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What Is Gabapentin?
According to one report, gabapentin is the 10th most prescribed medicine in the United States. Chemically speaking, its structure is similar to GABA, a neurotransmitter with calming properties naturally produced by the human body.
What is Gabapentin used for?
Developed initially as an anticonvulsant to prevent seizures in epileptic patients, gabapentin’s usage has multiplied since its approval in 1993. This is mainly due to its off-label use cases. It’s primarily used as a non-opioid alternative for pain management and mental health conditions like anxiety and insomnia.
Recent data shows that in 2020, more than 10 million Americans had a prescription for gabapentin. Beyond its medical applications, gabapentin is also popular among users of illicit substances. This is because individuals may utilize it to augment the effects of illegal opioids.
Others may misuse the drug because of the mild euphoria, mild dissociation, and other effects it can produce even without augmentation with other substances..
How Does Gabapentin Work?
Understanding how gabapentin works can help explain why this substance is commonly used (and abused). As this medication crosses the blood-brain barrier, it influences neurotransmitters in a way that inhibits or calms them.
This inhibitory property is why gabapentin is FDA-approved to treat certain conditions including seizures, postherpetic neuralgia (nerve pain after a shingles flareup) and restless leg syndrome. All of these conditions are characterized by states of excessive nerve activity.
However, these are not the only medical uses of gabapentin.
About 95% of individuals with a prescription for gabapentin in the U.S. utilize it for its off-label pain management indications. Why is this the case?
There are two main reasons why gabapentin has seen such widespread use in the United States as a pain medicine. The first is related to how pain works and the second one is associated with the opioid crisis.
Pain in the body is communicated to the brain through nerve impulses. Gabapentin may affect how these pain signals are transmitted, shifting how pain is perceived and reducing its debilitating consequences.
Off-label use of gabapentin includes using it for any type of pain beyond FDA-approved uses. As one journal explains, this usage stems from the clinical need to find opioid alternatives that are less harmful to patients.
Is gabapentin addictive? There’s evidence that shows the substance may have addictive qualities and can be detrimental to a person’s wellbeing.
The off-label gabapentin uses extend beyond its use as a pain management medication.
Gabapentin’s effects on cell calcium levels can also influence mental health states. This explains why this drug is widely used off-label for mood disorders and insomnia without robust evidence to justify its benefit for psychiatric conditions.
Gabapentin has many more off-label uses that only a medical professional should evaluate as suitable and safe for you. Among them are:
- Fibromyalgia
- Chronic pain
- Anxiety and depression
- Diabetic neuropathy pain
- Postoperative pain
- Alcohol withdrawal
- Bipolar disorder
- Posttraumatic stress disorder (PTSD)
- Migraine
- Insomnia
- Cystitis
- Hot flashes
- Irritable bowel syndrome (IBS)
- Refractory chronic cough
- Itching
It’s important to understand that these off-label use cases are not based on substantial scientific evidence from clinical trials. Without such evidence, the FDA will not approve their use for these indications.
Acute Gabapentin Side Effects
Here are the most common gabapentin side effects to know:
- Loss of muscle control (ataxia)
- Tiredness
- Sleepiness
- Nausea and vomiting
- Weakness
- Headaches
- Dizziness
- Depression or aggressiveness
- Eye problems (double vision, lazy eyes)
- Constipation or diarrhea
- Fever
- Swelling in hands or legs
- Restlessness in children
- Tremors (shaking)
- Dry mouth
- Memory problems
- Weight gain
- Impotence
- Back pain
- Infection
Gabapentin is a medication that requires strict medical supervision when being prescribed.
The FDA warns that using it with medicines that depress the central nervous system, like opioid pain medicines, antidepressants, anti-anxiety medication and antihistamines (allergy meds), may generate life-threatening breathing difficulties.
