Gabapentin Addiction: Symptoms, Effects, Treatment, and Prevention

Gabapentin addiction develops when repeated use of the medication alters brain chemistry, leading to compulsive consumption beyond prescribed doses. Gabapentin, a prescription medication marketed under the brand name Neurontin, is used to manage nerve pain, seizures, and other chronic conditions. While intended for therapeutic purposes, its misuse or excessive consumption precipitates dependency, resulting in gabapentin addiction, which is an inability to control usage, even when it negatively impacts physical, emotional, or social well-being. 

The symptoms of gabapentin addiction include consuming the drug in larger amounts or for longer durations than prescribed, repeated unsuccessful efforts to reduce or control use, spending excessive time obtaining, using, or recovering from gabapentin, experiencing intense cravings, and continuing use despite negative effects on work, school, or social relationships. 

Gabapentin abuse, dependence, and withdrawal have been documented, particularly in individuals with prior substance abuse histories involving alcohol, cocaine, or opioids. According to Mersfelder, T., & Nichols, W.’s 2015 study, ‘Gabapentin: Abuse, dependence, and withdrawal’, found 18 case reports and studies showing addiction occurring with daily doses exceeding 3000 mg (600–8000 mg/day). Misuse rates were 1.1% in the general population and 22% in drug treatment centers. Withdrawal symptoms emerged within 12 hours to 7 days after stopping the drug.

The effects of gabapentin addiction are fatigue, dizziness, oversedation, nausea, muscle weakness, respiratory depression, cognitive impairment, withdrawal seizures, preterm delivery during pregnancy, and low birth weight in infants. These effects vary in severity, with short-term issues like sedation and dizziness producing a decreased quality of life. Long-term abuse results in more severe consequences, such as cognitive decline and organ damage, pushing for individuals with addiction to seek appropriate treatment.

Treatments for gabapentin addiction are detoxification, medications, inpatient rehabilitation, behavioral therapies, and support groups.  Medically supervised detoxification ensures safe withdrawal, while therapies such as Cognitive Behavioral Therapy (CBT) address underlying triggers and help develop healthier coping mechanisms. Inpatient rehabilitation provides structured care, and support groups offer ongoing peer encouragement and accountability.

The strategies for preventing gabapentin addiction are responsible prescribing practices, patient education, alternative treatments, monitoring for signs of misuse, and addressing co-occurring mental health disorders. Healthcare providers must be vigilant in monitoring patients for signs of misuse and provide individualized treatment plans that address co-occurring mental health disorders.

What Is Gabapentin Addiction?

Gabapentin addiction is a type of prescription drug dependency disorder characterized by the compulsive use of and physical/psychological reliance on gabapentin (Neurontin), an anticonvulsant medication, despite negative consequences. The condition involves developing tolerance to the drug’s effects, experiencing withdrawal symptoms when stopping use, and continuing to use the medication beyond its prescribed purpose or dosage.

According to Chan et al. 2023 in “Gabapentinoid Consumption in 65 Countries and Regions from 2008 to 2018: A Longitudinal Trend Study.” gabapentinoid consumption such as gabapentin rose globally by an average of +17.2% annually, rising from 4.17 to 18.26 defined daily doses per ten thousand inhabitants per day (DDD/TID) between 2008 and 2018, with high-income countries consuming 39.92 DDD/TID in 2018, over six times more than the 6.11 DDD/TID in lower-middle-income countries.

Why Is Gabapentin Addictive?

Gabapentin is addictive because it alters the brain’s neurotransmitter activity, creating a calming or euphoric effect that some individuals misuse to self-medicate anxiety, pain, or withdrawal symptoms. Over time, repeated use generates physical dependence and psychological cravings, as the brain becomes accustomed to the drug’s effects. These changes precipitate tolerance, necessitating higher doses to achieve the same effect, further exacerbating the risk of addiction. While gabapentin lacks the direct euphoric effects seen with opioids, its capacity to create feelings of relaxation and sedation makes it prone to misuse. Chronic use elicits physical dependence, requiring increasingly higher doses to achieve the desired effects and withdrawal symptoms upon cessation.

This rising misuse correlates with its increased accessibility and widespread prescription rates. The US Food and Drug Administration (FDA) approved gabapentin for treating seizures and pain associated with shingles. 

According to Kuehn, B. M.’s, 2022 study, ‘Gabapentin Increasingly Implicated in Overdose Deaths’, The widespread off-label prescribing of gabapentin for nerve pain and various other conditions led to a significant increase in its prescription rate, which doubled from approximately 13 to 27 per 1000 insurance beneficiaries between 2009 and 2016. This trend continued, and by 2019, gabapentin had established itself as the seventh most frequently prescribed medication in the United States.

What Is Gabapentin?

