Is Neurontin (Gabapentin) a Drug of Misuse?
Gabapentin (often prescribed under its brand name Neurontin) is an anti-convulsant/sedative medication used to treat a wide range of medical issues, ranging from partial seizures to shingles-related nerve pain and restless leg syndrome.1 It is also commonly used off-label to treat an even wider variety of physical and mental health concerns, including fibromyalgia, neuropathic pain, and anxiety.1
While there is some evidence for its off-label efficacy in managing several health conditions, including the management of alcohol withdrawal and opioid addiction, gabapentin itself has misuse potential, which can in some cases lead to significantly adverse associated health issues.1
This page will discuss what gabapentin is, side effects of the drug, its misuse liability, symptoms of gabapentin addiction, gabapentin withdrawal, and how a gabapentin rehab program can help with addiction recovery.
What is Gabapentin?
Gabapentin is an FDA-approved prescription medication. It is an anticonvulsant agent primarily indicated for managing certain types of seizure and a painful condition known as post-herpetic neuralgia.2 Brand name formulations of gabapentin include Neurontin, Horizant, and Gralise.3 Although gabapentin is not currently a federally controlled drug, there have been reports of widespread diversion and non-medical misuse, misuse with other substances, as well as the potential for dependence and withdrawal.4,5
Despite having a fairly limited list of approved indications, gabapentin has increasingly been prescribed for the treatment of various types of neuropathic pain and other chronic pain scenarios—a relatively recent trend motivated in part by clinicians seeking to scale back on opioid prescribing.6,7
This medication has seen increasingly widespread use in recent years. In 2019, an estimated 69 million prescriptions were written for gabapentin in the United States.8 As of 2021, it was the 6th most frequently prescribed drug in the country, with some estimate pointing to roughly 95% of all gabapentin prescriptions being for off-label uses—in other words, for conditions it’s not specifically FDA-approved for.2,5,7
In tandem with the rise of gabapentin prescriptions, gabapentin misuse has also risen significantly in the past ten years. When people misuse gabapentin, they commonly misuse it in combination with other substances, such as opioids, to intensify euphoric effects. In other instances, people may misuse gabapentin to self-treat some conditions, such as insomnia, anxiety, pain, and substance withdrawal.9
Exactly how gabapentin works isn’t entirely understood. Gabapentin is structurally similar to a neurotransmitter in the brain known as gamma-aminobutyric acid (GABA).1,2 Despite its similarity to GABA, gabapentin doesn’t bind to the GABA receptors in the brain. Some of its therapeutic effects are thought to stem from inhibited activity of excitatory neurotransmitters in the brain and other modifications to brain cell signaling.1,2
Gabapentin is FDA-approved to treat seizures, nerve pain that occurs after shingles.1,4 However, it is also frequently used for the off-label treatment of a large number of conditions, including:1,5,6,7,8
- Sleep disorders.
- Sciatic back pain.
- Diabetic neuropathy.
- Migraine prophylaxis.
- Restless leg syndrome.
- Perimenopausal hot flashes.
- Mood disorders.
Gabapentin Acute (Short-Term) Side Effects
Gabapentin may cause some people to experience unpleasant side effects. When taken as prescribed, gabapentin’s side effects are typically mild.1 However, side effects may be more pronounced if someone consumes gabapentin in doses higher than prescribed for them, or if they consume gabapentin with other substances. For instance, when used with opioid drugs, gabapentin may be associated with additionally severe adverse effects, and even death.9
General side effects and adverse effects of gabapentin can include:1,4
- Peripheral edema.
- Nausea and vomiting.
- Problems with balance, coordination, and speech (i.e., ataxia).
- Abnormal eye movements (e.g., nystagmus).
- Double vision.
- Respiratory depression.
- Withdrawal seizure.
Gabapentin Abuse Potential
While gabapentin isn’t a controlled substance at the federal level, some states have chosen to make it a Schedule V controlled substance as evidence for certain drug risks accumulates.
For a long time, researchers didn’t believe gabapentin held potential for misuse. However, studies now indicate that it does have some risk for misuse, especially among people who have certain risk factors for substance misuse in general.2,3,10 Some of these risk factors might include taking larger doses of gabapentin than prescribed or having a history of substance misuse.2,4
People who misuse gabapentin may do so to elicit certain subjective effects, such as:6,11
- Euphoric high.
- Feelings of relaxation or calmness.
- Improved or elevated mood.
- Intoxication similar to being drunk.
- Reduced inhibition.
- Increased sociability.
Perhaps surprisingly, someone’s prescribed dose of gabapentin doesn’t dictate whether they will or will not abuse it. People abuse gabapentin at varying doses, including at therapeutic doses (900-3600mg per day) to supra-therapeutic doses.
One study found that 40% of people prescribed gabapentin take higher doses than are prescribed to them.2
Gabapentin is also commonly misused by ingesting it in combination with other substances, such as benzodiazepines, opioids, marijuana, stimulants, or alcohol.1,2 Someone may use these substances together in an attempt to enhance a subjective high, self-medicate, or manage the withdrawal symptoms associated with other substances.1,2 However, combining gabapentin with other depressants, such as alcohol or opioids, can be dangerous and lead to an increased risk of side effects, one of the most dangerous being suppressed breathing.7
Symptoms of Gabapentin Addiction
There are some signs to be aware of that might suggest someone has begun to misuse gabapentin. Warning signs that someone is misusing this drug can include, but aren’t limited to:2,4
- Claiming the symptoms that their doctor prescribes gabapentin for are worse than they are.
- Forging prescriptions.
- Taking larger doses of this medication than prescribed.
- Using gabapentin more often than prescribed.
- Visiting multiple doctors to get prescriptions.
