Gabapentin Use and Abuse:

Essential Things to Know

Gabapentin Use and Abuse

Essential Things to Know

What is Gabapentin?

It is a drug used to treat seizures and some types of pain. It is available only with a doctor’s prescription. There are three brands of the drug on the market. They are Neurontin, Gralise, and Horizant. The drug comes in the form of capsules, tablets, slow-release tablets, and oral liquids.

Millions of people in America use gabapentin daily. In 2016, the drug ranked 10th on the list of most frequently prescribed drugs in the US. Doctors wrote 64 million prescriptions for the drug in 2016, which was a 164% increase from 39 million in 2012.1 In 2019, the drug climbed to the 4th position in the list.2

Increasing evidence suggests that it is a potential drug of abuse. The number of exposure calls to US poison centers increased from 5,889 in 2012 to 20,064 in 2016. Likewise, exposures involving the drug alone increased by over 300% from 2,141 in 2012 to 7,024 in 2016.3 Gabapentin addiction could require treatment in a rehab facility.

Street Names

Street names are slang terms that people use to refer to a drug. These names can change over time and may differ from one location to another. It is not as common as other substances on the street. Thus, only a few street names have been reported. They are:

Johnnies 

Gabbies

Morontin 

What is Gabapentin Used to Treat?

It received FDA approval for treating partial seizures in 1993. Over the next few years, the FDA approved the drug for other conditions.

FDA-approved Uses

  • As an anticonvulsant. Doctors can use it as an adjunct to treat partial seizures. A partial seizure affects a specific area of the brain and does not cause fainting. Brands used: Neurontin
  • As a pain medication. A doctor may prescribe the drug for people who have a painful condition called postherpetic neuralgia, which causes burning pain that persists after shingles go away. Brands used: Horizant, Gralise, Neurontin
  • For restless leg syndrome (RLS). It may help relieve symptoms of RLS in some people. RLS is a sleep disorder. It causes a strong urge to move the legs. People with this condition may struggle to get the required amount of sleep. Brands used: Horizant

Off-label Uses

A doctor may use a drug for conditions other than those mentioned on the label. Such uses are known as off-label uses. Conditions for which it is commonly prescribed off-label include:

Neuropathic pain (nerve pain)

Fibromyalgia 

Bipolar disorder 

Postmenopausal hot flashes 

Essential tremors 

Anxiety 

Resistant depressant and mood disorders 

Irritable bowel syndrome (IBS) 

Alcohol withdrawal 

Postoperative analgesia 

Prevention of migraine 

Painful diabetic neuropathy 

Social phobia 

Post-traumatic stress disorder (PTSD) 

Refractory chronic cough

How Is It Used?

All preparations of the drug should be taken by mouth. It can be taken with or without food. Taking it with food can help reduce the odds of digestive issues. The dose depends on the patient’s age and general health, and on the condition for which the drug is prescribed.

For Seizures

The usual dosage for adults is 300 mg on the first day of therapy. A doctor can increase the dose to 300 mg two times a day on the second day and 300 mg three times a day on the third day. Depending on how the patient responds, the doctor may change the doses. However, more than 3600 mg of should never be taken in a single day. The FDA has approved the brand Neurontin to treat seizures.

For Postherpetic Neuralgia 

The starting adult dose is 300 mg on the first day of therapy, 300 mg two times a day on the second day, and 300 mg three times a day on the third day. Doctors may change the doses depending on pain control. The maximum daily dose is 1800 mg per day.

For slow-release tablets (brand: Horizant), the starting dose is 600 mg per day for the first three days of therapy. The dose is increased to 600 mg two times a day on the fourth day.

For Restless Leg Syndrome (RLS)

The FDA has approved the brand Horizant for RLS. The usual dose is 600 mg once a day in the evening.

