Gabapentin Abuse and Treatment
Gabapentin Abuse and Treatment
Table of Contents
What is Gabapentin?
It’s an anticonvulsant medication that was initially created for the treatment of epilepsy and seizures. It treats seizures by decreasing abnormal excitement in the brain, and it treats pain by changing the way that the body responds to pain.1 It was first approved for use in epileptic patients in 1993 by the US Food and Drug Administration (FDA).1
In 2004, it was also approved for use as an analgesic (pain reliever) for post-herpetic neuralgia, which is a painful condition that affects the skin and nerves of people who have had shingles.2 According to the Drug Enforcement Administration (DEA), the number of gabapentin prescriptions doubled between 2009 and 2017.2
Because it’s thought to have a low risk of abuse, it has a long list of off-label uses, meaning that doctors will prescribe it for issues other than those for which the FDA has approved it.
Neuropathic pain conditions
Borderline personality disorder
It is estimated that 83% to 95% of all gabapentin use is off-label, which accounts for approximately 90% of sales.1 This is because Pfizer, the pharmaceutical company that originally marketed gabapentin, promoted its off-label use, which is an illegal marketing tactic. Pfizer was fined $420 million as a punishment for their illegal marketing.1
How is Gabapentin Used?
It’s taken orally. It comes in the form of capsules, tablets, and an oral solution. Gabapentin is safely tolerated in doses ranging from 800 – 1800 mg per day; however, patients may be treated with doses as high as 3600 mg per day.1
Gabapentin must be taken regularly and at the same time every day to keep the level of gabapentin in the body stabilized. Not taking it at the same time could increase seizures and other symptoms for which it has been prescribed.
What are the Brand Names for Gabapentin?
Gabapentin is the name of the ingredient. Neurontin, Gralise, Gabarone, and Fanatrex are brand-name medications made of gabapentin.
What are the Street Names for Gabapentin?
Although it isn’t widely known and is less popular as a street drug than other medications, when it is used on the street it is typically called “gabbies” or “johnnies.”
What Class of Drugs is Gabapentin in?
It’s part of a category of drugs known as anticonvulsants, antiepileptic drugs, or anti-seizure drugs. As implied by the name, these types of drugs are typically prescribed for epilepsy and seizures; however, they have other uses and are often prescribed for other issues as well.
How Many Prescriptions for Gabapentin are Written Every Year in the US?
As is clear from the statistics reported, the number of prescriptions has increased significantly over the past decade.3 This is due to the increasing number of prescriptions that are off-label as well as the illegal marketing of off-label uses to the public.
What Precautions Should Be Taken Before Using Gabapentin?
Not every medication is safe for everyone to take. Individuals all have different pre-existing conditions, allergies, and reactions to different medications. A patient should inform their doctor if they:
Are allergic to gabapentin
Have any other allergies
Have a history of kidney disease
Abuse drugs or alcohol
Have breathing problems
Are taking antacids that contain aluminum or magnesium, as these may interfere with the absorption of gabapentin
Where is Gabapentin on the Schedule of Controlled Substances?
Despite increasing research and evidence that it does pose a risk of abuse, it is not a federally controlled substance and therefore is not on the schedule of controlled substances.
That being said, some states have opted to place gabapentin on the schedule, categorizing it as a Schedule IV or V substance. This classification means that it poses a low risk of misuse and abuse; however, these states believe that it poses enough risk to be placed on the schedule.
For reference, Schedule I drugs pose the highest risk of addiction and serve no medical purpose, whereas Schedule V drugs pose almost no risk of addiction and abuse.
As of 2019, the following states have reclassified gabapentin as a controlled substance: Kentucky, Michigan, West Virginia, and Tennessee. Additionally, pregabalin, a substance very similar to gabapentin, is a Schedule V drug under the Controlled Substances Act.
Effects and Overdose
Although gabapentin is safe to take, patients might experience some of the following side effects when taking gabapentin, particularly over the long term.
These effects may include the following:
Loss of coordination
Swollen hands, feet, and ankles
Unwanted eye movements
Taking a medication or drug long-term can come with its own set of effects that occur after extensive use. With gabapentin, long-term use can lead to memory loss, weakened muscles, respiratory failure, dependence, addiction, and the potential to experience withdrawal symptoms when stopping use.
Is it Possible to Overdose on Gabapentin?
While it’s thought to be relatively safe, there is a chance of overdosing when taking too much of it, and especially when mixing it with other substances such as opioids. But while naloxone can be administered to reverse the effects of an opioid overdose, no substance can be administered to reverse the effects of a gabapentin overdose. For this reason, it is important to seek medical attention right away if someone is experiencing a gabapentin overdose.
Symptoms of an overdose may include:
Can Gabapentin Be Abused?
Yes! There is a common misconception that gabapentin is safe to take and is not addictive because it is not a controlled substance. However, the reality is that gabapentin abuse exists and has been increasing, especially amongst people who are in methadone maintenance treatment for other substance abuse disorders.
