In September, Lin Ke found herself in a hospital emergency room after swallowing more than 20 pills of the prescription drug pregabalin — roughly 10 times the recommended daily dose.

The medicine is primarily used to treat epilepsy, neuropathic pain, and general anxiety disorders, but Lin had been self-medicating to suppress a raging sense of fear, and had wanted to “temporarily avoid reality.”

It was Lin’s second hospitalization of 2025 — in the summer, the 21-year-old collapsed in the street when her heart rate rocketed to 150 beats per minute, again as a result of misusing pregabalin. She has previously overdosed on other prescription medication too.

Since the Chinese government has clamped down on the use of dextromethorphan, a cough suppressant tied to overdoses in young people, pregabalin has for many become the go-to, readily available replacement. With reports of misuse increasing nationwide, many doctors believe that it’s only a matter of time before authorities place the drug under similarly tight control.

Grip of addiction

Lin, who’s in her second year of studying clinical medicine at a university in the northeastern Liaoning province, was diagnosed with a personality disorder comorbid with bipolar disorder when she was 19, marking her introduction to psychiatric medications. Over time, she grew accustomed to using drugs to manage her emotions.

In early 2025, after spending two months in hospital, she returned to university and felt she was facing an uphill battle — coursework was piling high and exams were looming. As the pressure mounted, she began seeking an escape.

Lin had read about pregabalin online: it was said to work fast, be hard to detect, and was “safer and more accessible” than dextromethorphan. After lying about the severity of her symptoms in an online evaluation to secure a prescription, Lin purchased two boxes of 32 pills from a licensed online pharmacy.

The drug had an immediate effect. After just a few pills, she remembers feeling lighter, relaxed, more sociable, and even euphoric.

Yet she quickly built up a tolerance, requiring her to constantly up the dosage. In just a few months, she went from six pills a day to more than 20. Soon, the side effects — including drowsiness, blurred vision, and memory loss — were becoming impossible to ignore.

After being admitted to hospital in September, Lin received supportive medical treatment to quit pregabalin. In recovery, she went more than 70 hours without sleep, developed olfactory disorders, and plunged into a severe, two-week depression.

Although now off the medication, she still regularly feels the urge to return to the habit. The only thing stopping her, she says, is the evidence linking long-term misuse of the drug to bladder and abdominal complications.

Wang Long, 25, was able to quit pregabalin before he became entirely dependent. He began self-medicating in March 2024 during an internship, as he’d been struggling with anxiety and communicating with his co-workers. The drug made him feel quicker, he says; conversations flowed, and “almost any song sounded amazing.”

As with Lin, it didn’t last. After more than a year of consistent use, the negatives started to outweigh the benefits. Wang would experience paranoid delusions, often breaking into cold sweats, and his memory declined. “I was like a frightened mouse,” he says, describing the drug’s comedown as “the thin line between heaven and hell.” He refused to fall into the trap of increasing the dosage.

Li Ruihua, a doctor specializing in addiction medicine in Jinan, capital of the eastern Shandong province, explains that pregabalin functions by reducing excitability in the nervous system, which can alleviate anxiety.

If used at the recommended dose, the psychoactive drug is not considered a highly addictive substance, she says. However, when abused, it can fundamentally affect the nervous system, leading to strong cravings and compulsive behaviors.

Controlled response

China’s first published case report of pregabalin misuse leading to addiction appeared in Frontiers in Psychiatry last March. It cited the hospitalization of a 20-year-old man in the central Hunan province who had attempted to detox in September 2024 after long-term, high-dose misuse. He experienced withdrawal symptoms including palpitations, fatigue, mild tremors, irritability, insomnia, and auditory hallucinations.

In April, a case report in the Chinese Journal of Drug Dependence stated that a teenager was taking up to 30 pills at a time, leading to drowsiness, weakness, and prolonged hallucinations.

A 30-year-old man who began self-medicating to improve his sleep quality was admitted to the Shanghai Mental Health Center in July, telling doctors that he had been taking 4,800 milligrams of pregabalin in a single dose — about 16 times the maximum recommended amount.

For many clinicians, these case reports have come as a surprise. Li concedes that doctors in other specialties might be unaware of the drug’s addictive potential, and therefore fail to warn patients of the dangers of dependency.

Ye Yujian, a specialist in substance dependence at the Shanghai Mental Health Center, says that an increase in case reports tends to directly influence clinical decisions. For example, patients might ask for a six-month supply of the medication, but now doctors will be more alert to risks and prescribe only enough for the treatment cycle, with regular follow-ups.

However, this change won’t come overnight. So, in the interim, should pregabalin be listed as a controlled substance?

Li argues that it’s not a yes-or-no question. Pregabalin is effective for neuropathic pain, and overly strict management could increase the burden on patients and result in some resorting to opioid-based painkillers, which are highly addictive.

