Gabapentin Addiction

Gabapentin Addiction

What is Gabapentin?

Gabapentin is usually used to treat epilepsy and is not viewed as an addictive, controlled substance by the United States federal government. Unfortunately, the use and abuse of the drug are on the rise and are creating additional complications in the ongoing opioid epidemic. Let’s look at what gabapentin is, how it is used and abused, the complications that can arise from its use, symptoms of withdrawal, and treatment for gabapentin addiction.

How is Gabapentin Used?

Gabapentin is a synthetic prescription medication. First formulated in 1993, it has been approved by the U.S. Food and Drug Administration (FDA) for the following uses:

Seizure control: It is used to control focal seizures (also called partial seizures) in people who have epilepsy. It is usually used in combination with other medications when used for this purpose. (Brand name: Neurontin)

Nerve pain: It is used to treat nerve pain that results from the herpes virus or the herpes zoster virus, also known as shingles. (Brand names: Gralise, Horizant)

Restless leg syndrome: The name brand Horizant is used to treat restless leg syndrome.1

Gabapentin is administered in tablet, capsule, or liquid form. It works by altering the electrical activity in the brain and changing the activity of neurotransmitters, which send messages between nerve cells in the brain. By altering electrical and chemical signals, it helps to control seizures and nerve pain.2

Growing Use as a Pain Reliever

Due to the nationwide opioid epidemic and the tightening of regulations on the prescription of opioid medications, doctors have begun turning to it as an alternative pain reliever for a variety of ailments. In addition to the conditions listed above, gabapentin may also be prescribed for the following:

Migraine headaches

Hot flashes

Fibromyalgia

Diabetic neuropathy

Nerve pain from spinal cord injuries

Relief of withdrawal symptoms3

These uses have not been approved by the FDA and are called “off-label” use. This type of use is legal in the United States, when prescribed by a doctor, although complications that arise from off-label use could be subject to state and local laws and regulations.

Regulation

Due to the growing concern over the abuse of gabapentin and the resulting deaths from overdose, some states are regulating it under their own state laws. Kentucky in particular has experienced a significant increase in gabapentin abuse and overdose, with more than a third of overdose deaths in 2017 including this substance. As a result, Kentucky classified it as a Schedule 5 controlled substance in 2017.

Virginia, West Virginia, Tennessee and Michigan joined Kentucky in classifying gabapentin as a Schedule 5 controlled substance in 2018 and 2019. Other states that have passed laws regulating how it is prescribed includes Illinois, Ohio, Minnesota, Massachusetts, and Wyoming.4

Abuse

In recent years, abuse of gabapentin has been in the rise. The drug is sometimes used to enhance the effects of opioid drugs, as well as to reduce withdrawal from other drugs. It can also bypass the effects of medications used to treat addiction, leading some people to abuse it while in drug treatment programs.5

Research is showing that gabapentin can actually reverse tolerance to heroin and other opioids. Therefore, Gabapentin is sometimes used to cut heroin for a more intense high. It also produces a marijuana-like high when used by itself in high doses.6

Street names for gabapentin include “gabbies” and “johnnies.” 

Danger of Overdose and Death

The primary danger associated with gabapentin abuse is risk of overdose and death. It produces the same slowing of breathing that opioids produce. Since it is usually abused in combination with opioids (especially heroin), the effects of these drugs are magnified and the risk of death from slowed or stopped respiration is increased. While opioid overdose can be reversed by administering Naloxone, there is no reversal agent for gabapentin.
People who overdose on gabapentin must also receive intensive medical treatment for a prolonged period of time, as it has a long half-life.7

According to the Centers for Disease Control (CDC), between June 2016 to June 2017, gabapentin was involved in about 1 in 5 prescription opioid deaths and 1 in 10 of other opioid deaths.

