Gabapentin Use Disorder

Table of Contents

Prescriptions for nonopioid pharmacological medication such as gabapentin have been growing significantly. Researchers have found a 72% increase in exposure to the drug between 2013 and 2017. Although gabapentin is less likely than opioids to lead to a fatal overdose, the drug is associated with dependence, misuse, and adverse side effects.  Learn about gabapentin, its abuse, and treatment for addiction in this article.

What is Gabapentin?

Gabapentin is a medication used in the treatment of epilepsy for its potential to weaken and stop seizures. Adults and children who have epilepsy take the prescription together with other seizure medications.

The medication is also prescribed to adults for treating nerve pain caused by herpes virus or shingles. Shingles is a painful rash that can appear in adults after infection with the varicella-zoster virus. The varicella-zoster virus can infect people who have had chickenpox.

In recent years, many health care providers have embraced it as a safer alternative to opioids for pain management.

The medical society doesn’t completely understand how gabapentin works in treating these conditions. For epilepsy seizures, it’s believed that it alters the effect of calcium. For nerve pain, it appears to stop the increase of sensitivity to pain.

Gabapentin’s other uses include treating:

Alcohol or cocaine withdrawal

Restless legs syndrome

Diabetic neuropathy

Fibromyalgia

Hot flashes

Chronic kidney disease

Brief History

Gabapentin belongs to a class of drugs known as gabapentinoids. Gabapentinoids are derivatives of the inhibitory neurotransmitter γ-aminobutyric acid (GABA), which is a brain chemical that relaxes the nervous system. The drug doesn’t bind to GABA receptors, but instead, it affects the body’s calcium channels to reduce seizures and nerve pain.

The drug was first approved in 1993 by the US Food and Drug Administration (FDA) as a treatment for seizures. Later, it was approved for the treatment of postherpetic neuralgia, and it has been available as a generic medication in the US since 2004.

Amid an opioid crisis, many physicians are prescribing fewer opioids and more medications like gabapentin. Consequently, prescriptions and misuse of the painkiller have increased. One report that was conducted between 2013 and 2017 found that exposures have increased by 72%.1 According to another research study, an estimated 4% of US adults have received a prescription for gabapentin at least once in 2015.2

How Often is It Prescribed?

According to Statista, in 2004, there were 18 million gabapentin prescriptions. In 2017, that number increased by over 46 million.

The New England Journal of Medicine reported that gabapentin was the 10th top medication in the U.S. in 2016 with 64 million prescriptions.

Pharmacists have also been reporting many cases of patients asking for early refills and continuing to take the medication past its prescription date. Medical experts agree that such widespread prescribing of the drug carries known and unknown risks.

Where is Gabapentin on the Drug Schedule?

The DEA hasn’t classified it as a controlled substance yet. Some states have already classified it as a Schedule V controlled substance. Schedule V controlled drugs have a lower potential for abuse than Schedule IV drugs and have an accepted medical use in treatment in the US. They’re used for antidiarrheal, antitussive, and analgesic purposes.

Common Brand and Street Names

Brand names are given by the companies that produce it. The most common include:

FusePaq Fanatrex

Gabarone

Gralise

Neurontin

Common street names for Gabapentin include:

Morontin

Gabbies

How Common is Gabapentin Abuse?

As prescription opioids have become less available, people have been substituting other licit and illicit drugs for abuse, including gabapentin.

In a 2016 study, it was found that 1% of the general population misused gabapentin. The same study discovered that misuse is the most prevalent among people who misuse opioids. Its findings show that 15% to 22% of people who abuse opioids are also abusing gabapentin.3

Gabapentin abuse is more common among people who abuse multiple substances, or in those who frequently combine it with other substances to increase the effects. Additionally, it may be abused by people who are trying to lower the symptoms of withdrawal from alcohol or other substances.

As a general rule, there’s a high probability that a person is abusing a prescription drug if they:

Take the medication without a prescription

Take the medication past the date the doctor recommended

Lie about their symptoms to get a prescription

Take more than instructed by the doctor

Contact multiple doctors to get extra doses

Switch doctors if they refuse to prescribe the medication

Are constantly thinking about abusing the drug

Feel anxious about the drug not being available

Change their social habits

Refuse to quit taking the drug

How is Gabapentin Abused?

Gabapentin is available as an oral capsule, oral tablet, and oral solution. The capsules and tablets can be taken with or without food. Doctors recommend taking them with food to reduce upset stomach.

People who abuse the drug crush the tablet and snort it through the nose. Some people empty the oral capsule contents to abuse the substance.

It doesn’t create the same effects of drugs that people often abuse, such as benzodiazepines and opiates. Still, there has been a growing number of people who abuse the drug. In 2012, the FDA issued a warning in which it addressed the health risks of misuse of gabapentin, particularly in combination with opioids.

