As far as prescription drugs go, gabapentin might seem like it’s not addictive. After all, it’s not scheduled as a controlled substance. The schedule categories display the addiction potential of a drug. Most painkillers, psychiatric medication, and stimulants are controlled by the government. You do still need a prescription to buy gabapentin, of course. But the lack of a control label suggests low abuse potential. That’s not the whole truth. Gabapentin abuse can and does happen. When it comes to your health, you can never be too safe. Here’s an overview to inform you on this potentially addictive drug.
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What Is Gabapentin?
Gabapentin belongs to the anticonvulsant class of medications. It was approved by the FDA somewhat recently in 1993. In 2000, the FDA further approved it for children. It was first sold under the brand name Neurontin. A generic version was made available in 2004. Other common brand names are Gralise and Horizant. Gralise is an immediate-release medication. Horizant, on the other hand, is an extended-release tablet.
Approved Uses for Gabapentin
The FDA has approved this drug for treating seizures and neuropathic pain. It does this by influencing certain chemicals and nerves in the body. Gabapentin can be used to treat epilepsy. This includes complex partial and simple partial seizures. However, research has shown limited effectiveness in epilepsy treatment. Neurontin is widely used for pain management. That’s especially true in cases of nerve pain caused by the shingles virus. Gabapentin targets different brain receptors than opioids and benzodiazepines. This accounts for its presumed low abuse potential.
Common Off-Label Uses
Neurontin is prescribed for a range of off-label purposes. Most gabapentin prescriptions are given for reasons that haven’t been FDA approved. In 2012, it was reported that this is true 83% of the time. Unfortunately, doctors don’t completely understand how this medication works. That’s why it’s hard to say how effective off-label use is. Some research suggests that it can treat:
- Hot flashes
- Restless legs syndrome
- Migraines
- Insomnia
- Bipolar disorder
- Attention deficit disorder
- Anxiety disorders
- Diabetic neuropathy
- Complex regional pain syndrome
- Alcohol withdrawal symptoms
- Trigeminal neuralgia
A Recent Upswing in Recreational Use
Gabapentin is not considered a controlled substance. Until recently, the risk of becoming addicted to it was low. However, abuse is becoming increasingly common. This is especially true with narcotic users and addicts. It’s crucial to test for illicit Neurontin use. Doctors often don’t catch its presence in patients who take opiates for pain management. In 2016, a small study was done using pain and addiction center patients. It found that 70 out of 323 patients were using Neurontin without a prescription. Researchers at ARIA Diagnostics found:
- 56% were using it in combination with an opioid.
- 27% were using it with an opioid and muscle relaxant or anxiety medication.
- 8.6% combined it with other various substances.
The last few years have seen a large uptick in Neurontin prescriptions. A 2015 report by IMS Health found that 57 million were written in the US. That amount shows a 42% increase since 2011. Many of these prescriptions end up falling into the wrong hands. Even before the upsurge, misuse was becoming more common. The Drug Abuse Warning Network cited statistics gathered between 2008 and 2011 as proof. Hospital visits for Neurontin abuse had increased five times in urban areas.
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Why Does Gabapentin Appeal to Addicts?
Neurontin has been known to cause feelings of euphoria. Adverse effects include hallucinations and “feeling high”. Feeling doped up is another adverse effect. Increased energy and giddiness have also been reported. Some patients describe a marijuana-like high. That is, a calming sense. Many don’t have this experience, however. It comes down to the user and the dosage they receive. Statistics show that prescription drug addictions are a huge problem. Among existing addicts, gabapentin poses a risk for abuse. Combining it with other intoxicants results in an increased high. This is why opiate users, in particular, tend to take it with their drug of choice. Individuals with opioid addiction are always chasing that “first high”. Continued opiate use builds a tolerance. This makes it harder to get the feeling they’re after. It also leads to a higher risk of overdose. It’s easy to lose control when taking higher doses. Using a narcotic and Neurontin cocktail presents the perfect solution for addicts. This is especially true because it’s not a controlled substance. As a result, access is relatively easy. The drug’s price is also appealing. It can cost as little as $10 for 90 pills. Court-ordered drug tests often don’t screen for gabapentin. Many addicts on probation or in treatment use it as a way to get high. It’s a loophole to keep abusing drugs while testing clean. Drug dealers have even begun using gabapentin to cut heroin. Methamphetamine users take it in an effort to “mellow out”. Street names for Neurontin include Quell, “gabbies”, and morontin. A study of case reports on the drug turned up shocking results. An estimated 1.1% of the population misuse this medication. Among patients in addiction treatment, the number rose to 22%.
