Gabapentin – also known by the brand names Neurontin, Horizant, and Gralise – is a prescription medication that is dispensed in an oral solution, in tablet form, and as capsules to relieve pain related to postherpetic neuralgia. It is also an analgesic, an adjunctive treatment for epileptic seizures, and an anticonvulsant. In some cases, it can be used as an alternative to opioids for pain relief.
Gabapentin is thought to control nerve pain and seizures by interacting with brain chemistry and calming overactive nerve firings. The medication is related to the naturally occurring neurotransmitter GABA (gamma-Aminobutyric acid), although it does not seem to specifically interact with levels of GABA in the brain. Like GABA, though, gabapentin likely works like a central nervous system depressant, slowing down autonomic functions and minimizing the fight-or-flight response. Blood pressure, heart rate, and body temperature are all lowered as a result of the drug’s interaction with the central nervous system.
Gabapentin is not a controlled substance by the U.S. Drug Enforcement Administration (DEA), but it is emerging as a drug of abuse. The Ohio Department of Mental Health and Addiction Services published an alert in February 2017 warning of the increase of abuse of gabapentin. In December 2016, gabapentin was the most commonly dispensed prescription drugs in Ohio, and increased prevalence often goes hand in hand with rising misuse trends.
Gabapentin misuse is commonly connected to opioid misuse. The American Journal of Psychiatry publishes that in a study of individuals in Appalachian Kentucky reporting misuse of prescription opioids, 15 percent reported using gabapentin to get high. The number of gabapentin prescriptions is rising across the United States, and so is the abuse of this potentially dangerous and addictive drug.
Side Effects of Use
Gabapentin is considered a safe and effective medication when used as directed and under the direction of a trained health professional. Like most medications, it can trigger some health hazards. Mayo Clinic lists the following as possible side effects of gabapentin:
- Unsteady gait
- Nystagmus (uncontrollable eye movements)
- Shortness of breath
- Chest pain
- Increased suicidal thoughts
- Difficult or painful urination
- Unusual bruising and bleeding
- Sore throat
- Leg or arm pain or swelling
- Memory loss
- Stools that are tarry and black
- Blurred vision
- Mouth sores
- Lower back pain
Long-term gabapentin use has not been widely studied, and it is unclear exactly what types of side effects may exist if the medication is taken continuously during a long period. Gabapentin may negatively affect pregnancy and fertility, and also possibly increase the risk for pancreatic and other cancers, the FDA warns.
It is thought to cause some level of physical dependence with chronic use, which can lead to a withdrawal syndrome when the medication is discontinued. As with other anticonvulsant medications, gabapentin withdrawal may be significant and include a re-emergence of epileptic seizures.
From Use to Abuse: When Use Crosses the Line
As published by the West Virginia Gazette, an estimated one-fifth of people taking gabapentin are misusing it. The medication seems to have a pull on people who struggle with opioid abuse and addiction. The journal U.S. Pharmacist reports that gabapentin is commonly combined with marijuana, opioids, opioid addiction treatment medication, and cocaine. As a non-controlled substance, it is often easier and cheaper to obtain than opioid drugs and may, therefore, be used as a substitute for a similar euphoric and mellowing high.
In the general population, the journal Addiction estimates gabapentin abuse rates to be around 1 percent; however, an estimated 15 to 20 percent of people who abuse opioids also misuse gabapentin. Since it is not a controlled substance in most states, possession of gabapentin without a prescription is also not considered a crime, making it even more appealing as a drug of abuse.
The British Journal of General Practice (BJGP) publishes that a gabapentin high may be mellowing like a marijuana high. It can have a euphoric effect, increase sociability, enhance calm, and promote relaxation. It also may cause a negative “zombie-like” high that is less desirable. Gabapentin may be abused to enhance an opioid high as it has similar effects to these drugs.
Warning signs to watch for regarding problematic use and misuse of gabapentin include:
- Taking the medication without a prescription or medical need for it
- Continuing to take it after a prescription has run out or is no longer medically necessary
- Taking gabapentin in between doses
- Increasing the dosage without a doctor’s consent or direction
- Taking it in a way other than it was prescribed to be taken, such as chewing it or crushing the tablets to snort, smoke, or inject them
- Exaggerating symptoms to get more of the drug
- Seeking additional prescriptions from more than one doctor
- Mixing gabapentin with alcohol or other drugs
Empty pill bottles, medication stashed in easy-to-reach locations, erratic behavior, unpredictable mood swings, changes in sleeping and eating habits, and a decline in physical appearance can all be signs of gabapentin abuse.
The National Survey on Drug Use and Health (NSDUH) reports that more than 6 million Americans misused a prescription psychotherapeutic medication in the month leading up to the 2016 survey. Prescription drug abuse is a very common, and potentially very dangerous, practice.
