still incredibly raw.

An inquest found Ladislav Kavur, to use 33-year-old Diego's real name, had taken a lethal cocktail of drugs.

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

He is in no doubt Diego had taken 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’re taking it with heroin but it’s too powerful - I know loads of people who’ve died. Gone to sleep and not woken up."

Pregabalin is a Class C drug, meaning it is illegal to either possess it without a valid prescription or supply it to others.

While it is regarded as a safe and effective drug when used as directed, according to the NHS website it can be addictive for some users.

Professor Ian Hamilton, an expert on addiction 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."

The Office for National Statistics confirms more than 90% of people who die from pregabalin poisoning have other substances in their system.

And the picture across England and Wales seems to be worsening.

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

Not far away, I meet another of Diego's friends.

Stick thin, with hollow eyes and arms striped with scars, Lindsay reaches into her pocket and takes out a blister pack of pills.

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

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

While still haunted by the horrors of that night, Lindsay says she is herself hooked on pregabalin.

Another of Lindsay and Ricky's friends to die was Sarah McDonagh.

"She was at the bus stop, took a load of pregabs on top of methadone to help with her withdrawals and choked on her own vomit," Ricky recalls.

While the 31-year-old's official cause of death on 1 April was recorded as methadone toxicity, the coroner at her inquest acknowledged the possibility of other drugs being 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 Greater Manchester’s Drug Information System and advises nationally on new and emerging trends, says "pregabalin is a very dangerous drug, particularly when it’s used with heroin because it enhances the effect and reduces tolerance, making overdose more likely”.

The Home Office's review will examine whether measures designed to tackle its misuse are sufficient.

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

He says most of the people he knows get theirs from "street dealers" who have sourced them online.

We found scores of dealers, including on the encrypted Telegram messaging app and the dark web.

One UK seller promises a first-class postal service, describing in great detail 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’s killing people.”

From 2018 to 2023, New Psychoactive Substances such as Spice were involved in 887 fatal poisonings in England and Wales.

During that same period pregabalin was named in 1,625.

Slumped in a bus stop near the trendy Northern Quarter, we find a mother and son. Both are homeless, both are desperate for help.

Deano says his mum Maz, lying motionless under a sleeping bag, ended up on the streets and turning to drugs after a violent home life.

He says he is with her because she’s "not well at all".

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

“It stops her from being ill - as in rattling - but then it makes her worse off.

“She’s had a few this morning. Just street ones. You get them anywhere."

Manchester City Council says it will monitor pregabalin use among homeless people and points to "extensive help" that is available.

"There are limitations 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 provide advice on minimizing risk."

The local authority says it will continue to help police target drug dealers preying on some of society's most vulnerable members.

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

Manchester's homeless community has been ravaged by the effects of pregabalin misuse, she says.

Echoing Ricky's words, she adds: "I know loads who’ve died. People have grown up with each other on the street and it’s so sad to see.

“There just needs to be a lot more help for people with addiction.

"But no-one really seems to care and that's the problem.

"Especially those on the streets."