With no nationwide epidemiological surveys and trend analysis of sales data, Ye also believes that the evidence supporting tighter control remains limited. He adds that the core purpose of drug management is to ensure medications serve clinical treatment and benefit patients, which is different from controlling illegal narcotics.

In addition, Ye says, even if pregabalin is controlled, as long as substances with similar pharmacological effects and not listed as narcotics or psychotropic drugs exist, they will be substituted. Strengthening control of one specific drug cannot cut off demand.

Peer pressure

For many of the people misusing pregabalin in China, their gateway drug was dextromethorphan, a common antitussive prescribed to relieve coughs and upper respiratory infections. It was initially considered nonaddictive and sold over the counter, but that has all changed in recent years.

Zhao Qing, 32, who was diagnosed with depression in her early teens and began regularly taking the sleeping medication Stilnox, began using dextromethorphan in 2020 on the recommendation of a friend. She went to a pharmacy, bought a box of 12 pills, and downed them all in one go.

She says it felt like entering another world. However, the brief dissociative effects came with severe loss of control, and at times she would be unable to move or respond to other people.

When her grandmother was hospitalized and required daily care, Zhao quit the drug. She eventually returned to the pharmacy to buy some more in 2022, but discovered that dextromethorphan had since been placed under strict control and was near-impossible to obtain.

The drug was made prescription-only in 2021 due to widespread misuse, especially among teenagers, with online sales banned the following year. In 2024, the government listed dextromethorphan as a psychotropic substance.

However, the demand for relief did not vanish — most simply switched to pregabalin, which was affordable, available, and had similar effects. Zhao first tried it in 2022 and was soon taking at least eight pills at a time. Within a year, she had gained more than 22 kilograms.

Ye says that drug abuse is concentrated among adolescents and young adults, often those with emotional disorders, social difficulties, or a prior history of addiction. Their main sources of information are not the medical system but social media, online forums, and private group chats.

He once treated a patient who revealed they ran a forum about prescription drugs and their various effects, sharing formulas and even offering comforting tips to newcomers. Ye believes the activities of such influencers and their followers significantly propel the spread of drug abuse.

Li also notes that in campus environments — where peer pressure and curiosity combine — some students will try drugs on the suggestion of others to ease their anxiety and enhance social performance.

When patterns shift, hospitals are often the first to see the warning signs. Ye recalls that after dextromethorphan was controlled, some adolescent patients stated frankly that their “pocket money wasn’t enough to cover it anymore.”

Simultaneously, he observed a rapid rise in pregabalin misuse. In the second half of 2025, the number of cases he treated jumped nearly fourfold compared with the first six months, a trend mirrored hospitalwide.

Ye highly expects pregabalin to follow a similar path as dextromethorphan and come under tighter control in the coming years.

Living with emotion

Although a prescription drug in China, there are currently almost no barriers to accessing pregabalin. On some online pharmacies, a box of pills costs just 20 yuan ($3). Few platforms require medical records or paper prescriptions; there’s only a brief online consultation before an electronic prescription is issued.

However, some local authorities are already alert to a potential crisis. Market supervision bureaus in cities including Turpan, in the northwestern Xinjiang Uyghur Autonomous Region, and Baotou, in the northern Inner Mongolia Autonomous Region, have launched inspections into pregabalin sales.

Ye suggests that drug regulatory authorities should enhance monitoring of purchasing behaviors, especially online, to catch abnormal patterns early and prevent excessive drug supplies.

Just taking away the pills won’t stop addiction, though.

Zhao argues that it’s also about the influences around a person. She was introduced to both dextromethorphan and pregabalin by a “toxic friend,” and has even come across online posts by middle school students who are self-medicating either because of trends or for emotional reasons.

“Addiction is just the tip of the iceberg,” Ye says, explaining that by the time an individual reaches the hospital, the misuse has often been going on for a considerable time. In such cases, a young person’s motivations are highly concentrated around issues such as anxiety, depression, social frustration, loneliness, and family conflict. The medical system can intervene only after these problems have surfaced.

As a result, many health professionals do not feel that government crackdowns alone can solve the problem.

Plus, if someone is concerned about being “treated like a lawbreaker,” they are less likely to seek medical assistance, pushing them further away and making it harder to guarantee early intervention.

Lin Ke recently received an administrative penalty from police after testing positive for compound guaifenesin hydrobromide tablets, which contain dextromethorphan. From a hospital room to an interrogation room, she feels she has experienced almost every possible consequence of misusing medication.

Now she’s attempting to live with her emotions, rather than rely on drugs to block them out.

(Due to privacy concerns, all names except Ye Yujian and Li Ruihua are pseudonyms.)

Reported by Li Cong.

A version of this article originally appeared in The Beijing News. It has been translated and edited for brevity and clarity, and is republished here with permission.

Translator: Kiong Xin Xi; editors: Wang Juyi and Hao Qibao.

(Header image: Visuals from FStop and Shijue Select/VCG)