Gabapentin’s Class

It belongs to a class of drugs known as gabapentinoids. Another similar drug in this class is pregabalin (Lyrica). Gabapentinoids are now the main class of drugs prescribed to treat neuropathic pain. The number of gabapentinoid prescriptions for people with cancer almost tripled from 1.2 million in 2005 to 3.5 million in 2015.4

Scientists do not know how these drugs work. They believe that gabapentinoids help relieve pain and control seizures by:5

Decreasing the activity of brain cells

Reducing substances that cause inflammation 

Altering the activity of certain brain chemicals (neurostransmitters) such as serotonin 

Gabapentin vs. Pregabalin

Both gabapentin and pregabalin (Lyrica) are members of the gabapentinoid class of drugs. Nevertheless, these two drugs are different. The key differences are summarized in the table below.

Drug name

Brand names

Cost

Side effects

Dosing frequency per day

FDA-approved uses

Availability of generic versions

Gabapentin

Neurontin, Gralise, Horizant

Low

More

Three times

Partial seizures and postherpetic neuralgia

Available

Pregabalin

Lyrica

High

Fewer

Two times

Partial seizures, painful diabetic peripheral neuropathy, postherpetic neuralgia, and fibromyalgia

Not available

Besides, a few studies suggest that pregabalin may be effective in certain anxiety disorders. However, because pregabalin is a relatively new drug, its long-term safety is not well documented.

Is Gabapentin Safe?

Any drug that has received FDA approval is typically safe. A drug becomes available on the market only after it has passed several safety tests, both in animals and humans. That said, gabapentin carries certain risks. Abusing it is extremely risky. Drug abuse refers to using a drug in ways other than those recommended by a doctor.

Some people taking the drug may be at a greater risk of suicidal thoughts or behavior. Thus, it is critically important to monitor signs that may show increased suicidal tendencies A patient experiencing any of the following side effects should consult their physician immediately:

Severe depression 

Worsening of existing depression 

Suicidal thoughts or behavior 

Rapid mood swings 

Thoughts about self-harm

Most notably, suicidal thoughts can appear within the very first week of treatment. Furthermore, the increased risk of suicide persists as long as a person uses the drug.

Is Gabapentin Addictive?

Limited studies show that the drug may cause addiction in some people. Notably, most of the findings rely on experiences rather than controlled scientific studies. Besides, the majority of people who have reported the addictive nature of the drug have a history of substance abuse. Using the drug exactly as recommended carries little risk of addiction. Nonetheless, abuse/misuse may cause addiction.

Before using gabapentin, patients should consult their doctors about the potential risks. This is even more important for those who have used other addictive substances. Doctors will prescribe the drug only if the benefits outweigh the potential risks.

Moreover, abuse doesn’t necessarily indicate the drug’s addictive nature. This is because abuse is not the same thing as addiction. Addiction is a long-term disease of the brain which causes compulsive use of a drug despite the known harm which will result.

Where is Gabapentin on the Schedule?

It is not a federally controlled substance. Thus, it does not appear in the list of controlled substances at the federal level. That said, some states have categorized the drug as a Schedule V controlled substance. These states are Michigan, Virginia, Alabama, Ohio, Kentucky, and West Virginia. Many other states are expected to add it to their list of controlled substances.

Schedule V Controlled Substances have low abuse potential compared to Schedule IV substances. Examples of drugs in Schedule V are pregabalin, certain marijuana-derived chemicals, and preparations containing low doses of narcotics.

Is Gabapentin an Opioid? 

It is not an opioid. It belongs to a class of drugs called gabapentinoids. Opioids help relieve pain by blocking pain signals in the brain. It appears to work by reducing brain activity and substances that cause inflammation. Gabapentin may also alter the activity of neurotransmitters, such as serotonin.

Is Gabapentin a Narcotic?

It is a non-narcotic pain medication commonly used in the treatment of neuropathic pain. Narcotics act on opioid receptors and block pain signals in the brain. Gabapentin is thought to work by preventing excitation in the brain and by altering certain brain chemicals associated with the perception of pain.

Can a Person Abuse Gabapentin?

