“The high rate of misuse of this medication is surprising and it is also a wakeup call for prescribers. Doctors don’t usually screen for gabapentin abuse when making sure patients are taking medications, such as opioids, as prescribed. These findings reveal that there is a growing risk of abuse and a need for more robust testing.” ~ Dr. Poluru Reddy, Ph.D., Medical Director, ARIA Diagnostics, Indianapolis According to a recent study, Gabapentin—commonly sold under the brand name Neurontin—has a much higher likelihood of recreational misuse than you might expect. Greater than 1 out of every 5 patients taking Neurontin do so illicitly.
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First Things First—What is Gabapentin?
“Community prescribers are generally unaware that gabapentin can be misused and (in my experience) are often incredulous and even disbelieving when told about ‘the dark side’ of gabapentin.” ~ Dr. Jeffrey Keller, M.D., Chief Medical Officer for Centurion, a private company that provides health care services to prisons If you’re like most, you’re probably wondering right now what is gabapentin anyway? Gabapentin is a non-opioid prescription medication that was originally approved by the Food and Drug Administration as a secondary treatment for seizures in 1993, and then again in 2004 for neuropathic pain. Some of the specific conditions that gabapentin treats, both approved and off-label, include:
- Diabetic neuropathy
- Multiple sclerosis pain and spasticity
- Hot flashes
- Restless leg syndrome
- Involuntary eye movement
- Itching due to kidney failure
- Non-seizure symptoms of alcohol withdrawal
- Second-line treatment for Substance Use Disorders (SUDs)
The Centers for Disease Control and Prevention has promoted Neurontin gabapentin as a safer potential alternative to dangerous opioids, and the American Pain Society has made the recommendation that it should be used to treat pain after surgery. Gabapentin is found in a number of name-brand medications, including Fanatrex, Gabarone, Gralise, Horizant, and Neurontin. Because gabapentin is not an opioid, it has—up till now—been considered to have a low potential for non-medical diversion. Currently, it is not even listed as a controlled substance by the US Drug Enforcement Administration. That distinction poses a challenge for law enforcement. Chuck Haegele, a field supervisor for the Major Crimes Unit at the Athens City Police Department, says, “There’s really not much we can do at this point. If it’s not controlled … it’s not illegal for somebody that’s not prescribed it to possess it.”
What Is Gabapentin – A Closer Look
While we’ve answered the question is gabapentin an opioid? we haven’t really looked at how gabapentin Neurontin really works in the brain. And in order to do that, you first have to know a bit about how the brain works. In the mind, there are two main types of neurotransmitters that effect how your brain cells respond to stimuli – excitatory neurotransmitters and inhibitory neurotransmitters. On the excitatory side, the to-go chemical compound is often glutamate. For inhibitory ones, it falls to a chemical called gamma-aminobutyric acid, or GABA for short. During normal functioning, neurons are either stimulated by excitatory chemicals into releasing an electrical signal which flows to other neurons, or they’re stopped from doing so by inhibitory neurotransmitters. In general, then, these two types of chemicals push against each other in a sense. Like anything else though, too much of one thing is never healthy. Too much GABA (or too little glutamate) in the brain, for example, can end up causing dangerously low levels of respiratory depression as with an opioid overdose. Too much glutamate (or too little GABA), on the other hand, can end up causing seizures, just as with the seizures caused by delirium tremens. The medication gabapentin Neurontin is actually thought to suppress the release of glutamate, making the ration of glutamate to GABA fall in GABA’s favor. In the end, this imbalance between the two can end up making seizures far less likely to occur. Ultimately then, what is gabapentin? It’s a drug that helps reduce the likelihood of seizures by decreasing the release of excitatory neurotransmitters (like glutamate) in the brain.
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Gabapentin—Wonder Drug or Snake Oil?
“We were truly experimenting on patients, which put them at risk. I was involved in this, trained, and asked to deceive physicians and take advantage of their trust, and I’m embarrassed by that.” ~ Dr. David Franklin, former medical liaison for Warner-Lambert who “blew the whistle” on the company’s deceptive marketing practices It is estimated that 90% of Neurontin (gabapentin) sales are for off-label use. Part of the reason is because of heavy promotion by the manufacturers, who have touted gabapentin medications as treatments for bipolar disorder, smoking cessation, migraines, and dozens of other conditions. While it is a common and legal practice for a licensed physician to prescribe a medication for off-label use, it is illegal for a company to market such unapproved uses. In 2004, in the first off-label promotion case ever successfully tried under the False Claims Act, Neurontin’s manufacturer was ordered to pay $430 million in civil and criminal fines.
Reports of Gabapentin Abuse – Can You Get High on Gabapentin?
