Gabapentin, a drug used to treat nerve pain and epilepsy, has snuck up on authorities, physicians, and the general public, to become one of most overprescribed and misused medications in the United States today. In fact, it recently became the fifth-most prescribed drug in the country. In 2016, 64 million gabapentin prescriptions were sold in the U.S.—a 60% increase from 2012 sales. This is especially worrying as 20% of those prescriptions are being used recreationally.
Gabapentin abuse is rampant, and it’s also very dangerous. In 2011, the number of emergency room visits for gabapentin were five times higher than they were in 2008.
What is gabapentin and how is it contributing to the opioid epidemic?
Gabapentin has become a major player in the current opioid epidemic, with approximately 22% of people abusing opioids also abusing gabapentin. But what exactly is gabapentin?
Gabapentin (brand name Neurontin) is an FDA approved drug for controlling epileptic seizures, and for the relief of neuropathy, a kind of pain caused by nerve damage, which impacts approximately 8% of the U.S. population. Gabapentin is generally considered to be a good alternative to opiate drugs for patients with chronic pain, and its list of common off-label uses—such as for restless leg syndrome, fibromyalgia, and marijuana and alcohol dependence—is rapidly growing. Gabapentin is a sedative and anticonvulsant that decreases abnormal activity in the brain and alters how our bodies sense pain. It can be taken in tablet, capsule, and oral liquid forms.
Neurontin was introduced in 1993, and the generic form of gabapentin appeared in 2004. As a relatively new drug, gabapentin is still being studied, and negative factors such as side effects and the potential for abuse and addiction are still being discovered. Most qualified physicians freely prescribe the drug with no idea of its great potential for abuse, a problem demonstrated by the fact that many opioid-addicted inmates try to get doctors to put it on their approved list of medications before they start serving time, so that they can still get high behind bars.
Gabapentin can augment opioid-induced euphoria, create euphoria when used with CNS depressants, relieve drug and alcohol withdrawal symptoms, cause pain relief and an intense sense of calm, and bypass the blocking effect of opioid addiction treatment medications so that patients can get high while supposedly in addiction recovery. These patients can easily get away with this too, because gabapentin is not one of the drugs routinely tested for in court-mandated or rehab facility drug screenings. Adding a gabapentin test to the screening process would cause extra expense, so it is only tested for when there is already evidence of gabapentin abuse. Also, because the potential for gabapentin abuse is only recently being recognized, many medical professionals would consider screening patients for the drug to be unnecessary.
What are the causes of gabapentin abuse?
Gabapentin abuse is proliferating for a number of reasons, the first of which is the drug’s desirable physical and psychoactive effects. These effects can be somewhat unpredictable between users, partly due to biology, but expectations, dosages, and conditions of use can lead to significant variations in experience as well. However, most people who abuse gabapentin agree that the drug causes:
- a marijuana-like high
- improved sociability
- a sense of wellbeing and calmness
In addition to these desirable effects, gabapentin abuse can also lead to a zombie-like feeling, and many users say it is difficult to predict when and how the zombie effect will appear, although it is most common at high doses.
Street names for the drug are johnnies, gabbies, and morontin, and gabapentin abuse most often occurs in combination with other drugs like opioids, anti-anxiety meds like Xanax or Valium, muscle relaxants, and even alcohol, because the interaction between substances produces euphoria. Gabapentin can cause euphoria on its own, but only in high doses, and at high doses, dissociative and psychedelic effects can also occur. Some users appreciate these more intense reactions, but many others do not.
Most physicians have no idea of how widespread gabapentin abuse has become, or even that the drug can be abused at all. Knowledge of this potential is only common among regular drug users and in prison populations. Many drug users take gabapentin with crystal meth to prevent “tweaking,” the uncomfortable agitation and paranoia that often accompanies a stimulant high, and it is sometimes used to cut heroin, which of course, amplifies the drug’s sedating and euphoric effects. Professionals working in the U.S. prison system are discovering that many inmates consider gabapentin to be a “jail substitute” for their usual drugs of abuse. Getting prescriptions for gabapentin is fairly easy, as it has numerous off-label uses, and very few doctors recognize it as a drug of addiction and abuse. They will freely prescribe gabapentin, because they believe there is no reason for patients to take it other than for the condition it was prescribed to treat.
Gabapentin has been demonstrated to be addictive, however, both psychologically, and physically, causing withdrawal symptoms in users who try to quit or cut down on the drug. Addictions to gabapentin are made more dangerous and complicated to treat because gabapentin abuse is usually accompanied by an addiction to another substance or substances.
Why is gabapentin abuse so common?
Gabapentin abuse is so common that one in five prescriptions are diverted for illicit use. How is this possible?
For one, gabapentin is not a controlled substance. Because it affects GABA neurotransmitters, but does not appear to affect the opioid receptors that cause the euphoric and sedating effects of drugs like benzodiazepines and opioids, it is officially considered to not be a drug of abuse, and to not be addictive. However, its effects are similar to some of the most popular intoxicants—such as marijuana, alcohol, and opioids—and regular use leads to physical dependence and withdrawal symptoms, all of which point to the drug in fact being addictive. And gabapentin has inarguably become a drug of abuse; general awareness and our legal system just haven’t caught up to this development yet.