Health Hazards of Abuse
The DEA reports that gabapentin was involved in 168 deaths between 2012 and 2016, and in a total of close to 75,000 calls to the American Association of Poison Control Centers (AAPCC) for toxic exposure. In most of these cases, gabapentin was combined with other drugs. Mixing gabapentin with another central nervous system depressant, such as alcohol, a benzodiazepine, a sleep aid, or an opioid drug, enhances its sedative and depressant effects, which can lead to a toxic and potentially life-threatening overdose.
A gabapentin overdose can cause breathing problems, double vision, lethargy, slurred speech, diarrhea, coordination issues, sedation, and drooping eyes. Seek immediate medical attention if a gabapentin overdose is suspected, as it may be reversible with hemodialysis, a medical procedure that filters and cleans the blood.
Short-term health hazards associated with gabapentin abuse are commonly related to intoxication and mental impairment. The intoxication that comes with the drug interferes with a person’s ability to think clearly and rationally, and therefore opens the individual up to take bigger risks, make unsafe decisions, get into accidents, and not think through consequences logically.
Other health risks of gabapentin abuse are often associated with how the drug is abused. For example, snorting it can cause damage to the sinus and nasal cavities, resulting in chronic nosebleeds and a runny nose as well as the potential for a lost sense of smell. Injecting the drug can leave track marks, or scars, at the injection site as well as increase the risk for infection, the spread of infectious diseases, and collapsed veins. Swallowing or ingesting large quantities of the drug may cause stomach and gastrointestinal issues, and smoking it often leads to respiratory issues, such as a chronic cough and potential lung infections.
Long-term health risks of gabapentin abuse include physical dependence, withdrawal symptoms, and possible addiction. When someone takes the drug on a regular basis, the brain becomes accustomed to it, and its chemical balance is altered. It can take time for the brain to regulate itself after gabapentin processes out of the body, causing drug cravings and withdrawal symptoms in the meantime.
Drug dependence is also a physical component of addiction. While a person can be dependent on a drug without battling addiction, it can be more difficult to stop taking the drug when dependence is present. This can quickly encourage compulsive drug use.
The American Society of Addiction Medicine (ASAM) calls addiction a brain disease that involves brain chemistry, dysfunctional behaviors, and loss of control over drug use. When a person is struggling with an addiction that involves gabapentin, they likely have already made several attempts to stop taking the drug and have a desire to do so, although they are unable to curb use without help. Individuals will continue to use gabapentin at great personal risk, even when they recognize the costs of doing so. They will use gabapentin in situations that are physically hazardous and continue to use the drug for longer and in greater amounts than initially intended.
Addiction can affect a person’s professional life. Personal issues crop up due to addiction, as mood swings and broken promises become commonplace. Drug use will become the most important aspect of life, and all other things take a back seat. Things that were priorities before are frequently given up, and changes in social circles and peer groups are often the result of addiction. Addiction can affect social lives, relationships, families, financial and occupational situations, and physical and emotional health. It is a chronic disease that is treatable with proper care and attention.
Help For Abuse and Addiction
Gabapentin abuse and addiction are optimally treated with a range of methods and therapies, either in an outpatient or inpatient setting. A detailed assessment before admission can help trained professionals determine the proper level of care and design a treatment plan.
Gabapentin dependence often requires a medical detox program first for the person in recovery to attain a level of physical stability. When gabapentin processes out of the brain, the chemical balance is thrown off, and the brain can try to regulate itself too fast, causing a sort of rebound. When this occurs, nerve firings and the central nervous system can become hyperactive, and blood pressure, heart rate, respiration, and body temperature can shoot up. Tremors and even seizures, hallucinations, anxiety, irritability, and insomnia can be side effects of gabapentin withdrawal.
Gabapentin withdrawal is serious; therefore, the drug should not be stopped suddenly after physical dependence has formed. Instead, a medical detox program can design a safe and controlled tapering schedule that will gradually lower the dosage and wean the drug out of the body while helping to minimize withdrawal symptoms.
During medical detox, medications can be beneficial for specific side effects of withdrawal, such as mood stabilizers for depression and anxiety or sleep aids for insomnia.
In addition to medical detox, the following methods can be helpful for the treatment of gabapentin abuse and addiction:
- Group and individual therapy sessions
- Life skills training, including teaching stress management and coping skills
- Support groups and 12-step programs
- Educational programs
- Relapse prevention programming
- Holistic methods like massage therapy, yoga, mindfulness meditation, and art therapy
- Nutritional planning
- Fitness programs
- Concurrent treatment for co-occurring disorders (dual diagnosis)
- Aftercare and recovery support
Addiction treatment programs can improve overall life functioning and well-being. With comprehensive treatment, those who have been struggling with substance abuse can embrace life in recovery.