Side Effects of Gabapentin

Gabapentin has many side effects. Some of these are more common and shorter term, and some are more serious, long-term effects. There are also some side effects that occur more often with children.8

Short-Term Side Effects

Common, short term side effects:

Cold or flu-like symptoms

Hoarseness

Loss of strength

Blurred vision

Swelling of the extremities (hands and feet)

Trembling or shaking

Dementia/confusion

Pain in the lower back or the side

Delusions

Unsteadiness (requires medical attention)

Uncontrolled, rolling eye movements (requires medical attention)

Side Effects in Children

Side effects in children (these may require medical attention):

Restlessness

Anxiety

Aggressiveness/behavior problems

Impaired concentration

False sense of wellbeing

Mistrust of others

Crying

Changes in performance at school

Mood swings

Hyperactivity

Overreacting

Depression

Rare Side Effects

Rare side effects (requires medical attention):

Body aches and pains

Congestion or productive cough

Changes in vision

Difficulty swallowing

Difficulty breathing

Watery eyes

Frequent urination

Changes in appetite

Poor balance/clumsiness

Long-Term Side Effects

Long term side effects (requires medical attention):

Memory loss

Muscle weakness

Respiratory failure

Fatal toxicity with pre-existing kidney disease

Gabapentin and Mental Health

Among with the many side effects of gabapentin, there is an increased risk of depression, anxiety, and agitation. Researchers have studied these side effects and have identified a  increasing numbers of suicides or suicide attempts associated with the drug. People who take the drug for chronic pain are already at an increased risk of developing depression and anxiety due to the nature of their conditions. Gabapentin appears to intensify these pre-existing conditions.

In addition, people who receive treatment for chronic pain may also have underlying psychiatric disorders (such as bipolar disorder) which could contribute to the increased risk of depression and suicidal thoughts. People who take this drug along with multiple medications for more than one condition are found to be at a higher risk of suicidal thoughts than people who take it alone.9

Attempted Suicides Involving Gabapentin

A study conducted by the University of Pittsburgh examined over 90,000 calls to U.S. poison control centers regarding exposures to medications. Between 2013 and 2017, calls involving gabapentin exposures increased by almost 120 percent. In addition, calls about attempted suicides involving gabapentin increased 80 percent over the same time period. The following chart shows the number of calls in the thousands regarding intentional suicide attempts in which gabapentin was a factor from 2013 to 2017:10

Gabapentin Suicide Statistics

Fortunately, researchers found that only 19 deaths occurred as a result of gabapentin in intentional suicide attempts during this time period.

Is Gabapentin Addictive?

The drug has gained popularity as a medication for severe pain due to its supposed lack of addictive properties. From 2008 to 2015, the number of opioids prescribed in the U.S. decreased by 23 percent, while the number of prescriptions for gabapentin increased by 153 percent.11

While it is not addictive in the same way as opioids, long-term use can result in physical and psychological dependence. People who abuse this drug may experience addiction along with addiction to other substances, including opioids, alcohol, cocaine, or other addictive substances. This makes it difficult to sort out the symptoms of addictions that are due solely to gabapentin. 

Additionally complicating matters is the fact that gabapentin is used in the treatment of addiction to other substances, especially alcohol, marijuana and benzodiazepines. It is important that anyone taking this drug use it only under the supervision of a physician for these reasons.

Withdrawal Symptoms

Withdrawal symptoms will occur if gabapentin use is stopped abruptly. Even when other substances are involved and a person is ending use of multiple substances, the symptoms of gabapentin withdrawal can be sorted out from withdrawal symptoms of other drugs.

A 2010 case study sheds some light on this, showing specific withdrawal symptoms connected to gabapentin use two days after stopping gabapentin, even though the patient had a history of alcohol abuse and multiple medications for a number of health conditions. After the drug was stopped, the patient developed the following withdrawal symptoms:

Restlessness

Disorientation

Confusion

Anxiety

Headache

Light sensitivity

Nervousness

Gabapentin was reintroduced five days after being stopped and the above symptoms subsided for this patient.12

Other case studies have shown similar results, with severe mental changes being the primary factor in withdrawal. If a person has taken this drug for seizure control for a long time, the increased risk of seizures is also present as the drug’s use is ended.

Treatment for Gabapentin Addiction

There are a couple of factors that need to be considered when receiving treatment for gabapentin addiction. Due to the severity of withdrawal symptoms and the long-term nature of withdrawal, it is recommended that this drug be gradually reduced over a number of weeks under the direct supervision of a physician to reduce the negative effects that may result. 