Gabapentin Abuse in the Prison System
Neurontin abuse among prisoners is a serious problem. Many inmates with drug addictions already know its street uses. They often view it as a “jail substitute” for their drug of choice. Gabapentin’s popularity in prison predates recent widespread abuse. Correctional facilities were the first to see its dangers as a result. Prisoners abusing it on the inside add to the growing street market. Jeffrey Keller, MD, has first-hand experience with Neurontin and the correctional system. He serves as chief medical officer of Centurion. As such, he’s seen the dark side of this drug. Centurion offers healthcare services to inmates. To him, gabapentin is “one of the most abused and diverted drugs” in jails. Outside of the system, he points to a lack of awareness. Doctors often don’t realize its recreational uses. In 2004, there was a study at a Florida prison facility. It focused on inmates receiving Neurontin. Of the 96 individuals surveyed, only 19 had a prescription. Five had histories of cocaine abuse. They reported crushing and snorting the pills. Almost all claimed the high was similar to a cocaine buzz. This study led to many prisons banning the use of gabapentin completely.
How Can a Gabapentin Addiction Affect Your Health?
Long-term use of Neurontin can cause physical dependence. This increases the chance of withdrawal symptoms. These symptoms occur if you stop taking the drug. Users who experience feelings of euphoria can develop a psychological addiction. Abusing gabapentin will result in a higher risk of overdose. They also face increased side effects. Side effects include but are not limited to:
- Drowsiness
- Dizziness
- Poor coordination
- Abnormal eye movements
- Double vision
- Hallucinations
- Weakness
- Uncontrollable laugher
- Feelings of euphoria
- Swelling of the extremities
- Trouble speaking
- Increased appetite and weight gain
- Memory loss
- Dry mouth
- Heartburn
- Unsteadiness
- Back or joint pain
- Ear pain
- Itchy, red eyes
- Anxiety
- Fever
- Suicidal thoughts
- Body tremors
- Nausea
- Vomiting
- Flu-like symptoms
Taking gabapentin recreationally can result in adverse reactions. Some of the reactions you might experience are:
- Fainting
- Rashes
- Swelling of the face or mouth
- Seizures
- Coma
Even first time abusers are at risk. An initial high dose can cause great damage. A lack of tolerance to Neurontin may overwhelm your body. This can lead to overdose. A severe crash once the effects wear off is also common. Symptoms can be similar to those of benzodiazepine withdrawal. These can include feelings of anger, anxiety, confusion, and restlessness.
What Are the Common Gabapentin Abuse Methods?
For long-term patients, the dosage won’t exceed 1800 to 2400 mg per day. Recreational users take anywhere from 300 to 5000 mg orally. The FDA has reported overdoses of 49 grams and more. The dosage depends on the user and their tolerance level. Individuals will often use additional, smaller doses of gabapentin as “bumps”. These are intended to maintain the high. Most take the pills whole. Still, some prefer to “parachute” them. Parachuting is when pills are crushed. Then, they’re placed inside tissue paper to be swallowed. The result is reportedly a faster, stronger high. Snorting is another common form of Neurontin abuse. This is done by grinding or crushing the pills. Afterward, the user inhales through the nose. Compared to oral ingestion, snorting leads to a faster high. This is because the drug enters the bloodstream very quickly. However, this comes at a cost. It can increase the likelihood of addiction.
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Signs of Gabapentin Abuse in Someone You Know
Addiction is far more common than most people realize. It’s important to know what to look for. If you think someone is abusing Neurontin, be informed. Recognizing the signs could make all the difference. Recreational drug users start to show personality changes. They do and say things they normally wouldn’t. It’s common for them to act secretive and start seeing new friends. Most begin to show less interest in work or school. Their drug of choice becomes the only thing they care about. Many addiction treatments and recovery patients abuse gabapentin. A report by the NHS of England stated this clearly. Someone with a history of substance dependence needs monitoring. If they are prescribed Neurontin, monitoring can avoid misuse. Addicts can become desperate to get more of the drug. This can lead to incidents of stealing. It can also result in more upsetting behavior. Often, drug-seeking involves deception. They may visit multiple doctors or hospitals to get a prescription. Some even resort to forging or stealing one. Other signs of misuse can include:
- Worsening personal hygiene and grooming habits
- Not quitting despite social, financial or legal problems
- Frequently switching doctors
- Lying about symptoms
- Repeated attempts at quitting
- Withdrawing from friends and family
When planning an intervention, it’s important to be prepared. Consulting an expert is always a good idea.
