The Risks of Gabapentin Abuse

Gabapentin, a medication commonly prescribed for nerve pain and epilepsy, has become increasingly misused in recent years. While this drug serves an important therapeutic purpose when taken as directed, its potential for abuse can damage your overall well-being. The rising rates of gabapentin misuse have prompted healthcare teams to implement stricter monitoring protocols and sparked discussions about its best practices for prescription use.

What is Gabapentin, and What Is It Used For?

Gabapentin belongs to a class of medications called anticonvulsants and works by altering the way nerves send signals throughout the nervous system.[1] Initially developed to treat epilepsy, doctors now prescribe this medication for several approved and off-label conditions. The medication functions by reducing abnormal brain activity and calming overactive nerve signals that cause seizures and certain types of pain.

Primary care physicians, neurologists, and pain management specialists commonly prescribe gabapentin for numerous conditions. The FDA has approved its use for treating epilepsy, nerve pain from shingles, and restless leg syndrome.[2] Additionally, physicians often prescribe it off-label for conditions like diabetic neuropathy, fibromyalgia, hot flashes, and certain types of anxiety disorders. Research supports its effectiveness in managing various forms of chronic nerve pain that may not respond well to other treatments.

The medication comes in several forms, including oral capsules, tablets, and liquid solutions, with dosing schedules tailored to each person’s specific condition and response to treatment. When starting gabapentin, doctors typically begin with a low dose and gradually increase it over time to reach therapeutic levels. This careful approach helps minimize side effects while allowing the body to adjust to the medication. Most people take the medication three times daily, though schedules may vary based on individual needs and medical conditions.

Is Gabapentin a Controlled Substance?

Gabapentin closely resembles pregabalin, a Schedule V drug in certain states, in both its chemical structure and pharmacological activity.[3] While not federally scheduled by the Drug Enforcement Administration (DEA), increasing concerns about its potential for abuse have led to stricter prescription monitoring and documentation requirements. These regulations were enacted in response to rising rates of gabapentin misuse, particularly in regions heavily affected by the opioid epidemic, where the medication is often used to enhance the effects of other drugs or manage withdrawal symptoms.

What Are Its Primary Effects?

The effects of gabapentin can vary significantly depending on dosage, individual response, and whether it’s taken as prescribed or misused. When taken appropriately, gabapentin produces several primary effects on the body and mind that make it therapeutically valuable for certain conditions:[4]

• Pain reduction: Decreases nerve pain throughout the body by altering how pain signals travel through the nervous system.
• Seizure control: Reduces the frequency and severity of epileptic seizures by calming overactive brain activity.
• Anxiety relief: Creates a calming effect that can help reduce feelings of anxiety and restlessness.
• Sleep improvement: Helps establish better sleep patterns and may increase sleep quality.
• Nerve signal regulation: Stabilizes abnormal nerve firing that contributes to various conditions.
• Muscle relaxation: Provides mild muscle relaxant effects that can help with tension and spasms.

Can Gabapentin Be Abused?

Gabapentin has an increasing potential for abuse.[5] While it was once considered to have low abuse potential, recent research shows that gabapentin can create euphoric effects when taken in high doses or combined with other substances like opioids or alcohol. The medication can produce feelings of calmness, increased sociability, and a marijuana-like high, especially at doses that exceed prescribed amounts. These effects have led to rising rates of gabapentin misuse, with some people crushing and snorting the medication, taking multiple doses at once, or mixing it with other drugs to enhance its effects.

What Are the Signs of Gabapentin Abuse?

Recognizing gabapentin abuse involves understanding both physical and behavioral changes. People who misuse gabapentin may take larger doses than prescribed, seek early refills, or obtain the medication from multiple doctors. They might crush and snort the medication, combine it with other substances, or take it specifically to experience euphoric effects. Changes in sleep patterns, coordination problems, and dramatic mood swings often become more pronounced when the medication is misused.

The social and behavioral signs of gabapentin abuse frequently include withdrawal from regular activities, changes in friend groups, and declining performance at work or school. Someone misusing gabapentin might become secretive about their medication use, appear unusually sedated or confused or experience memory problems. Financial difficulties may arise from purchasing the medication illegally, and relationships often suffer as the person focuses increasingly on obtaining and using the drug. Physical symptoms like severe drowsiness, tremors, and slurred speech typically become more noticeable as abuse continues.[6]

Can Gabapentin Abuse Be Prevented?

Preventing gabapentin abuse requires a collaborative approach between healthcare providers and the people they treat. Several strategies can help reduce the risk of misuse while ensuring those who need the medication can still access appropriate treatment.

• Careful prescribing practices: Doctors complete thorough evaluations and monitor medication use through regular check-ups and drug screenings.
• Patient education: Clear communication about proper usage, risks, and the importance of taking the medication exactly as prescribed.
• Prescription monitoring: Healthcare teams track prescription patterns and refill requests through state monitoring programs.
• Safe storage methods: Keeping medication in locked containers and properly disposing of unused pills through approved take-back programs.
• Regular check-ins: Maintaining open communication with doctors about medication effectiveness and any concerns.
• Risk assessment: Healthcare providers evaluate personal and family history of substance use before prescribing.
• Documentation requirements: Keep detailed records of all prescriptions and maintain a single prescribing doctor.
• Alternative pain management: When appropriate, explore additional treatment options like physical therapy or counseling.
• Gradual dose adjustments: Making medication changes slowly and only under medical supervision to prevent withdrawal.

What To Do If You Need Help

If you recognize signs of gabapentin misuse in your own life, reaching out for help can open the door to recovery. Speaking with trusted family members or close friends about your concerns can provide essential emotional support and help you feel less alone. Your loved ones can offer encouragement, assist with practical needs, and support you through treatment.

Having an honest conversation with your healthcare provider about gabapentin use is vital for your safety and recovery. Your doctor can help develop a supervised plan to adjust or stop the medication safely, recommend alternative treatments for your underlying conditions, and coordinate your care with addiction specialists. Remember that doctors are trained to help with medication concerns and will focus on your well-being rather than judgment.

Professional addiction treatment offers comprehensive support for recovery from gabapentin misuse. Treatment programs can provide medical supervision during withdrawal, counseling to address underlying issues, and strategies to prevent future substance use. These programs often include individual and group therapy, family support services, and aftercare planning. Your healthcare provider can help connect you with appropriate treatment options, or you can contact addiction specialists directly to learn about available programs. Many treatment centers offer confidential assessments and can work with you to find a program that fits your needs and circumstances.