Gabapentin is not a substance that is tested for during treatment, so people will use it to try to get high in the absence of other drugs. The Drug Abuse Warning Network reported that about 20% of patients who are in methadone maintenance treatment misuse or abuse gabapentin.4 Gabapentin also tends to be abused because it is relatively cheap and widely available.
It’s also frequently abused together with other medications such as muscle relaxants, opioids, or anxiety medications, all of which can cause a “high” or a feeling of euphoria.
People Taking Gabapentin with an Opioid
People taking Gabapentin with a Muscle Relaxant
A study on gabapentin abuse showed that, out of a group of people found to be using it without a prescription, 56% of people took it with an opioid and 27% of people took it with a muscle relaxant, or anxiety medication.5 Mixing gabapentin with alcohol or other drugs can make people tired or dizzy, or can increase side effects. Between 2008 and 2015, the Drug Abuse Warning Network reported that emergency room visits related to gabapentin increased by 90%.5
What are the Signs of Gabapentin Abuse?
Characteristics which may indicate gabapentin abuse include:
Taking a higher dosage than prescribed
Taking it more frequently than prescribed
Using it without a prescription
Buying it on the streets
Stealing or taking pills from others
Isolating oneself from friends and family
Using it together with other drugs
Irregular sleep patterns/habits
Failing to keep up with life, school, and work responsibilities
Spending increasing amounts of money to obtain it
Refusing to stop using gabapentin
Lying about drug use
How Can a Person Stop Using Gabapentin Safely?
There are no medications that have been medically approved for use in gabapentin withdrawal and addiction treatment. Gabapentin is actually used in the treatment of other substance use disorders and can help reduce withdrawal symptoms. It is important to taper down gradually and to detox with the instruction or under the supervision of a doctor. Abruptly stopping use can increase seizures in patients, and therefore it is important to stop using gabapentin safely.
What Are the Withdrawal Symptoms of Stopping Gabapentin Use?
Withdrawal occurs when a person has been taking a substance for an extended period and has become dependent on the drug. This means that their body adapts to the presence of the substance and learns to function with it, so when they stop using the substance, their body goes through withdrawal.
Because withdrawal symptoms can be quite serious and even life-threatening, it is best to stop using a drug through a medically supervised detox. If a medically supervised detox is not available, it is best to taper off of the drug slowly so that the body has time to adjust to a smaller dose of the substance. Gabapentin withdrawal typically begins between 12 hours and 7 days after the last dose.
Symptoms of withdrawal include:
Increased heart rate
High blood pressure
It is also important to note that withdrawal symptoms are more likely to occur if patients have been taking gabapentin along with other substances. People who experience any confusion or psychosis after stopping substance use should seek medical help immediately.
Treatment Options for Gabapentin Abuse
Because gabapentin is not a federally controlled substance and has a relatively low risk of abuse, there are no clinical protocols specific to gabapentin addiction treatment or gabapentin withdrawal symptom management. Tapering off slowly, with instruction from a doctor, is the best way to stop using gabapentin.
Treatment options will then depend on whether the person has taken other drugs with gabapentin and might need to treat opioid addiction or some other concurrent disorder. Patients shouldn’t be afraid to consult their doctors and ask for referrals to other healthcare professionals to be able to create comprehensive and individualized treatment plans.
Need to Understand the Issues Underlying Substance Abuse
While there are medications to treat opioid addiction, there are no medications that specifically target gabapentin dependence. That is why it is necessary to tackle all substance abuse issues at once and to understand why the patient might have started abusing substances in the first place. Behavioral treatment options might help in tackling the issues underlying substance abuse and addiction while specifically tackling gabapentin addiction as well.
Behavioral therapies include individual therapy, group therapy, and family therapy. One example is cognitive-behavioral therapy, which can occur either on a one-to-one basis with a psychotherapist or in a group setting. Cognitive-behavioral therapy focuses on thought patterns and behaviors surrounding drug use, and on ways in which patients can adapt their thinking and behavior to support recovery.
Another group therapy option is Narcotics Anonymous, which is based on the principles of Alcoholics Anonymous and revolves around the peer support of people going through the same process. This might be a good option for people struggling with multiple substances. It is always helpful to have the support of friends and family as well, as addiction treatment can be difficult to succeed without any support.
There are a variety of treatment facilities where behavioral therapy and other treatments can occur.
Outpatient substance use treatment facilities: Outpatient treatment facilities are the most popular option in the United States. In an outpatient treatment facility, the patient lives at home and travels to the facility for treatment. This can take place over weeks, months, or even years.
Inpatient substance use treatment facilities: Inpatient treatment facilities are rarer than outpatient facilities because patients stay at inpatient facilities overnight, for up to 28 days. Inpatient treatment facilities offer more structure and support for individuals and are typically located in hospitals or other medical facilities where patients receive more care. After about a month, patients might be transferred to outpatient treatment facilities or residential treatment facilities.
Residential substance use treatment facilities: Residential substance use treatment facilities are facilities where people live full-time for a longer period because they need more intensive structure and support. They will often be dealing with co-occurring problems along with substance use.