The elderly and individuals with respiratory risk factors, such as chronic obstructive pulmonary disease (COPD) and other conditions affecting lung function, should also be monitored if they use gabapentin due to the increased risk of respiratory complications. Gabapentin can be toxic if you have chronic kidney disease so please consult your doctor for guidance and support.
Seek medical assistance if you experience the following more severe gabapentin adverse reactions:
- Feeling suicidal
- Depression
- Anaphylaxis (severe allergic reaction)
- Stevens-Johnson syndrome (flu-like symptoms with severe rash in response to medication)
- Rash or itch
- Rhabdomyolysis (damage of muscle tissue)
- Swelling
- Withdrawal symptoms (like seizures)
Gabapentin Abuse Potential
Is gabapentin a controlled substance? No. Gabapentin was initially considered non-addictive. This explains why it is not a federally controlled substance.
For years, clinicians have mainly prescribed it as a safe medication for pain management, used to replace other medications with addictive properties, such as opioids and benzodiazepines.
However, the safety of gabapentin has recently come into question. The U.K. classified it as a controlled drug in 2019 due to its abuse potential.
Since 2017, several states in the U.S. like Kentucky, Tennessee, and Michigan have classified it as a Schedule V controlled substance due to its potential for abuse. As the DEA reports, 26 additional states have introduced a bill or enacted legislation to schedule gabapentin as a controlled substance.
Why is the misuse potential of gabapentin in question?
Studies show that about 40% to 65% of individuals with a gabapentin prescription misuse it and that approximately one in five persons who abuse opioids also consume gabapentin.
These are worrisome numbers, considering that combining gabapentin with opioids can augment the risk of requiring inpatient hospital admission by 400%. Another report shows that more than 90% of deaths associated with gabapentin also involved opioids.
The abuse of gabapentin is strongly associated with opioid misuse. Gabapentin can potentiate opioid-induced euphoria and may lessen the withdrawal symptoms that people with opioid addiction experience.
Most people who misuse gabapentin consume it via capsules or tablets while a minority may snort it, chew it or inject it. Individuals may use it to achieve feelings of euphoria, calmness, drunkenness, dissociation, sedation and other sensations that resemble the effects of opioids.
Much like opioids, misusers of gabapentin can experience rapidly increased drug tolerance which requires them to escalate their dosage to achieve desired effects. They may also experience dependency.
Gabapentin abuse is also associated with legal consequences typical of addictive substances like alcohol because it can lead to impairment in motor skills and reaction time.
The current situation with gabapentin demands attention. As JAMA Network informs, it’s often co-prescribed with benzodiazepines and opioids which increases the chances of death due to respiratory depression.
Also, clinicians may be unaware of the addiction risks that gabapentin poses. It’s important to screen patients for previous overdoses, substance abuse history, current smoking, mental health challenges and concurrent medications (mainly central nervous system depressants) before prescribing it, as these are all risk factors for gabapentin misuse.
Symptoms of Gabapentin Addiction
If you suspect you or someone you love is addicted to gabapentin then it’s important to seek medical help. Only a licensed professional can accurately diagnose you.
Here are some signs to look out for:
- Consuming more gabapentin than prescribed or using it without a prescription
- Experiencing withdrawal symptoms (like hopelessness, anxiety, depression, mood swings, sweating, restlessness, nausea, tremors or insomnia) when you stop taking gabapentin
- An inability to stop taking gabapentin despite wanting to
- Taking higher gabapentin doses to achieve a desired effect, as you’ve developed tolerance
- Feeling sleepy, having trouble concentrating or remembering things, or a lack of coordination that disrupts execution of your daily tasks.
- Spending lots of time thinking about gabapentin and craving it
- Seeking multiple doctors to obtain additional prescriptions for gabapentin
- Declining performance at work or school and a negative impact on the quality of your relationships
- Gastrointestinal distress with symptoms like nausea and vomiting
- Becoming secretive, isolating yourself from friends and family to hide your gabapentin use
- Experiencing legal problems as you seek ways to acquire gabapentin unlawfully
- Having trouble managing your daily expenses, maybe even borrowing money from closed ones, because you need additional funds to buy gabapentin
Gabapentin Withdrawal
The withdrawal symptoms of gabapentin can be intense. You should only stop taking gabapentin with medical guidance as it will require gradual tapering off to diminish the risk of side effects.
