The opioid crisis is now better understood all over the world. As opioid medications have increased in popularity, both because of prescriptions and illicit use, alternatives have been created to deal with pain.
Gabapentin is available in liquid, tablet, and capsule form, according to MedlinePlus.
It has legitimate medical use as a treatment for nerve pain caused by shingles, called postherpetic neuralgia (PHN). This type of pain often shows up as a burning feeling that can hamper the quality of life.
The medication is only available as a prescription with a proper diagnosis, and it can also be used to treat seizures because it decreases excess brain activity. Though gabapentin has several benefits when used correctly, it is known to cause withdrawal.
Gabapentin has also appeared more frequently in toxicity screens of people who have overdosed on opioids, according to a May 2018 report from The Pew Charitable Trusts.
Many commonly abused drugs cause physical and psychological dependence. Physical dependence means that your body needs to have this medication to perform a given function because it has become used to the drug’s presence.
This is the case with gabapentin. Per Healthline, if you skip a dose of this medication, take it outside of a regular schedule, or stop taking it suddenly, it may become less effective or even stop working. People with epilepsy may be more prone to seizures, and pain can come back in patients with PNH.
Tolerance to gabapentin is also possible. Pharmacy Times mentions that the medication can be abused.
An August 2018 paper from Risk Management and Healthcare Policy states that gabapentin misuse has been linked to a desire for patients to increase the strength of opioids, known as potentiation.
Pharmacy Times also states that some people may resort to taking more gabapentin than prescribed. Gabapentin is known by street nicknames, such as gabbies and johnnies. Often, they are sold for less than $1 per tablet.
A high dose of gabapentin used on its own is said to provide a high that resembles that of marijuana. In addition, it is used to strengthen the high from opioid medications. Some users use gabapentin along with heroin for a more sustained high.
The state of Kentucky reclassified gabapentin as a controlled substance. This is probably in response to the fact that rates of use of this medication as a recreational substance (either on its own or along with opioids) were 30 times higher in the Appalachians in 2014 than they were in 2008.
Doctors in Ohio also noticed that gabapentin was linked to some overdose fatalities in 2016.
According to Pharmacy Times, the maximum dose of gabapentin is 1200 mg. Most people who misuse it take as much as 3600 mg — three times the daily recommended amount. Some predictors for gabapentin abuse are:
At the moment, alcohol misuse is not linked to gabapentin misuse. Risk Management and Healthcare Policy finds that states with a high rate of opioid misuses, such as West Virginia, have been vocal about the need to schedule gabapentin differently.
Besides Kentucky, states such as Tennessee, North Dakota, and Nebraska have decided to look at gabapentin use closely. Some states now ask pharmacists and doctors to add patients to a monitoring list to prevent people from doctor shopping.
A demographic breakdown of gabapentin misuse is still needed to understand whether or not a person’s gender, age, or other factors influence its misuse. Through data collected so far, we know the following:
Children can experience withdrawal from gabapentin.
Writer Sarah Ratliff wrote about her withdrawal symptoms from gabapentin for The Fix in 2012. She wrote of feeling hot flashes and vertigo. Ratliff took the medication because of nerve pain, and she was concerned about using it because her family had a history of drug misuse.
However, her doctor explained that gabapentin would be safe. At one point, she was prescribed 2400 mg per day for her nerve pain. She finally spoke with a doctor who recommended decreasing her dose by 25 percent per week. She went with a smaller taper per week until she was able to stop using it.
In all, it took Ratliff about 12 weeks to stop using gabapentin, and she was able to stay away from it.
Some people can start feeling symptoms of withdrawal between 12 hours to seven days after taking it last. The National Institute on Drug Abuse (NIDA) states that withdrawal or detoxification is a crucial first step in helping people start their recovery journey.Medical detox can help people deal with cravings and discomfort stemming from quitting a particular drug. It can help to prevent relapse. Without supervision, people may resort to taking drugs again so they can get rid of withdrawal symptoms.
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People who have been addicted to certain substances or had psychiatric conditions are especially at risk of becoming addicted to gabapentin.
Failing to take gabapentin, even in cases of withdrawal or when you are trying to quit on your own, can cause you to develop the conditions your gabapentin is trying to treat. As such, addiction to gabapentin should be treated with supervision from a doctor or addiction specialist.
NIDA also mentions that addiction affects your brain and causes it to change by adjusting your reward system. Even if you want to stop taking gabapentin, you may not be able to do it on your own.
You should seek medical help if you feel the onset of withdrawal. It can feel like anything from relative discomfort to delirium. In cases of psychosis or symptoms of delirium, go to the emergency room or call 911.
Treatment for misuse of gabapentin has not yet been standardized. Several factors are taken into consideration before treatment is prescribed. These are usually:
If you have been misusing gabapentin on its own, your doctor may decide that tapering is enough for you. Tapering means that your doses of gabapentin will decrease slowly to minimize withdrawal.
You may taper off gabapentin and have to start using another medication, depending on what you and your doctor determine is best for your condition.
People who have misused gabapentin can benefit from support groups, such as Narcotics Anonymous (NA) or other group counseling that may be available in their vicinity. This is especially the case if you have been mixing gabapentin with other drugs or with alcohol.
Though gabapentin has the potential to help people who need it, it can also be misused, particularly by people who have certain risk factors.
Catching your misuse can help you avoid complications caused by addiction, including overdose. Talk to your doctor about options if you feel you may be dependent on this medication.
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(May 2018) Abuse of Opioid Alternative Gabapentin Is on the Rise. The Pew Charitable Trusts. Retrieved March 2019 from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/05/10/abuse-of-opioid-alternative-gabapentin-is-on-the-rise
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