Gabapentin’s abuse potential is less than that of opioids or other stronger drugs. Nonetheless, increasing cases of both intentional and accidental exposures indicate a looming drug crisis. Even worse, studies suggest that 1 out of every 5 people using prescription gabapentin may abuse the drug.6

Gabapentin abuse is on the rise, especially among people who have used opioids in the past. From 2013 to 2017, abuse/misuse increased by a whopping 119%. Likewise, the number of suicide attempts involving gabapentin increased by 80.5% during the same period.7

When gabapentin is abused, it is typically mixed with cocaine, opioids, marijuana, methadone, or buprenorphine. This increases both sedation and the drug’s effects.

Why Do People Abuse Gabapentin?

People who abuse it mostly report that they are seeking the following effects:

Euphoria 

Relaxation 

Improved sociability 

A high similar to that produced by cannabis 

Enhanced sense of calm 

Besides, some people consider gabapentin a safer alternative to other illicit drugs. This is because urine tests do not detect the drug. Moreover, gabapentin may be used to “cut” heroin.

What Are the Signs and Symptoms of Abuse?

Abuse can make the side effects of gabapentin worse. Watch out for the following signs and symptoms of abuse.

Problems with balance and coordination 

Feeling tired all the time

Difficulty remembering things

Problems with multitasking 

Shaking, espcially in the arms 

Fever

Stuffy or runny nose

Sore throat 

Persistent low mood 

Unexplained feeling of anxiety 

Besides, a person abusing gabapentin may experience certain behavioral changes. These can include:

Faking symptoms to get more gabapentin 

Visiting many doctors to get multiple prescriptions for the drug

Using gabapentin originally prescribed for a friend or a family member

Having money problems 

Effects of Gabapentin

Gabapentin has an excellent safety profile. Nonetheless, some people may experience one or more side effects. Side effects are unwanted effects that may appear when patients take a drug in the recommended doses. Some of these unwanted effects may go away on their own. If they persist or become worse, the prescribing doctor should be contacted immediately.

Below is a list of side effects that typically appear within a few weeks of drug use.

    Short Term Effects

    • Diarrhea
    • Enhanced feelings of well-being
    • Aggressive behavior
    • Depression
    • Mood swings
    • Hyperactivity
    • Flu-like symptoms
    • Fever
    • Pain in the lower back or side
    • Shaking
    • Increased appetite
    • Dry eyes
    • Reduced sex drive
    • Dry skin
    • Flushing
    • Changes in breath odor
    • Increased thirst
    • Abdominal bloating
    • Sweating

    Long Term Effects

    • Memory problems
    • Muscle weakness
    • Stopped breathing
    • Sedation
    • Dizziness
    • Swelling
    • Weight gain
    • Drowsiness
    • Skin rashes
    • Nausea
    • Hallucinations
    • Blurred vision
    • Involuntary muscle contractions
    • Dry mouth
    • Upset stomach
    • Sore throat
    • Fatigue

    Serious Side Effects

    Some people may develop potentially life-threatening allergic reactions. Immediate medical help is required if the following symptoms develop:

    Itching or hives

    Swelling in the face or hands

    Tingling in the mouth or throat

    Tightness in the chest

    Breathing difficulties 

    Other symptoms that call for immediate medical attention include:

    Uncontrolled eye movements

    Clumsiness 

    Slurred speech 

    Extreme tiredness

    Is it Possible to Overdose on Gabapentin?

    Both intentional and accidental overdose can occur. Accidental gabapentin overdose rarely causes death. However, intentional overdose can cause death, probably because those who overdose intentionally are more likely to mix the drug with other substances.

    People have swallowed up to 49 grams of Neurontin and still survived with supportive care. This is according to Pfizer, the manufacturer of Neurontin.

