Abstract
The misuse of pregabalin and gabapentin, prescribed for the treatment of epilepsy and neuropathic pain, has become an emerging public health issue in Belgium. These gabapentinoids are reportedly increasingly (mis)used in combination with psychotropic or sedative substances, including benzodiazepines, which significantly increases the risk of respiratory depression, coma or fatal outcomes. However, despite increased awareness of this problem, comprehensive data on misuse patterns in Belgium is limited. This PhD project aims to bridge this knowledge gap by applying wastewater-based epidemiology (WBE) with liquid chromatography tandem mass spectrometry (LC-MS/MS) to monitor spatial and temporal consumption trends of pregabalin and gabapentin at population level. The WBE results will be triangulated with prescription data and sales data to identify discrepancies between prescribed, sold and consumed quantities, thereby revealing regional patterns of misuse. Complementary analysis of biological samples (e.g., urine, blood, saliva, hair,...) will focus on detecting and quantifying pregabalin and gabapentin at individual level. Co-consumption of benzodiazepines, opioids and alcohol will be investigated to understand polydrug use patterns. This integrated approach will provide actionable insights for policymakers, supporting prevention strategies and enhancing prescription monitoring programs that would reduce the misuse of gabapentinoids in Belgium.
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