Gabapentin Abuse & Addiction in Ohio

Gabapentin pills on a pharmacy counter

The United States may be facing a major opioid crisis, but this crisis should not take our attention away from other drugs of abuse.

Gabapentin, brand name Neurontin, is a prescription medication originally approved to treat seizure and nerve pain disorders. Since its approval in 2002, gabapentin has quickly become the drug of choice for many disorders outside of its labeled indication.

Part of the popularity around prescribing gabapentin is driven by the belief by prescribers that gabapentin is not addictive and cannot be abused. This belief has come under challenge in recent years as evidence is showing the abuse potential of gabapentin.

What Is Gabapentin?

Gabapentin generic is structurally related to the neurotransmitter GABA. Naturally, GABA acts as a chemical signal in brain cells. It is an “inhibitory neurotransmitter,” meaning brain cells release GABA to turn off the function of other brain cells.

Gabapentin mimics the actions of this neurotransmitter, slowing or stopping certain signals in the brain. Gabapentin does not work the same way as GABA but activates the same targets.

Gabapentin shuts down signals that are “too active” or firing too much, explaining its utility in preventing seizures and nerve pain.

This slowing of nerves explains the primary side effect of gabapentin when it induces a feeling of slowness or “drunkenness.”

Classification

Gabapentin is not a federally scheduled drug according to the Drug Enforcement Agency (DEA). However, as evidence grows that gabapentin can be abused, some states have classified it as a Schedule V substance, including Kentucky and Tennessee.

The following states have passed laws that require gabapentin prescription be reporting in prescription monitoring databases, including:

  • Kansas
  • Massachusetts
  • Minnesota
  • Nebraska
  • New Jersey
  • North Dakota
  • Ohio
  • Virginia
  • West Virginia
  • Wyoming

An analog of gabapentin, pregabalin (Lyrica), works very similar to gabapentin and is already a Schedule V medication, lending further support that gabapentin should have a drug scheduling.

Addiction to gabapentin appears to be more likely in people with a history of substance use disorder (SUD).

What is Gabapentin Used For?

Gabapentin was originally approved to treat seizures and postherpetic neuralgia, which is a type of nerve pain caused by shingles.

Since its approval, gabapentin has found use many off-label conditions, including:

  • Alcohol use disorder (AUD)
  • Anxiety
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Complex regional pain syndrome
  • Cough
  • Diabetic neuropathy
  • Drug and alcohol withdrawal seizures
  • Fibromyalgia
  • Headache
  • Hiccups
  • Restless Legs Syndrome (RLS)

Part of the reason gabapentin has gained so much popularity as an off-label product is because of the mistaken belief that it has no addictive potential. Many of the other prescription drugs used to treat anxiety, ADHD, pain and RLS are known to be addictive and are controlled medications. Therefore gabapentin has been an ideal alternative.

Dosage and Administration

  • The dosage of gabapentin varies from 100 mg per day to 3600 mg per day in divided dosages for the immediate-release and once daily for the extended-release.
  • Dosages should be taken whole. The tablet or capsule should never be chewed, crushed or broken. Gabapentin can be taken without or food.
  • If gabapentin is being used for sleep or RLS, it should be taken about 30 minutes before bedtime.
  • If gabapentin is being used as needed for anxiety, hiccups, headache or another pain condition it should be taken as needed, no more than the directions on the bottle.
  • Tablets can be split, but capsules cannot.
  • Gabapentin is usually started as a low dose and titrated upwards to the target dose. Dose increases should happen no more than every three days.

Prescribed Methods

  • Gabapentin comes in capsule, tablets, and liquid solutions.
  • Immediate-release gabapentin comes as 100, 300 and 400 milligram (mg) tablets, and 600 and 800 mg capsules.
  • Gralise extended-release comes as 300 and 600 mg capsules. Liquid gabapentin comes as 250 mg/5 mL. Five milliliters (mL) is about one teaspoon.

Abusive Methods

People who abuse gabapentin may take more than the directions on the prescription or more often. Using gabapentin without a prescription is gabapentin abuse.

Gabapentin should not be sold to others if you have a prescription and should not be taken without one. In some states where gabapentin is a controlled medication selling it or using it without a prescription is a crime.

What Does Gabapentin Look Like?

Gabapentin comes in a variety of shapes and sizes, some of which can be found here. For specific questions about a loose tablet or pill, a person should call their pharmacy or pharmacist for prescription identification.