    Of 168 fatal cases involving gabapentin between 2012 and 2016, gabapentin was the main cause of death in 23 cases.3

    Mixing gabapentin and other substances, most notably opioids, can greatly increase the risk of death. Compared to using an opioid alone, mixing in gabapentin can increase the risk of opioid-related death by about 60%. Likewise, the risk of opioid overdose is 49% higher in people who mix gabapentin with an opioid.8

    In 2016, more than 20% of (prescription) opioid overdose deaths also involved gabapentin, according to the Centers for Disease Control and Prevention (CDC).9 Sadly, opioid prescriptions for gabapentin users are very common. Studies reveal that about half of gabapentin users also receive a prescription for an opioid drug.8

    Overdose Symptoms

    The symptoms of an overdose can include:

    Loss of control of muscle movements 

    Breathing difficulties 

    Drooping eyes 

    Excessive sedation 

    Reduced movement or activity 

    Excitation 

    Slurred speech 

    Double vision 

    Diarrhea 

    Coma, especially in people with kidney disease 

    No antidote for overdose is available. The drug stays in the system for up to 48 hours. Thus, prolonged and intensive treatment is necessary to ensure a full recovery. Some people may need hemodialysis. Hemodialysis uses artificial kidneys to remove toxic substances from the blood.

    Bystanders who think an overdose has occurred should dial 911 for emergency assistance or call Poison Control at 800-222-1222.

    How To Stop Using Gabapentin

    Patients should not stop taking gabapentin on their own, but should always consult their doctors. Quitting suddenly can cause withdrawal symptoms. Surprisingly, some people report experiencing withdrawal even with gradual dose reduction (tapering). However, this is rare. We will discuss gabapentin withdrawal in the upcoming section.

    A withdrawal plan is essential to stopping gabapentin use safely. Doctors create plans before asking patients to stop using the drug. Tapering is the most important component of the plan. The dose is gradually reduced over one week to several weeks. The duration of tapering depends on the initial doses and on how the patient’s body handles the drug.

    Patients who experience seizures or breathing problems while coming off the drug should talk to their doctors immediately. Doctors can also give advice about ways to manage common withdrawal effects, such as sleep problems and shaking.

    Gabapentin Withdrawal Symptoms

    Withdrawal symptoms can include:

    Restlessness 

    Confusion 

    Racing heartbeats while the person is at rest 

    Excessive sweating 

    Shaking 

    Elevated blood pressure 

    Problems falling or staying asleep 

    Digestive problems 

    Rarely, abnormal movements and seizures 

    Withdrawal symptoms typically develop within 24 to 48 hours after the last use. Most people who abuse gabapentin use more than 3000 mg of the drug per day. The abuse dosage can range from 3600 to 7200 mg of the drug per day. However, heavy users may take over 11,000 mg per day.

    There is no standard treatment for gabapentin withdrawal. Treatments are supportive and depend on the symptoms. For example, the antipsychotic drug haloperidol may be effective in controlling abnormal movements. Likewise, phenobarbital and phenytoin can help control seizures. Scientists are studying whether drugs like Ativan and clonidine can facilitate withdrawal. Interestingly, the withdrawal symptoms go away when the person experiencing them takes the drug again.

    Treatment for Abuse and Addiction

    Abuse and addiction can cause potentially fatal effects, such as seizures. Furthermore, abuse may lead to addiction to harder substances. Thus, timely treatment is of paramount importance. There are many addiction treatment options.

    Detox

    Detox or detoxification involves flushing the drug out of the body. People who have used gabapentin chronically or heavily may need medical detox. Detox usually lasts a few weeks. Nonetheless, some may need more time to get their systems clean.

    Inpatient Treatment

    Inpatient treatment programs provide structured care to address issues associated with drug abuse. Patients stay at a treatment facility for the entire period of treatment. These programs are ideal for patients who have used gabapentin heavily or chronically, or who have a co-occurring mental illness.

    Outpatient Treatment

    Outpatient treatment programs require patients to visit a facility for a few hours every week. These programs are ideal for people who have recently begun to use the drug, and for those who have completed treatment at inpatient facilities.

    Support Groups

    Support groups connect people who have had similar experiences. They can involve face-to-face meetings or online communities. People joining support groups can ask questions, share experiences, and seek emotional support.

    Aftercare (Recovery Management or Continuing Care)

    Aftercare is a long-term intervention. It focuses on a person’s unique individual needs through medical, psychosocial, and economic programs. Aftercare is essential in preventing relapse and maintaining sobriety.