Gabapentin is a medication primarily prescribed for managing neuropathic pain, seizures, and conditions like postherpetic neuralgia. Neurontin, its brand name, has gained popularity for its off-label uses, such as alleviating anxiety or insomnia. As of September 2022, the states that have reclassified gabapentin as a Schedule C-V controlled substance are Michigan, Kentucky, North Dakota, Tennessee, Virginia, West Virginia, and Alabama. 

Gabapentin, an anticonvulsant prescribed for epilepsy and certain types of pain, is also used off-label to manage alcohol withdrawal symptoms, cravings, anxiety, and insomnia. 

According to Carter, E. J. R.’s 2024 study, ‘Gabapentin and pregabalin exposures reported to United States poison centers, 2012-2022’, there were 124,161 reported exposures to gabapentin and pregabalin, revealing significant patterns and concerns in their use. The study found that gabapentin dominated these cases, accounting for 85.9% of all exposures, with a notable female predominance (59.4%). Most concerning was the high rate of suspected suicide attempts, which constituted 45.2% of all cases. While the majority of exposures (61.4%) resulted in minor or no effects, 22.1% led to serious medical outcomes, including 96 fatalities. The data showed a dramatic 236.1% increase in exposure rates from 2012 to 2019, before plateauing through 2022. These findings underscore the urgent need for enhanced suicide prevention strategies and raise important questions about reclassifying gabapentin as a federally controlled substance, particularly given its widespread use as the seventh most commonly prescribed medication in the United States as of 2019.

How Does Gabapentin Work?

Gabapentin works by modulating nerve cell activity in the brain and spinal cord. Its mechanism of action remains unclear, yet it affects pain and seizure signal transmission. Gabapentin interacts with calcium channels on nerve cells and diminishes the release of excitatory neurotransmitters that contribute to overactive nerve activity. Despite its name suggesting a connection to Gamma-Aminobutyric Acid (GABA), gabapentin does not affect GABA receptors directly. Gabapentin alters nerve cell communication, stabilizes neural activity, and alleviates symptoms such as pain and seizures.

The prevalence of gabapentin misuse and its role in overdose deaths underscores the pertinence of its impact. Based on an analysis by the CDC using data from the State Unintentional Drug Overdose Reporting System (SUDORS) in 23 states and the District of Columbia, gabapentin was detected in 9.7% of 58,362 documented toxicology results from overdose deaths in 2019–2020. Alarmingly, 52.3% of those with a positive gabapentin test score were associated with gabapentin as the cause of death. Most of these deaths occurred among non-Hispanic White individuals (83.2%) aged 35–54 (52.2%), with gender distribution nearly equal between men (49.7%) and women (50.3%). This data underpins the urgent need for augmented monitoring and education regarding gabapentin use.

How Common Is Gabapentin Addiction?

Gabapentin addiction is very common. The prevalence of gabapentin prescriptions has risen dramatically across the United States, nearly doubling between 2009 and 2016.

According to Pauly, N. J.’s 2020 study, ‘Trends in Gabapentin Prescribing in a Commercially Insured U.S. Adult Population, 2009-2016.’, gabapentin prescribing increased by 44-179% across all states, reaching rates of up to 43.9 per 1,000 beneficiaries by 2016. The data showed that most users were female (62.5%) from the Southern states, with a striking 60.8% of gabapentin users also receiving opioid prescriptions compared to just 16.5% of non-users.

Also according to the Drug Enforcement Administration’s Diversion Control Division National Forensics Laboratory Information System in the “NFLIS-Drug Special Report: Gabapentin and Pregabalin Reported in NFLIS, 2011–2020,” gabapentin addiction rates reached 1.1% in the general population and 22% in drug treatment centers. Regional trends in gabapentin reports per 100,000 individuals aged 15 or older from January 2011 to December 2020 indicate that California had between 24 and 49 reports.

What Are the Symptoms of Gabapentin Addiction?

The symptoms of gabapentin addiction are taking larger amounts or using for longer periods than prescribed, unsuccessful attempts to cut down or control use, spending a huge amount of time obtaining, using, or recovering from gabapentin, cravings or strong urges, continued use despite negative impacts on work, school, or social life, developing a tolerance requiring higher doses, withdrawal symptoms like anxiety, insomnia, and nausea, and neglecting responsibilities or activities in favor of using gabapentin.

The common physical, psychological, and behavioral symptoms of gabapentin addiction are explained below:

Physical Symptoms of Gabapentin Addiction

The physical symptoms of gabapentin addiction are given below:

• Drowsiness: Excessive sleepiness or difficulty staying awake, even during the day, due to the lulling effect of gabapentin.
• Dizziness or lightheadedness: A feeling of unsteadiness or faintness, particularly when standing or moving quickly.
• Fatigue or feeling unusually tired: Persistent tiredness or a lack of energy, due to the body adjusting to prolonged use.
• Coordination problems or difficulty walking: Impaired motor skills, leading to stumbling or trouble maintaining balance.
• Tremors or muscle spasms: Uncontrolled shaking or twitching of the limbs, worsening with increased use.

