BACKGROUND: Gabapentinoids are commonly used for neuropathic pain but are increasingly linked with misuse/mortality. In 2019, the UK reclassified them as Schedule 3 controlled drugs. The onset of the COVID-19 pandemic created additional uncertainty regarding their utilization. We aimed to examine the impact of reclassification and COVID-19 on gabapentinoid utilization and related mortality in Scotland and Northern Ireland (NI).

RESEARCH DESIGN/METHODS: A population-based, cross-national study was conducted using prescribing datasets (April/2018-February/2025). Utilization was measured as total items dispensed per 1,000 inhabitants and defined daily doses per 1,000 inhabitants/day. Gabapentinoid-related mortality data were analyzed in parallel. Segmented regression assessed changes in trends following the 2019 reclassification and two COVID-19 lockdowns.

RESULTS: Overall utilization was higher in Scotland than NI. In Scotland, pregabalin prescribing significantly increased over the study period, while NI demonstrated a decline, largely attributable to formulary restrictions. Neither reclassification nor pandemic lockdowns were associated with statistically significant changes in prescribing patterns. Mortality rates showed no significant correlation with utilization in either country.

CONCLUSIONS: Gabapentinoid utilization does not appear to have been significantly affected by the reclassification or by COVID-19. Cross-national differences underscore the influence of formulary guidance, highlighting the need for harmonized policies/patient-level research to inform safe prescribing.