With most doctors considering gabapentin to be a safe drug for treating a range of conditions, and a particularly good alternative to opioids for chronic pain, the drug is widely overprescribed. When taken as directed, on its own and in lower doses, gabapentin can be a safe and effective medication for pain, seizures, and other legitimate medical conditions. But when taken in high doses, or in any dose along with an opiate, alcohol, or anti-anxiety medication, the interaction will cause an addictive, euphoric high.
Most doctors are honestly unaware of the risk of abuse with gabapentin, and believe they are making a positive choice for their patients when they prescribe it. In fact, doctors are increasingly turning to gabapentin as a treatment for chronic pain and other conditions they would have once prescribed opiates for. They make this choice so that they will not be contributing to the opioid epidemic, sadly unaware that these 64 million nationwide prescriptions are playing a major role in the very problem doctors are hoping to remedy.
What are the side effects of gabapentin?
It is easy for patients to manipulate prescribers into giving them gabapentin, because doctors have no reason to suspect their patients of gabapentin abuse. If their patients complain of symptoms that can be diagnosed as restless leg syndrome, for example, they won’t think twice before prescribing the drug. Many people take gabapentin every day for legitimate conditions, and for them, the drug can be a lifesaver. But even in those cases, and even when taken as directed, gabapentin side effects are still possible. These may include:
- Stomach problems
- Panic attacks
- Jerky movements
- Ear, back, and joint pain
- Uncontrolled eye and mouth movements
- Double vision
- Loss of coordination
- Dry mouth
- Itchy, red eyes
- Flu-like symptoms
- Temporary loss of memory
- Speech difficulties
- Dangerous impulses
- Angry, aggressive, or violent behavior
- Suicidal thoughts and intent
High doses will increase the frequency and severity of gabapentin side effects, as well as the potential for a zombie-like dissociative effect. Mixing gabapentin with alcohol, opiates, or anti-anxiety medications such as Ativan, Xanax, or Valium, will also increase the frequency and severity of side effects.
Signs of Gabapentin Abuse
There are signs you can watch out for that indicate when someone you love has an addiction to any prescription medication, not just gabapentin. These can include:
- Exaggerating or lying about symptoms to doctors
- Doctor shopping- seeking out multiple physicians or clinics to obtain more pills
- Preoccupation with the drug and how many pills are left
- Needing to fill prescriptions too soon; running out of pills too early
- Anxiety over not being able to get more pills
- Refusing to quit despite side effects
- Refusing to quit despite financial, social or legal consequences
- Failed attempts to quit
- Withdrawal symptoms when attempting to quit or when the drug begins to wear off
Another way to spot gabapentin abuse is to look for signs of a gabapentin high. These include:
- Unexplained giddiness
- Unusual sleepiness
- Increased talkativeness and sociability
- Stopping talking entirely
- Intense calm
- Unexplained mood swings
Get Help for Gabapentin Abuse Today
Treating gabapentin abuse and addiction is complicated by two major factors—the intensity of the withdrawal symptoms, and the fact that most people addicted to gabapentin are also addicted to another intoxicant at the same time. Nevertheless, recovery from gabapentin abuse is still possible.
Treatment for gabapentin addiction will always begin with a slow, careful tapering of the medication to minimize the unpleasant and potentially dangerous withdrawal symptoms. For this reason, you must have a doctor’s guidance when quitting gabapentin, and you should consider an inpatient detox at an addiction treatment facility with 24/7 medical staff. The doctors and nurses will be able to monitor your condition and respond immediately to any withdrawal complications.
Common symptoms of gabapentin withdrawal are:
- Abdominal pain
- Muscle pain and spasms
- Changes in appetite
Two very dangerous symptoms of gabapentin withdrawal are seizures and suicidal thoughts. Medical supervision and treatment is advisable to protect you from these serious withdrawal complications.
After the detox and withdrawal phase of treatment, you will start focusing on counseling and behavioral therapies, which are effective treatments for all forms of addiction. You will just need to work with your treatment facility and counselor to determine the best kind of behavioral therapy for your needs.
Cognitive behavioral therapy produces excellent results for most people in recovery. With cognitive behavioral therapy, you are taught new ways of thinking about drugs and drug use. You also learn to identify your addiction triggers, and new coping techniques and perspectives that you can use in response to those triggers and any other kind of drug cravings. Contingency management is another form of behavioral therapy; it involves patients getting cash prizes or vouchers for healthy rewards every time you get a drug-free lab screening.
Behavioral therapy can be helpful for co-occurring mental health disorders, such as anxiety and depression, which commonly accompany substance abuse. These problems are also side effects of both gabapentin abuse and gabapentin withdrawal. Learning new ways to process your emotions and healthy coping techniques can help produce a more content, stable, day to day existence and a happier future. Some of these healthier coping responses include deep breathing, social interaction, physical exercise, and many other alternatives. Exercise is particularly effective for substance abuse recovery because it causes the brain to release dopamine and other feel-good neurotransmitters, which will simultaneously improve your mood and reward you for healthy behavior. These and other tools you will acquire during treatment for gabapentin abuse treatment will help you avoid relapse, and will give you the foundation to build a positive, productive life after treatment.
To find the right addiction rehabilitation facility for your needs, consult the Addictions.com rehab directory.