Psychological Symptoms of Gabapentin Addiction

The psychological symptoms of gabapentin addiction are given below:

• Anxiety or irritability: Heightened feelings of restlessness or agitation, as a result of the drug’s pacifying effects wearing off.
• Mood swings or depression: Sudden and extreme changes in mood, or a prolonged feeling of sadness or hopelessness, especially when using gabapentin regularly.
• Intense cravings or urges to use gabapentin: A strong desire to continue using the drug, despite negative consequences.
• Impaired memory or concentration: Difficulty recalling information or maintaining focus, influencing day-to-day tasks and interactions.
• Distorted thinking or confusion: A sense of mental fog or altered perception, making it difficult to think clearly or make decisions.

Behavioral Symptoms of Gabapentin Addiction

The behavioral symptoms of gabapentin addiction are given below:

• Neglecting responsibilities or activities: Prioritizing drug use over work, school, or personal obligations.
• Obsessive thoughts about obtaining or using gabapentin: Frequent preoccupation with getting more of the drug or using it at all costs.
• Increasing isolation from friends or family: Withdrawal from social interactions, because of feelings of shame or a desire to use the drug without judgment.
• Engaging in risky behaviors or unsafe practices: Taking high doses or combining gabapentin with other substances, thus elevating the risk of overdose or harm.
• Using gabapentin in a way not prescribed: Taking higher doses, using it more frequently, or using someone else’s prescription to experience stronger effects.

What Are the Effects of Gabapentin Addiction?

The effects of gabapentin addiction are fatigue, dizziness, and nausea as the drug impacts the central nervous system, muscle weakness, cognitive impairments, and severe withdrawal symptoms like seizures, demonstrating the major risks of addiction. Gabapentin’s widespread use has escalated the potential for misuse. 

The number of gabapentin prescriptions in the United States surged from 39 million in 2012 to 64 million in 2016, making it the 10th most prescribed medication that year, as cited by Lanham S. & Riley B. 2022 in “Gabapentin Presents High Potential for Misuse.” This considerable rise in prescriptions settles the growing concerns regarding the short-term and long-term effects of gabapentin addiction.

Short-Term Effects Of Gabapentin Addiction

The short-term effects of gabapentin addiction are given below:

• Fatigue: Gabapentin generates excessive tiredness by depressing the central nervous system, impairing energy levels and motivation.
• Dizziness: As a sedative, gabapentin alters brain activity, invoking feelings of unsteadiness or lightheadedness. According to Vasigh, A.’s 2016 study, ‘The Effect of Gabapentin Plus Celecoxib on Pain and Associated Complications After Laminectomy.’, dizziness was reported as a side effect in 34.2% of patients who received gabapentin alone, and the same percentage (34.2%) in those who received gabapentin plus celecoxib combination therapy, compared to 21.1% in the placebo group.
• Over-sedation: Gabapentin’s calming effects induce drowsiness, making it difficult to stay alert and perform normal daily tasks.
• Nausea: The body reacts negatively to the drug, aggravating stomach discomfort and the urge to vomit, especially when taken in high doses.
• Blurred vision: Gabapentin interferes with normal vision by affecting the brain’s ability to process visual stimuli, causing blurred or double vision.

Long-Term Effects Of Gabapentin Addiction

The long-term effects of gabapentin addiction are given below:

• Muscle weakness: Prolonged use of gabapentin inhibits the proper functioning of muscles by disrupting neurotransmitter activity, exacerbating declining strength and coordination.
• Respiratory depression: Gabapentin slows the rate of breathing by influencing the brain’s respiratory centers, which is dangerous, especially at high doses. 

According to Corriere, M. A.’s 2023 study, ‘Concurrent Gabapentin and Opioid Use and Risk of Mortality in Medicare Recipients with Non-Cancer Pain.’, gabapentin causes life-threatening respiratory depression, particularly when combined with opioids or other central nervous system depressants. The FDA reported 12 deaths from respiratory depression between 2012-2018 among gabapentinoid users with risk factors, leading to a 2019 FDA warning about serious breathing difficulties. This prompted the American Geriatrics Society to advise against combining gabapentin with opioids in seniors, though concurrent use had already increased from 17.0% (2011) to 23.5% (2018) in older adults with chronic non-cancer pain.