Brand Name

The following are gabapentin brand names:

  • Fanatrex (oral suspension)
  • Gralise (extended-release)
  • Horizant (extended-release)
  • Neuraptine (cream)
  • Neurontin

Other Names & Street Names for Gabapentin

Gabapentin does not have many street names because it’s a relatively uncommon drug of abuse. However, a person may hear it called gabbies, morontin or johnnies.

Can Gabapentin Be Abused?

Gabapentin abuse occurs in about 1% of the population.40-65% of the people who abuse it have a prescription, while the rest do not.

About 15-22% of people who abuse opioids report abusing gabapentin as well. Mixtures of opioids and gabapentin can be particularly dangerous, and the mixture is implicated in many cases of overdose and hospital visits each year.

Side Effects of Gabapentin

Some side effects of gabapentin include:

  • Constipation
  • Diarrhea
  • Dizziness
  • Drowsiness
  • Dry Mouth
  • Fever
  • Heartburn
  • Increased Appetite
  • Memory Problems
  • Nausea or vomiting
  • Red, itchy eyes (sometimes with swelling or discharge)
  • Runny nose, sneezing, cough, sore throat, or flu-like symptoms
  • Strange or unusual thoughts
  • Swelling of the hands, feet, ankles, or lower legs
  • Tiredness or weakness
  • Unsteadiness
  • Unwanted eye movements
  • Weight gain

The most reported side effects of gabapentin are dizziness and drowsiness, which produce a feeling similar to “drunkenness.” The effects are generally described as unpleasant because it clouds thinking and causes confusion in some people.

To avoid the negative side effects, gabapentin is usually slowly titrated to the target dose. Doses start at 100 mg daily and are increased every three days until the target dose is reached.

How Long Does Gabapentin Stay in Your System?

Gabapentin stays in the system for a different amount of time depending on what kind of test is used to detect it. Based on gabapentin’s half-life, a blood test may be able to detect it for up to 36 hours.

Since gabapentin is not a traditional drug of abuse, urine screens do not traditionally look for it. However, gabapentin specific tests can measure its presence for 2-4 days after last use.

A hair test has the potential to measure use for the last 90 days.

At this time, there is no drug test that detects gabapentin in saliva or oral fluid.

Gabapentin Half-Life

Gabapentin’s half-life is between 5-7 hours. Half-life describes the amount of time the body takes to completely metabolize a drug and remove it.

Drugs take about five half-lives to completely metabolize from the body, so most people will metabolize gabapentin in 25-35 hours.

Key Points: Understanding Gabapentin

Some important points to remember about gabapentin:

  • Gabapentin is a medication used to treat seizures and certain pain disorders
  • It works by slowing down certain signals in the brain
  • Gabapentin is not a scheduled medication in most states, however, Michigan and Kentucky are changing that
  • Gabapentin has many off-label uses including anxiety, ADHD, neuropathy, cough and RLS
  • Gabapentin comes as a capsule, tablet or liquid formulation
  • Using gabapentin without a prescription or in a way in which it was not prescribed is gabapentin abuse
  • Gabapentin stays in the system for about 36 hours but may be detectable for up to 90 days in a hair test

If you or a loved one is using more gabapentin than you intend to, call The Recovery Village Columbus. Our representatives can help guide treatment and get you into the right program. Treatment is possible, call The Recovery Village Columbus today.

Sources

Drugs.com. “Gabapentin Images.” 2019. Accessed Aug 22, 2019.

Bonnet, U, and N Scherbaum. “How Addictive Are Gabapentin and Pregabalin? A Systematic Review.” European Neuropsychopharmacology, 2017. Accessed Aug 22, 2019.

DailyMed. “Gabapentin Package Insert.” 2012. Accessed Aug 22, 2019.

‌The Department of Licencing and Regulatory Affairs. “Gabapentin Scheduled as Controlled Substance to Help with State’s Opioid Epidemic.” Michigan.Gov, 2019. Accessed Aug 22, 2019.

MedlinePlus “Gabapentin: MedlinePlus Drug Information.”  2017. Accessed Aug 22, 2019.

Quintero, Gabriel C. “Review About Gabapentin Misuse, Interactions, Contraindications and Side Effects.” Journal of Experimental Pharmacology, Feb. 2017. Accessed Aug 22, 2019.

Smith, Blair H, et al. “Substance Misuse of Gabapentin.” British Journal of General Practice, 2012. Accessed Aug 22, 2019.

‌Smith, Rachel V., et al. “Gabapentin Misuse, Abuse and Diversion: A Systematic Review.” Addiction, 2016. Accessed Aug 22, 2019.

Medical Disclaimer: The Recovery Village Columbus aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.