It’s Very Possible to Overdose on Gabapentin
The federal government has yet to name this drug a controlled substance. That doesn’t mean the dangers aren’t real. It’s true that Neurontin doesn’t claim as many lives as opiates. Still, its misuse and abuse are cause for concern. In 2011, there was the first known suicide by gabapentin overdose. In 2015, there were 109 fatalities in West Virginia where it was a factor. Usually, the substance was combined with other intoxicants. During the same year, statistics on similar deaths in England and Wales came out. 137 fatalities involving gabapentin and pregabalin were reported. Pregabalin is a Schedule V controlled substance in the US. It’s a very similar drug to gabapentin. 29 of the deaths had nothing to do with opioids. Opioid abuse played a factor in the rest. In 2016, deaths in the UK related to pregabalin totaled 111. This was a huge rise compared to previous years. A new study was published on October 3rd, 2017. It analyzes gabapentin and opioid-related deaths. The study sought to see the risks of combining these drugs. It also considered the chances of overdose and death. Researchers studied deaths in Ontario, Canada caused by opioid abuse between 1997 – 2013. The findings were conclusive. Combining Neurontin and opioids results in a much stronger chance of overdose. The risk of death when using them both increases by 60%. The difference between gabapentin and opioid overdoses is noteworthy. There is no antidote if this Neurontin reaches toxic levels. For opioids, a number of medications can be administered. They are crucial for reversing the effects of an overdose. Even early intervention in gabapentin overdoses might not be enough. Permanent physical and mental damage is possible. Overdoses related to Neurontin abuse often involve opioids and/or alcohol. This is why it’s troubling that the drug is used to cut heroin. If this practice becomes popular, it could worsen the opioid crisis. Instances of heroin overdoses could rise even further. Signs of a gabapentin overdose can include:
- Ataxia (loss of coordination)
- Labored breathing
- Ptosis (drooping upper eyelid)
- Slurred speech
- Dizziness
- High or low blood pressure
- Tremors
- Drowsiness
- Depression of the respiratory system
- Excitation
- Double vision
- Rapid heartbeat
- Diarrhea
- Lethargy
- Unusually slow heart rate
Managing Gabapentin Withdrawal Symptoms
Withdrawal happens in people who have become dependent on a drug. It occurs when a substance is suddenly removed from the body. It can also be the result of a rapid decrease in dosage. Symptoms of gabapentin withdrawal show up after 12 hours since the last dosage. This drug has a relatively short half-life. This means that symptoms can be very serious. It’s important that help is available for people intent on stopping. Individuals who want to stop taking Neurontin should keep a few things in mind. First, it’s important to set aside a recovery period. Having a stable support system is also essential. Long-term abusers should prepare for a challenging experience. Withdrawal can also be hard for people with medication sensitivity. The higher a dose, the longer it takes to leave the body. Tolerance to gabapentin builds very quickly. This means that physical dependency can happen relatively fast. It’s crucial to note that willpower is never the answer. Going “cold turkey” can lead to life-threatening health risks. Instead, a gradual taper is usually best. This involves slowly reducing a patient’s dosage. Finding a practitioner who specializes in this method is best. There is a wide range of Neurontin withdrawal side effects. The process can trigger severe changes in mood. Psychological problems can also present. This is especially true for young adults and children. Other withdrawal symptoms include:
- Sweating
- Anxiety
- Nausea
- Changes in appetite
- Crying spells
- Depression
- Dizziness
- Feelings of fatigue
- Headaches
- Insomnia
- Irritability
- Itchiness
- Muscle pain
- Restlessness
- Seizures
- Spasms
- Stomach pain
- Suicidal tendencies
What Is Being Done to Address Gabapentin Abuse?
Recent statistics about Neurontin addiction have shocked the public. Many ask why it isn’t being regulated. On December 1st, 2016, the State of Ohio Board of Pharmacy took a stand. They acted to try to stop the problem. The new measure was a mandatory report system. Pharmacies, wholesalers, and physicians must submit gabapentin sales records. This way, it will be easier for the government to monitor misuse. Officials hope that this will help keep the drug out of the wrong hands. Unfortunately, much still needs to be done. A change in classification would go a long way. Many prescriptions will fall through the cracks meanwhile. Other states that monitor Neurontin prescriptions. They include Massachusetts, North Dakota, and West Virginia. Kentucky named gabapentin a Schedule V controlled substance on July 1, 2017. Schedule V substances have limited narcotic properties. The government considers them to be “relatively safe”. If you are a Kentucky resident with a Neurontin prescription, here are a few things to keep in mind:
- The prescription is no longer valid if given by a Physician’s Assistant. PAs are may not prescribe controlled substances.
