Gabapentin Abuse
In 2021, Gabapentin was ranked among the top 10 most prescribed medications in the U.S. In fact, it was reported as the 6th most prescribed drug in the nation. Gabapentin was initially approved in 1993 by the FDA for the treatment of epilepsy and was marketed as a medication that is well tolerated, and effective with a low potential for abuse. Today research has found the medication has the ability to tackle a wide range of ailments, which has helped make it one of the most popular medications in the nation. The drug is easily prescribed without restriction with users being prescribed a wide range of doses. The flexibility in treatment use along with overprescribing and ease of accessibility, have contributed to the growing concern of gabapentin abuse.
According to clinical studies, neuropathic pain affects up to 8% of the U.S. population. Gabapentin is the most commonly prescribed medication used to treat neuropathic conditions. In 2004, it was approved as an analgesic treatment for post-herpetic neuralgia. Today it is commonly used to treat conditions such as seizures, restless leg syndrome and pain associated with shingles.
Gabapentin is more popularly used in off-label treatments of hot sweats, nerve pain, pain after surgery, kidney-related pain, nerve damage associated with diabetes, mood disorders, anxiety, bipolar disorder, PTSD, substance use disorders, insomnia, borderline personality disorder, migraines, vertigo and menopausal conditions. In fact, off-label usage of the drug is reported to range from 83-95% of all gabapentin use. The popularity of off-label usage can also be a driving factor in gabapentin abuse.
What is Gabapentin and how does it work?
Gabapentin is a psychotropic medication that works by crossing the blood-brain barrier and mimicking inhibitory neurotransmitters like GABA. It binds to a type of calcium channel in the nerve cells that modify how the nerves function. This helps control specific types of nerve pain as well as treat seizure disorders. Gabapentin acts on the nervous system to reduce nerve transmission to the rest of the body causing the user to instead experience feelings of calm and relaxation.
Brand names of the medication include Neurontin and Gralise. Street names of the medication include Gabbies or Johnnies. Gabapentin is widely considered to be nonaddictive and can be prescribed in varying doses from 1800mg to 2400mg per day.
Side Effects of Gabapentin Use
- Calm and relaxation
- Euphoria
- Drowsiness and fatigue
- Dizziness
- Headache
- Dry mouth
- Weight gain
- Swelling of hands, feet and ankles
- Back or joint pain
- Flu-like symptoms – nausea, fever and body aches
- Rapid involuntary eye movement
- Hyperactive behavior
- Changes in thinking
- Increased heart rate
- Memory problems
- Confusion
- Psychosis
- Suicidal thoughts and behavior
- Withdrawal and overdose
- Tolerance, dependence and addiction
What is the difference between Misuse and Abuse?
Misuse of a drug is defined as using a drug for a purpose other than indicated. This includes taking another person’s medication, unprescribed or non-recommended routes of drug administration and taking a higher dose of the medication prescribed. Abuse of a drug is defined as persistent use of a drug despite resulting in negative consequences. Often time when a drug is being abused, users develop a dependence. Dependence refers to physical and psychological elements associated with abuse that can include compulsion to use the drug, tolerance for the drug and experiencing withdrawal symptoms when not using the drug.
The rise of prescriptions in Gabapentin Abuse
Today, there is a significant increase in prescriptions written for gabapentin, which has been one factor in the rise of gabapentin abuse. In a report from JAMA Internal Medicine, studies found that U.S. prescriptions for gabapentin climbed from 2006 to 2018. In 2019, the total prescriptions dispensed for gabapentin totaled around $68.3 million. In 2020, the total prescriptions dispensed totaled around $69 million. And in 2021, the total prescription dispensed totaled an estimate of $70.9 million.
The rise in prescriptions can be due to many different factors including the pharmaceutical industry’s promotion of using it for off-label treatment. Because of this, the manufacturer Pfizer pleaded guilty to multiple counts of illegally promoting the drug’s off-label uses and resulting in about $430 million dollars in fines.
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Other factors driving the rise in Gabapentin Abuse
Gabapentin is a prescription medication without any additional or strict controls. It is generally inexpensive, readily available and easily accessible to the public. The combination of these factors makes it much more appealing to use and abuse. Research has found the reasons for misuse and abuse were often related to substance abuse behaviors and using other drugs such as opioids, benzos and alcohol. Behaviors such as recreational use, management of mood and anxiety, and self-medication, to help reduce cravings for other drugs, to substitute for other drugs or to avoid withdrawal from other drugs were common motivations for abusing gabapentin.
Part of gabapentin abuse may be driven by dependence and withdrawal symptoms. Some patients have taken as little as 400mg per day for three weeks and experience withdrawal symptoms that include anxiety, pain, nausea, fatigue and restlessness. Withdrawal symptoms can begin as soon as 12 hours after the last medication dose and can last for up to 10 days. Therefore, those who abuse the drug, often take it to put off symptoms of withdrawal.
Other studies find that gabapentin abuse is more likely to occur in those who already have an addiction to other substances. In 2019, the FDA issued a warning over the potential risks of respiratory depression in patients taking gabapentin in combination with other central nervous system depressants such as opioids, benzo and antidepressants. The combination of gabapentin with opioids, can cause an intense euphoria and enhance the psychological symptoms of opioids. One study found that almost a quarter of patients with co-prescriptions of opioids and gabapentin were receiving more than three times their prescribed amount of gabapentin to supply their addiction. Many of these cases saw that patients had a prescription for the drug, but took higher doses than recommended.
Effects of Gabapentin Abuse
- Coordination problems
- Tremors
- Anxiety and depression
- Suicidal thoughts
- Drastic mood changes
- Forgetfulness
- Difficulty speaking
- Hallucinations
- Dependence, tolerance, addiction and overdose
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Treatment for Substance Use Disorder
Today, gabapentin is one of the most popularly prescribed medications across the nation. Its ability to address various ailments makes it popular for off-label uses in a variety of treatment methods. It is generally considered a safe and effective drug with a very low potential for abuse. However, the rise in prescriptions, ease of access and low restrictions on the drug make it easy to misuse and abuse. Researchers and clinicians are now seeing an emerging pattern of misuse and its potential for abuse is being recognized where some states are considering classifying the drug as a controlled substance.
Hotel California by the Sea is a behavioral health treatment center with programs that specialize in treating addiction to prescription medication. We offer treatment at all levels including detox, residential, PHP and IOP. We utilize evidence-based treatment methods including CBT, DBT and EMDR therapy. Hotel California by the Sea specializes in treating co-occurring mental health conditions and is dedicated to helping our clients reach their goals of sobriety and overcoming their addiction.
References:
https://www.addictioncenter.com/drugs/gabapentin/
https://www.addictions.com/gabapentin-abuse/how-to-know-if-someone-you-love-is-high-on-gabapentin/
https://www.statnews.com/2017/07/06/gabapentin-becomes-target-of-opioid-abuse/
https://www.usatoday.com/story/life/health-wellness/2024/10/01/gabapentin-used-for-side-effects/75220690007
https://psychiatryonline.org/doi/full/10.1176/appi.pn.2023.11.11.29
https://pmc.ncbi.nlm.nih.gov/articles/PMC5573873
https://pmc.ncbi.nlm.nih.gov/articles/PMC3404313/