People have been mixing gabapentin with other opioids in an effort to get a more intense “high.” According to authorities, although gabapentin is not a very potent drug, combining it with a central nervous system depressant like heroin can lead to a dangerous high or even death.

What are the Associated Health Risks?

Although there are medical reasons a doctor might prescribe gabapentin to a patient, at the same time, there are many health risks associated with the drug.

One study conducted in 2010 found that people with preexisting chronic kidney disease may be at risk for toxicity.4 In addition, the drug can lead to other health risks, such as weakened muscles, memory loss, and respiratory failure.

Some of the more severe side effects of gabapentin misuse can include:

Shifts in mood

Depression

Anxiety

Panic attack

Violent behavior, aggressiveness, or anger

Irritability

Mania

Insomnia

Suicidal thoughts or behaviors

Overdose (if combined with other substances)

According to a study in the Clinical Toxicology Journal, suicide attempts that involve gabapentin have increased by 81% between 2013–2017.

Moreover, if it’s taken in large quantities, the drug can produce the same dissociative effects typical for substances like PCP and ketamine.

Risk of Allergic Reaction

It’s also possible to develop a serious and life-threatening allergic reaction to gabapentin. The most common symptoms of an allergic reaction are:

Skin rashes

Hives

Fever

Swollen glands

Swollen lips and tongue

Yellowing of the skin or the whites of the eyes

Tiredness or weakness

Muscle pain

Potential Side Effects

The drug acts as a mild tranquilizer. It produces feelings similar to the effects of marijuana on some people. It can also lead to feelings of relaxation and increased sociability.

Some of the common side effects of gabapentin can include:

Drowsiness

Dizziness

Memory loss

Fatigue

Tremors

Weight gain

Double vision

Nervousness

Difficulty speaking

Dry mouth

Mixing gabapentin with other substances can worsen the side effects. There’s a high chance of an overdose if it’s taken together with opioids. People should also avoid combining it with alcohol as the mix can amplify the side effects of both substances.

Gabapentin Withdrawal

Gabapentin is considered to have a low potential for addiction. Despite its low potency, people who take it can develop some dependence.

With regular use, the body adapts to the presence of the drug and depends on it to function normally. The body will also develop tolerance and need higher doses in order to experience the same effects.

People who abuse the drug and use it recreationally may experience more severe withdrawal symptoms upon stopping, both physical and psychological.

The symptoms of gabapentin withdrawal are similar to the symptoms experienced during alcohol withdrawal due to a similar mechanism of action. The most common include:

Anxiety

Irritability 

Headache

Nausea

Fatigue

Dizziness

Insomnia 

Abdominal pain

Sweating

Muscle pain

Itching

Restlessness

Seizures

Suicidal thoughts

In young to middle-aged people who chronically use gabapentin, these symptoms can appear after 1-2 days after suddenly discontinuing the drug.5

Factors that Influence Withdrawal Symptoms

The intensity and the set of symptoms a person will experience depend on a number of factors, including:

Age of the person

Dosage

Length of use

Mental health

Physical health

Concurrent abuse of other substances

Moreover, people who are taking gabapentin to weaken seizure attacks but stop taking the drug abruptly may experience an increased activity of seizures.

The best way to stop taking gabapentin and avoid the uncomfortable withdrawal symptoms is to taper off the medication under medical supervision in a detox center. The process can last for one week or more, depending on the specific situation.

Misconceptions

Misconception 1: Gabapentin isn't an opioid; therefore, it's safe.

Gabapentin is not considered to be a potent drug. However, it produces a set of side effects. The most common side effects include drowsiness, memory loss, tremors, and weight gain. Some of the more severe side effects are depression, anxiety, panic attack, violent behavior, aggressiveness, and suicidal thoughts or behaviors.

Misconception 2: Gabapentin doesn’t produce a high feeling.

Gabapentin produces the same high as cannabis, and it is often mixed with other opioids to intensify the effect. Although it’s not a very potent drug, combining it with a central nervous system depressant like alcohol can lead to a dangerous high or even death.

Misconception 3: Gabapentin doesn't cause addiction.

Gabapentin is often prescribed as an alternative to opioids. However, many studies have shown that people are misusing the drug. The wide misuse seems to be due to its availability and low price. Some people develop withdrawal symptoms, which indicates that dependence can develop. Misuse can cause physical symptoms like headaches, nausea, and fatigue. It can also induce psychological symptoms, including anxiety and suicidal ideation. Addiction is more likely to happen in people who already suffer from addictions to opioids and other drugs.

Is it Possible to Overdose on Gabapentin?