Another factor to consider is whether or not the substance use disorder involves other drugs. If the drug was used along with alcohol, opioids, benzodiazepines, or other drugs, then the methods of treatment for those substances will have to be combined with treatment for gabapentin addiction.

Detox

The process of managing withdrawal symptoms while decreasing and ending use of this drug is called detoxification. This process should be completed under the direct supervision of a medical professional. If detox involves ending multiple drugs, then it should be completed in an inpatient setting where any withdrawal symptoms can be managed immediately and on an emergency basis, if needed.

Therapies

Once withdrawal symptoms are managed, treatment for addiction may include behavioral interventions that are the standard in addressing drug addiction. These methods primarily address the addiction to alcohol, opioids, or other drugs and may include the following:

  • Cognitive Behavioral Therapy: One-on-one counseling that helps determine the thought processes involved with drug use. Counseling provides strategies to help change thought processes and to develop alternate thinking patterns.
  • Contingency Management: Programs that use rewards or prizes as incentives to help people abstain from substance use.
  • Marital and Family Counseling: Family and marital counseling helps to identify dysfunctional family relations and/or to repair relationships damaged by substance use.
  • Motivational Enhancement Therapy: Counseling to build the motivation and self-confidence needed to live life without substance use.

Exploring Other Options

People who have used gabapentin long-term for medical conditions must also work with their physicians to manage the symptoms of their conditions without using the drug. This will involve exploring other options for medication and treatment. Management of health conditions previously treated by gabapentin is best done by working with medical staff who specialize in the treatment of such health conditions. Specialists work closely with other medical staff who are assisting with the recovery process. 

Whether or not it is in the best interests of a person to stop long-term use for seizure control is a decision that should be made between a person and their neurological specialist.

Safe Alternative, Danger, or Both?

Gabapentin may appear to be a safe alternative to opioids for the treatment of multiple health conditions. People who use gabapentin may think that the drug is safe and not addictive. The dangers of abuse, however, include the increased risk of overdose, suicide, and severe withdrawal symptoms once use is ended. 

People who do not need to take gabapentin should avoid it, and its use for medical reasons should be closely supervised by a doctor. If you or someone you love is struggling with gabapentin use, help for this condition is available. Get help immediately.


Resources

  1. Neurontin (Gabapentin) Patient Information: Side Effects and Drug Images at RxList.” RxList, RxList, 17 Oct. 2018.
  2. Leonard, Jayne. “Gabapentin: Uses, Safety, and Side Effects.” Medical News Today, MediLexicon International, 13 Nov. 2018.
  3. Rodriguez, Carmen Heredia. “Gabapentin, a Drug for Nerve Pain, and a New Target of Opioid Abuse.” STAT, 8 Mar. 2018.
  4. Vestal, Christine. “Abuse of Opioid Alternative Gabapentin Is on the Rise.” PEW, The Pew Charitable Trusts, 10 May 2018.
  5. Smith, Blair H, et al. “Substance Misuse of Gabapentin.” The British Journal of General Practice : the Journal of the Royal College of General Practitioners, Royal College of General Practitioners, Aug. 2012.
  6. Vestal, Christine. “Abuse of Opioid Alternative Gabapentin Is on the Rise.” PEW, The Pew Charitable Trusts, 10 May 2018.
  7. Ibid.
  8. Gál, Kat. “Gabapentin: Common, Long-Term, and Rare Side Effects.” Medical News Today, MediLexicon International, 21 Nov. 2018.
  9. Ghaly, Ramsis F, et al. “Gabapentin-Related Suicide: Myth or Fact?” Surgical Neurology International, Medknow Publications & Media Pvt Ltd, 23 Oct. 2018.
  10. Reynolds, Kimberly. “Trends in Gabapentin and Baclofen Exposures Reported to U.S. Poison Centers.” Taylor & Francis Online, Informa UK Group, 1 Dec. 2019.
  11. Ghaly, Ramsis F, et al. “Gabapentin-Related Suicide: Myth or Fact?” Surgical Neurology International, Medknow Publications & Media Pvt Ltd, 23 Oct. 2018.
  12. Hellwig, Thaddaus R., et al. “Withdrawal Symptoms After Gabapentin Discontinuation.” Medscape, 22 June 2010.