“I think that some individuals may say that they use it to get high, and others may say they use it and get a drowsy effect. So, we’re talking about the euphoria versus sedation.” ~ Dr. Rachel Vickers Smith, Ph.D. Despite the original supposition that gabapentin was unlikely to be abused, there have nonetheless been numerous reports disproving that notion. When taking the medication at much-higher doses than what is typically prescribed, people who abuse “gabbies” or “johnnies” describe feeling:
Interestingly, the effects of gabapentin abuse have been likened to the highs produced by both marijuana and cocaine. Some users even say abusing gabapentin Neurontin makes them feel “zombie-like”. At high enough doses, gabapentin can produce psychedelic effects. According to a recent meta-analysis of international case studies, up to two-thirds of people with gabapentin prescriptions will misuse the drug, primarily for recreational or self-medication purposes. Gabapentin is frequently misused concurrently with other substances:
- Opioids – at least 56%, although a report from the European Monitoring Centre for Drugs and Drug Addiction puts that percentage at closer to 90%..
- Muscle relaxants or anxiety medications – 27%
- Other illicit substances – 8.6%
Most at-risk are people who have a history of poly drug abuse – the misuse of multiple substances at one time. Dr. Keller says, “It works so well that it is used in the drug community to mellow out methamphetamine tweaking and to cut heroin.”
Gabapentin and the Opioid Epidemic
“It’s not a narcotic, but what it does, is, it intensifies your methadone…so if you take your methadone and you go buy 10 Neurontin and you take all 10, it’s sort of like you tripled your dose.” ~ an anonymous gabapentin abuser, responding to a survey released by the Ohio Substance Abuse Monitoring (OSAM) network People who abuse opioids are at particular risk of gabapentin misuse. Studies have shown that more than 1 out of 5 opioid abusers also commit Neurontin recreational use, while conversely, over half of all gabapentin abusers also misuse opioids. Gabapentin abuse is so similar to opioid abuse that the two frequently overlap. This is most likely due to reports that gabapentin Neurontin greatly enhances the euphoric effects produced by opioid abuse. Additionally, because of its own effects, gabapentin is misused to ward off withdrawal symptoms when opioid addicts are out of their drug of choice. The multiplied effect is dose-specific. As the frequency and dose of gabapentin is increased, so is the opioid intoxication. However, using opioids and gabapentin is extremely dangerous. A new study published in October 2017 found that concomitant use of both substances can result in a 49% greater risk of a fatal opioid overdose. Significantly, the study only included participants who had been prescribed gabapentin within the previous 120 days. In 2015, there were over 52,000 overdose deaths in America – an all-time high. But in 2016, the number spiked again by 22%, to approximately 64,000. 2017 is on yet another record pace, trending toward 71,000 fatal overdoses this year. Roughly 2 out of every 3 drugs deaths involve opioids.
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What Does Neurontin Gabapentin Abuse Look Like?
Abusing gabapentin Neurontin is rampant today. Whether it’s to help increase the euphoria and potency of abusing opioids like Fentanyl or OxyContin or if it’s being taken at especially high doses on its own to elicit a gabapentin high, Neurontin recreational use is far more popular today than it’s ever been. And beyond that, most people haven’t even heard about this dangerous drug. But how are drug users committing gabapentin abuse? In the first place, gabapentin abuse typically occurs via oral ingestion rather than intravenous injection or intranasal administration. Injecting or snorting gabapentin has been shown to lead to a higher incidence of medical complications, adverse reactions, and also more of a risk of a life-threatening overdose. The exact quantity for a gabapentin recreational dose isn’t the same for everyone. Some people who engage in gabapentin abuse may only need a few hundred milligrams of gabapentin Neurontin to start feeling the effects of the drug. Others will have to take the drug in dosages of thousands of milligrams to attain any euphoria. How much Neurontin to get high, then, depends entirely on the person involved. In general, though, the intoxicating effects of gabapentin abuse usually occur around 900mg to 5000mg doses. A Neurontin recreational dose, then, can actually end up being quite high based on your individual physiology and level of tolerance. Those who engage in gabapentin abuse will also likely mix this drug with a variety of other substances, most notably opioids as we’ve seen. Gabapentin’s onset is usually relatively slow compared to other drugs and can actually take around an hour before the abuser will notice any effects.