Gabapentin misuse can progress to patterns of compulsive misuse associated with a substance use disorder (SUD), or gabapentin addiction.
Criteria for the diagnosis an SUD include:12
- Using gabapentin in higher doses or for longer periods of time than initially planned.
- Wanting or trying without success to cut back or stop using gabapentin.
- Spending a lot of time getting, using, or getting over the effects of gabapentin.
- Experiencing strong cravings for gabapentin.
- Having trouble completing important tasks at home, school, or work because of gabapentin use.
- Not stopping gabapentin use even after it has caused or worsened social or relationship problems.
- Reducing or quitting important hobbies or work activities because of gabapentin use.
- Taking gabapentin in situations where it could be physically dangerous, such as when driving.
- Inability to stop using gabapentin even after knowing that it has caused or worsened an ongoing physical or mental health issue.
- Developing a tolerance to the effects of gabapentin.
- Experiencing withdrawal symptoms if you try to stop using gabapentin.
After taking gabapentin regularly, someone may become dependent on it—this happens because the brain adapts over time to some of the neurochemical changes caused by gabapentin, at which point the person becomes reliant on continued use of the drug to feel or function normally.13 When significant gabapentin dependence develops, if use of the drug slows or stops suddenly, withdrawal symptoms can arise.2 (p9)
Gabapentin withdrawal symptoms can include:4,11
- Rapid heartbeat.
Signs of a gabapentin overdose include seeing double vision, slurring while speaking, excessive lethargy and drowsiness, and diarrhea.4 The likelihood of a fatal respiratory depression and gabapentin overdose is significantly higher when it’s combined with opioids or central nervous system depressants, or when it is used by people with pre-existing respiratory issues.4,5,8
Past analyses of unintentional overdose data have suggested that roughly 90% of fatal gabapentin-related overdoses also involved opioid use.8 People who simultaneously use gabapentin and benzodiazepines are also at higher risk for overdose, and people who combine gabapentin with opioids and benzodiazepines at the same time further compound the likelihood of experiencing a fatal overdose.14
Gabapentin Addiction Treatment & Rehab
If you are struggling with compulsive gabapentin misuse, or any other substance addiction issues, treatment is available and can help you recover. Substance abuse treatment centers provide a variety of settings and targeted treatment techniques designed to help patients recover fully from substance abuse issues and meet their unique needs.15 Treatment programs may include various types of care, including:15
- Detoxification. Medically managed withdrawal entails patients staying at a safe facility while they detox from their drug of choice under 24/7 supervision. Sometimes, detox from certain drugs may involve the use of medications.
- Inpatient care involves staying at a facility where a patient receives intensive group and individual therapy and around-the-clock support for around 4 weeks, typically followed by outpatient care, aftercare, and participation in self-help meetings to help someone remain sober.
- Outpatient care involves living at home while they attend scheduled group and individual counseling sessions at a facility on a predetermined schedule. The intensity can range depending on a person’s needs and may include comprehensive care for mental and physical health concerns.
- Behavioral therapy is used to help patients learn how to maintain sobriety, reduce their risk of relapse, improve the quality of their social interactions, and habituate healthy activities.
- Medications can be incorporated into a patient’s treatment plan to reduce withdrawal risks as well as lessen the risk of relapse or overdose for certain substances, such as alcohol or opioids, if a patient struggles with poly-substance addiction.
- Yasaei, R., Katta, S., & Saadabadi, A. (2022). Gabapentin. Treasure Island, FL: StatPearls Publishing.
- Smith, R.V., Havens, J.R., & Walsh, S.L. (2016). Gabapentin misuse, abuse, and diversion: A systematic review. Addiction, 111(7), 1160-1174.
- Quintero, G.C. (2017). Review about gabapentin misuse, interactions, contraindications, and side effects. Journal of Experimental Pharmacology, 9, 12-21.
- U.S. Food and Drug Administration. (2020). Neurontin (gabapentin).
- Collins, S. (2021). More states make gabapentin a Schedule V controlled substance. Pharmacy Today, 27(10), 33.
- Smith, B.H., Higgins, C., Baldacchino, A., Kidd, B., & Bannister, J. (2012). Substance misuse of gabapentin. British Journal of General Practice, 62(601), 406-407.
- Peckham, A.M., Evoy, K.E., Ochs, L., & Covvey, J.R. (2018). Gabapentin for off-label use: Evidence-based or cause for concern? Substance Abuse, 12, 1-8.
- Mattson, C.L., & Chowdhury, F. (2022). Trends in gabapentin detection and involvement in drug overdose deaths — 23 states and the District of Columbia, 2019-2020. Morbidity and Mortality Weekly Report, 71(19), 664-666.
- Evoy, K.E., Peckham, A.M., Covvey, J.R. and Tidgewell, K.J. (2021), Gabapentinoid Pharmacology in the Context of Emerging Misuse Liability. The Journal of Clinical Pharmacology, 61: S89-S99.
- Mah, L., & Hart, M. (2013). Gabapentin withdrawal: Case report in an older adult and review of the literature. Journal of the American Geriatrics Society, 61(9), 1635-1637.
- Vickers-Smith, R., Sun, J., Charnigo, R.J., Lofwall, M.R., Walsh, S.L., & Havens, J.R. Gabapentin drug misuse signals: A pharmacovigilance assessment using the FDA adverse event reporting system. Drug and Alcohol Dependence, 206.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2019, February). Teaching addiction science.
- Olopoenia, A., Camelo-Castillo, W., Qato, D.M., Adekoya, A., Palumbo, F., … & Simoni-Wastila, L. (2022). Adverse outcomes associated with concurrent gabapentin, opioid, and benzodiazepine utilization\] A nested case-control study. The Lancet Regional Health — Americas, 13.
- National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (third edition).