- Plan ahead. Current gabapentin prescriptions will only be good for five refills.
- Only doctors registered with the DEA can dispense controlled substances.
- Prescriptions given after January 1, 2017, cannot be transferred to a new pharmacy.
- Samples of this drug will no longer be made available.
- Offenders caught selling Schedule V drugs face prison time. They can also be fined a maximum of $100,000.
Gabapentin Abuse Isn’t Limited to the US
Neurontin is becoming a hot topic in the UK as well. Public Health England reported growing concerns over the drug in 2014. This was mostly due to an increase in gabapentin related deaths. In January 2016, coroners began testing for it in cases requiring a toxic screen. The Toxicology Unit at Imperial College analyzed these reports. In drug-related deaths, this medication is regularly present. Studies like this are raising awareness for the dangers gabapentin can pose. Things may finally change if enough attention is raised. More officials will begin to see the threat of Neurontin abuse. Also in early 2016, UK government advisors called for a change of classification. This would oversee gabapentin be named a “class C” controlled drug. The same would apply to pregabalin. Professor Les Iverson, chair of the Advisory Council on the Misuse of Drugs, lead the charge. He sent a letter to Home Office Ministers warning them. In it, he says that these drugs pose a high risk of abuse. Illegal distribution is a concern as well. Pfizer, the company that markets Neurontin, “strongly disagreed”. In a statement, the drug manufacturer said they were “extremely concerned”. They explained that a change in classification could harm many. Those being treated with gabapentin could suffer as a result. The company claimed that the advice officials received was inaccurate and misleading. They also stated that controlling the drug could negatively impact the healthcare system. As of 2014, Pfizer had paid $945 million in Neurontin settlements. Most of that money went toward cases accusing the company of marketing for off-label uses. Most UK doctors support the move. They agree with making Neurontin and pregabalin controlled substances. In September, 2017, the UK government announced a change. Pregabalin will become a class C drug. The ruling came after a huge spike in related deaths. Last year, the numbers reached a total of111. Patients will now have to renew their prescriptions month-to-month. The government didn’t include gabapentin in this decision.
Are You Addicted to Gabapentin?
If you’re not sure, take a step back. Consider the physical and psychological signs. These can include:
- Feeling poorly once the drug begins to wear off
- Experiencing insomnia, constant sleepiness, or nightmares
- Having bloodshot or watery eyes
- Showing less interest in physical appearance
- Talking with slurred speech
- Constantly thinking about the drug
- Feeling anxiety if you’re not able to get your hands on it
- Not being able to quit even if you want to
- Lying to friends and family members
- Withdrawing from hobbies and responsibilities
What Are the Options for Gabapentin Addiction Treatment?
Treatment for a gabapentin addiction usually starts with a detox program. This allows your body to get rid of the drug safely. Medical supervision is available throughout the process. Afterward, individuals can enter treatment centers. These can be inpatient, outpatient, or residential. It’s important to do your research when choosing a facility. Inpatient treatment is a good option for severe addicts. They’re also recommended for those who need intensive care. It’s beneficial helpful for people with co-occurring health issues. Such programs offer a safe environment. They come with minimal triggers. Patients receive a tailored treatment plan. These address many individual needs. Residential treatment is best for those who require a long stay. Constant medical supervision is one of the perks. These facilities offer a high level of structure. They offer a great variety of services. Patients can get nutritional counseling, family therapy, aftercare and more. Outpatient treatment is a great way to continue recovering. It’s a great asset after an inpatient or detox program. It can also be helpful in the early stages of addiction. Patients can live at home. They are still expected to attend therapy weekly. Support groups can be helpful before, during, or post-treatment. Connecting with those facing the same struggles is a fantastic idea. Groups like these are also an opportunity to build a support network. People who’ve been in recovery for years can pass on a lot of wisdom. Taking steps to avoid a relapse while recovering is crucial. Finding someone trustworthy and relatable to talk to is one of the best ways to stay on a journey toward health and happiness.
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