Gabapentin Interferes with Recovery
“…a significant amount of patients are taking Gabapentin without physician consent. This could be due to the fact that recent studies have revealed that Gabapentin may potentiate the ‘high’ obtained from other central nervous system acting drugs.” ~ Dr. Reddy The drugs prescribed during the Medication-Assisted Treatment that is utilized by top rehab programs can block the pleasurable effects of opioids, but they have no effect on non-opioid substances like gabapentin. The barrier that MAT drugs provides is thereby bypassed. Standard drug panels don’t test for gabapentin. By exploiting this omission, abusers can continue to get high while they still test clean. This is especially relevant for individuals who are participating in rehab programs, either voluntarily or as a mandate of the Court. Privacy laws can also be a hindrance to addressing gabapentin abuse. Because most rehab facilities don’t drug test for gabapentin, they rely on their clients’ honesty and on medical information shared by their outside health providers. But if a rehab participant doesn’t disclose that they take gabapentin and they haven’t given their doctor permission to release that information, then accurate monitoring can be difficult. Even if the experienced staff at an accredited drug rehab program tests for gabapentin and is aware that certain clients may be at-risk for diversion, their hands are somewhat tied without written consent from those clients. In other words, they can’t share their concerns with the outside gabapentin prescriber without permission, because by doing so, they would reveal that the client was in a recovery program. Meanwhile, the patient can still continue to get high on their legally-obtained gabapentin prescription.
Neurontin is EVERYWHERE
“Gabapentin is so readily available. That, in my opinion, is where a lot of that danger is. It’s available to be abused.” ~ Rachel Quivey, pharmacist, Athens, Ohio One of the biggest hurdles inherent in any efforts to combat Neurontin misuse is the fact that it is so widely available. Up to 8% of the US population affected by neuropathic pain. In 2015 alone, there were 57 MILLION gabapentin prescriptions written in this country. That represents a 42% increase since 2011. By 2016, the number of prescriptions had reached 64 MILLION. As recently as September 2017, it was the seventh-most-prescribed medication in the United States. Of special relevance, Neurontin prescribing is highest in those areas of the country that are suffering the highest rates of opioid abuse. For example, according to the Ohio Board of Pharmacy, gabapentin was the most-dispensed drug in the state of Ohio in December 2016. To give that statement perspective, gabapentin was prescribed at a rate that was 30% higher than the medication in second place, oxycodone. And as is the case with most diverted drugs, abuse follows increased use. In January 2014, only one of the OSAM network’s eight regions had reports of illicit gabapentin Neurontin use. But by January 2016, six of the eight were reporting misuse. That trend has continued in 2017. Dr. Thomas Sherba, OSAM’s Principal Investigator, says, “It’s a drug that needs to be tracked now. We’ve been noticing an uptake in reports from participants in our focus groups throughout the state. Gabapentin has been diverged in the street and it has been used illicitly…” Similarly, in Appalachia, another region hit hard by the opioid crisis, gabapentin abuse increased 3000% between 2008 and 2014.
Side Effects of Gabapentin Abuse
“If you are addicted, or even if you just like to get high once in a while, and you can’t obtain your preferred drugs of abuse…these are the drugs that can serve as an alternative in a pinch.” ~ Dr. Keller Even when taken in the prescribed dosage, gabapentin can produce a number of side effects. These are only magnified when taking a gabapentin recreational dose:
- Blurred or double vision
- Memory problems, to the point of amnesia
- Heightened anxiety
- Panic attacks
- Poor impulse control
- Difficulty speaking
- Poor coordination
- Jerky movements
- Itchy or red eyes
- Extreme fatigue
- Dry mouth
- Flu-like symptoms
- Muscle and joint pain
- Tremors in the extremities
- Uncontrollable eye movement
- Increased appetite
- Weight gain
- Suicidal ideation
- Withdrawal when the drug is discontinued, very similar to opioid withdrawal
- Overdose, possibly fatal
Signs of a Gabapentin Overdose
“It is important that doctors and people dependent on opioids are aware that the number of overdose deaths involving the combination of opioids with gabapentin…has increased substantially and that there is evidence now that their concomitant use – either through co-prescription or diversion of prescriptions – increases the risk of acute overdose deaths.” ~ Matthew Hickman, Professor of Public Health and Epidemiology, University of Bristol’s School of Social and Community Medicine. For the relief of neuropathic pain, the typical daily dose usually doesn’t exceed 1800 mg, but for epileptic seizures some patients are prescribed up to 3600 mg per day. The danger arises when gabapentin is abused at higher levels, because fatal overdoses been reported at doses as low as 4900 mg. Gabapentin abuse can increase the likelihood of a dangerous overdose and as such, it’s important to know the signs of this very serious medical condition. Symptoms of gabapentin overdose include:
- Loss of muscle coordination (ataxia)
- Extreme sedation
- Slurred speech
- Drooping eyelids
- Difficulty breathing
- Violent diarrhea
These effects are dangerously magnified when gabapentin and alcohol are used together, especially since alcohol is already quite dangerous on its own. Although a gabapentin overdose appears very similar to an opioid overdose, victims will not successfully respond to an administration of Narcan, the anti-opioid overdose reversal emergency medication. That’s because gabapentin Neurontin affects different aspects of the brain than opioids. Emergency help is always needed during gabapentin overdose situations. Kidney dialysis may be necessary to remove excess gabapentin from the victim’s system.