Please seek medical counseling if you are experiencing these symptoms after discontinuing gabapentin:
- Rapid heartbeat
- Anxiety or restlessness
- Pain in your body
- Panic attacks episodes
- Unexplained sweating
- Tremors
- Insomnia
- Upset stomach
- Elevated blood pressure
- Irritability
- Confusion or unresponsive states (catatonia)
- Seizures
You can begin to experience withdrawal symptoms 12 hours after your last gabapentin dosage and these effects can last up to seven days following discontinuation.
Can You Overdose on Gabapentin?
Yes, you can overdose on gabapentin. However, it’s an unlikely occurrence when the drug is taken by itself as most gabapentin overdoses typically involve another substance.
The overdose statistics of gabapentin are alarming. According to the CDC, in one in 10 deaths attributed to a drug overdose, gabapentin was detected in toxicology reports. Its concurrent use with other drugs—in 50% of these cases—was the cause of death. This highlights how severe the consequences of combining gabapentin with other substances can be.
Studies of the drug’s impact on senior adults have shown that when these individuals are co-prescribed gabapentin with elevated doses of opioids for chronic pain, their risk of dying may double. This is due to an augmented likelihood of fatal respiratory depression.
Without medical guidance, don’t combine gabapentin with other depressants like allergy meds, antidepressants and alcohol. It can elevate the risk of life-threatening breathing complications.
Seek medical assistance if you experience any of these signs that may indicate a gabapentin overdose:
- Difficulty breathing
- Extreme drowsiness
- Slurred speech
- Fainting
- Low blood pressure
- Elevated heartbeat
- Impaired coordination
What Are the Treatment Options for Addiction to Gabapentin?
Recovery from gabapentin addiction is possible. Here are some available treatment alternatives to consider.
Detox
Detox is a medical process delivered in specialized facilities that helps individuals safely manage withdrawal symptoms after stopping a substance consumption. Qualified professionals aim to provide a safe and comfortable process by monitoring around the clock and employing medications as necessary to reduce cravings and minimize discomfort.
Inpatient Treatment
Inpatient treatment modalities are sometimes necessary to assist individuals in focusing full-time on recovery. A change of scenery and removing yourself from familiar triggers and stressors can do wonders for the mind and body.
Here, you can access mental health support and 24/7 clinical assistance to help you overcome a gabapentin addiction. You’ll also have the opportunity to meet other persons in recovery and go deep into the causes of addiction. Your care team will help you rebuild your life, face your trauma and begin a long-lasting and healthy chapter for you and everyone you love.
Outpatient Treatment
Depending on your needs and circumstances, outpatient programs that allow you to attend recovery treatment part-time can ideally suit you. In these programs, you will get access to evidence-based treatment while continuing to live at home or even hold a part-time job.
Outpatient treatment offers group and individual therapy to help you understand the causes of your addiction. Some facilities include clinicians who can prescribe medication as needed to help you manage cravings and withdrawal symptoms.
Here, you will rebuild your life. You will develop skills that will serve you for years, address mental health issues and meet other individuals invested in leading healthy lives.
Aftercare
Recovery never stops. After completing treatment, you will rejoin your daily responsibilities and life challenges can pose a threat to a sober life.
Aftercare programs are designed to equip you with life skills, provide clinical and mental health support and offer community help to combat relapse triggers and face life stronger than ever before.
Addiction to gabapentin can happen to anyone, especially in individuals with a history of addiction to other substances. It takes courage to seek help but recovery is possible and treatment that adapts to your life is available. The best version of yourself is waiting to emerge so don’t hesitate to seek the help you need.