When a prescription drug like gabapentin is abused, it’s often taken in higher doses than what a doctor prescribed, and it’s often mixed with other substances. In such cases, it can have a range of negative consequences.

Although gabapentin has been involved in a large number of fatal overdoses, officials claim that it’s not the primary cause of the deaths. More powerful substances mixed with gabapentin are usually the primary cause of death.

Some signs of gabapentin overdose include:

Drowsiness

Muscle weakness

Lethargy

Drooping eyelids

Diarrhea 

Sedation

The state of Kentucky has classified gabapentin as a controlled substance after it was detected in 25% of all overdose deaths in Louisville in 2017. According to coroner data in Jefferson County, the drug was found in 93 of 407 fatal overdoses.

What Increases the Risk of Overdose?

Gabapentin is most often taken in combination with opioids. One study examined data from the Office of National Statistics and found that the number of deaths involving gabapentinoids grew from less than one per year before 2009 to 137 in 2015. Nearly 79% of these deaths also involved opioids.6

Mixing heroin with gabapentin potentially increases the risk of overdose, leading to depressed respiration and, ultimately, death.

Treating Addiction to Gabapentin

Gabapentin abuse is often followed by a range of physical and psychological withdrawal symptoms upon stopping. The best way to recover is by seeking help from a detox center under the supervision of a medical team, before moving to inpatient or outpatient care.

Medical Detox

A detoxification program has three main components:

Offer detox

Identify the status of the addiction

Motivate the patient to proceed with ongoing treatment

During detox, the body will be cleared of all toxins. The majority of treatment centers use the taper method. In a tapering program, the medication is gradually reduced, allowing the body to readjust to its drug-free state.

Medical detox centers offer 24/7 supervision and care, and they facilitate intervention for any complication that might occur during the withdrawal management period.

Treatment can be more complicated in people who abuse multiple substances. In such cases, a wide range of withdrawal symptoms might be at play. Alcohol, opioid, and benzodiazepine withdrawal cause the greatest discomfort and most complications during the detox process.

The best way to long-term recovery, especially for people with a history of abusing multiple substances, is inpatient treatment.

Inpatient Care

Substance dependence is a condition that can lead to impaired mental, physical, and social functioning. Inpatient programs aim to address these issues and help the patient recover into a life of healthy physical and psychological health.

Every patient receives an individualized treatment plan that ranges between 28 and 90 days. Depending on the treatment center, patients participate in daily group and individual therapies, as well as 12-step meetings, educational seminars, relapse prevention classes, and stress management.

Other activities can include meditation, yoga, relapse prevention, animal therapy, art therapy, and family therapy.

Some centers also offer nutritional counseling. They employ nutrition counselors and registered dietitians who educate the clients on the importance of proper eating and incorporating essential vitamins such as A, B, D, and E in their diet.

Every activity aims to help the person heal as a whole. They learn sober living skills and how to avoid destructive behaviors.

Outpatient Care

Outpatient care is a less-restricted structured plan that aims to help those who don’t need a higher level of care. If the person has a healthy and supportive home environment, is physically healthy, and has already completed detox, then outpatient care is the more suitable option. Patients live off-site but come to the rehab center to attend:

Group therapy

One-on-one therapy

Relapse prevention

Medication management

Skills building

Family education groups, and more

Outpatient programs last for 1-3 months, depending on the person and the severity of the addiction.

Aftercare

The aftercare plan focuses on what happens after a patient leaves the rehab center. Recovery from addiction is a long-term process, and inpatient/outpatient care is only the beginning.

Before a patient leaves residential or outpatient care, their case manager prepares a discharge plan to determine what type of aftercare services they may need.

Although every patient gets an individualized plan, a typical aftercare treatment plan generally involves:

One-on-one counseling

Family therapy

Participation in a 12-step or alternative support group

Vocational rehabilitation

Educational assistance

Legal assistance

Maintenance medication

Relapse prevention programming

Final Thoughts

Although gabapentin is a safer alternative to opioids, like any medicine, it can be misused. Its off-label use comes with a number of side effects, including depression, anxiety, panic attack, violent behavior, and suicidal thoughts or behaviors. Patients can experience withdrawal when high doses are stopped abruptly, leading to nausea, fatigue, dizziness, muscle pain, and seizures. When used on its own, gabapentin rarely leads to an overdose. However, overdoses have happened when the drug is mixed with other substances like alcohol or opioids.

If you or someone you love becomes dependent on gabapentin, inpatient, and outpatient rehab centers can offer proper treatment. Long-term recovery efforts, including support groups, have also been proven to be effective.

This information should not replace a visit to a doctor or treatment center. If you are concerned that you or your loved one might be suffering from addiction to gabapentin, ask for professional help today.