Signs of Gabapentin Abuse
Because it is a supposedly “safe” prescription medication given for legitimate medical conditions, it can be hard to tell when someone is abusing Neurontin gabapentin. However, if you notice the signs of Neurontin recreational use in others, it’s important that you try to get them the professional help they need before it’s too late. The most notable signs of gabapentin abuse are:
- Takes more than is prescribed.
- Runs out much sooner than expected.
- Self-medicates to prevent opioid withdrawal.
- Impaired coordination.
- Drug intoxication.
- Complains that the drug isn’t as effective as it used to be. This is an indication of drug tolerance – one of the first signs of a developing an addictive disorder.
- Fakes symptoms in order to obtain gabapentin.
- “Doctor shops” to get more drugs or higher doses.
- Has multiple prescriptions.
- Buys, receives, or steals gabapentin from friends or relatives.
- Hides or lies about gabapentin use.
- Takes gabapentin in combination with painkillers, tranquilizers, or muscle relaxants.
- Uses gabapentin drug slang – “gabbies, johnnies, or Morontin”.
- Becomes agitated or anxious whenever the drug isn’t available.
- Talks about or obsesses with suicide or thoughts about death.
Signs of Gabapentin Abuse in Yourself
And while recognizing the signs of Neurontin gabapentin abuse in others can end up being quite hard to do, it’s even more difficult with the person committing gabapentin abuse is you. That’s because denial is so common with addiction, whether it’s to Neurontin gabapentin, alcohol, cocaine, or any other substance of abuse. In fact, a whopping 95.5% of U.S. citizens with a substance use disorder didn’t seek treatment for their addiction in 2016 simply because they didn’t view it as a problem at all. That’s why it’s so important to be able to recognize the signs of gabapentin abuse in yourself by looking at your behaviors objectively. And one of the best ways of doing that is by taking a short online addiction quiz. It only takes a few minutes to complete and could end up being the objective opinion you need to finally recognize your gabapentin abuse and addiction. You can also use the guidelines for a substance use disorder that are provided by the Diagnostic and Statistical Manual of Mental Health to take a more objective look at patterns of gabapentin abuse. These 11 scenarios (from the National Institute on Drug Abuse) are used by licensed physicians and psychiatrists around the world to diagnose substance use disorders. And if you have experienced two or more of these scenarios in the past 12 months, it’s likely that you are in fact struggling with gabapentin abuse and perhaps even an addiction.
How to Guard Against Gabapentin Abuse
“It is critically important for medical professionals…to know which seemingly benign drugs have the potential to be abused and diverted.” ~ Dr. Keller Addressing gabapentin abuse will take a concerted effort by everyone involved.
- Prescribers – Doctors should conduct more though patient screens to include gabapentin, not just the more familiar drugs of abuse. Special care should be taken when gabapentin prescribing may coincide with that of opioids, benzodiazepines, or muscle relaxants.
Most especially, doctors should be cautious of giving gabapentin Neurontin to patients with a personal or family history of substance abuse, particularly if that history of abuse involves opioids.
- Patients – By the same token, patients should be completely honest with their doctors, and even proactively volunteer any relevant information not asked for in the screening process. Always discuss any concerns about any medications prescribed and their possible interactions.
- Addiction recovery specialists – Gabapentin abuse is largely ignored. It is critical that rehab staff members address the possibility by specifically screening for the drug. Greater efforts at educating clients about the dangers of gabapentin abuse should also be made.
- Legislators –Law enforcement agencies would have more authority to deal with Neurontin gabapentin abuse and illicit distribution if the drug was Scheduled as a controlled substance.
This isn’t a matter of depriving patients in need of a medication that is effective and safe when used as intended and directed. Rather, the entire focus needs to be on curtailing the diversion and abuse of gabapentin, which can in turn positively impact the ongoing opioid epidemic.
What Does All This Mean?
More than anything, patients and providers alike should have an increased awareness of the abuse potential of gabapentin and the dangers of drug diversion. Unfortunately, NO prescription medication is safe when it is not taken in the prescribed manner or at the correct dosage. Curbing the misuse of Neurontin and other medications containing gabapentin will take away one of the biggest strategies used by opioid addicts to maintain their addiction. Without the “crutch” provided by gabapentin, many opioid abusers will potentially be compelled to seek treatment. And THAT will save lives.
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