• Severe withdrawal symptoms: When individuals stop using gabapentin after prolonged use, they experience withdrawal symptoms like seizures or intense anxiety due to the body’s physical dependence on the drug.
• Cognitive impairments: Chronic use of gabapentin negatively imposes memory, concentration, and cognitive function, posing difficulties in daily tasks and decision-making. According to Huang, Y. H.’s 2023 study, ‘The association between Gabapentin or Pregabalin use and the risk of dementia: an analysis of the National Health Insurance Research Database in Taiwan.’, gabapentin or pregabalin showed a 45% higher risk of developing dementia compared to non-users (HR 1.45). The risk was notably age-dependent, with younger patients under 50 showing the highest vulnerability at over three times the risk (HR 3.16). This risk steadily decreased with age, dropping to 1.58 for ages 50-59, 1.54 for ages 60-69, and 1.30 for those 70 and above.
• Psychological issues: Over time, gabapentin addiction contributes to or worsens mental health problems, such as depression, anxiety, or mood instability.

What Are the Effects of Gabapentin Addiction During Pregnancy?

The effects of gabapentin addiction during pregnancy include an increased risk of preterm delivery, low birth weight, neonatal intensive care unit (NICU) admissions, potential cardiac malformations, and small for gestational age (SGA) infants. Notably, maternal use of gabapentin, particularly later in pregnancy, is associated with an elevated risk of preterm birth (delivery before week 37) and small for gestational age (SGA) infants, those weighing less than 5 pounds, 8 ounces (2500 grams) at birth.

According to Fujii, H.’s 2013 study, ‘Pregnancy outcomes following gabapentin use: results of a prospective comparative cohort study.’, researchers identified concerning outcomes including higher rates of preterm birth (p = 0.019), low birth weight <2,500g (p = 0.033), and significantly increased NICU admissions (38% vs 2.9%, p < 0.001) in the gabapentin group. The medication was primarily prescribed for pain (43%) and epilepsy (34%), with average daily doses ranging from 538mg to 1,538mg depending on the indication.

What Are the Causes of Gabapentin Addiction?

The causes of gabapentin addiction are prescription for medical purposes, psychological factors, history of substance abuse, co-occurring mental health disorders, and lack of proper medical supervision. 

Common causes of gabapentin addiction are given below:

• Prescription for medical purposes: Many people start using gabapentin for legitimate medical reasons, such as for nerve pain or epilepsy. Over time, some individuals misuse the drug due to its narcotic effects and potential to provide relief from stress or anxiety, leading to addiction. 

According to Smith, R. V.’s 2016 study, ‘Gabapentin misuse, abuse and diversion: a systematic review.’, gabapentin misuse is alarmingly high among individuals with prescriptions, affecting 40-65% of these patients. In contrast, the prevalence in the general population is much lower at just 1%, while among people who abuse opioids, the misuse rate falls between 15-22%.

• Psychological factors: Conditions like anxiety, depression, or chronic pain prompt individuals to misuse gabapentin, seeking relief from emotional distress. This behavior elevates the risk of dependency.
• History of substance abuse: Individuals with a history of drug or alcohol abuse are more susceptible to developing a gabapentin addiction. The craving for relaxation or euphoria drives them to misuse the medication.
• Co-occurring mental health disorders: Having multiple mental health conditions, such as depression or anxiety, creates a cycle where individuals turn to gabapentin to self-medicate, further reinforcing the potential for addiction.
• Lack of awareness or proper medical supervision: Misuse also occurs when patients are unaware of the risks associated with gabapentin or are not properly monitored by healthcare professionals, increasing the likelihood of escalating use.

What Are the Withdrawal Symptoms of Gabapentin Addiction?

The withdrawal symptoms of gabapentin addiction are anxiety, insomnia, rapid heartbeat, sweating, nausea, headaches, irritability, and tremors. These symptoms occur because the body becomes dependent on gabapentin to regulate nerve signaling, and when the drug is stopped, the body must adjust to its absence.

According to Tran, K. T.’s 2005 study, ‘Gabapentin withdrawal syndrome in the presence of a taper.’, gabapentin withdrawal symptoms begin 1-2 days after discontinuation, starting with respiratory symptoms and somatic complaints. These symptoms worsen over 10 days, leading to severe mental status changes, chest pain, and hypertension. Reintroducing gabapentin resolved symptoms within 1-2 days, suggesting that a slow taper over weeks to months is recommended, rather than a rapid one-week taper.

Common withdrawal symptoms of gabapentin addiction are given below:

• Anxiety: Gabapentin influences the neurotransmitter GABA, which aims to calm the brain’s overstimulation. When the drug is withdrawn, anxiety intensifies as the brain struggles to adjust, setting the stage for increased nervousness and restlessness.
• Insomnia: Gabapentin affects the central nervous system, promoting relaxation and better sleep. Upon discontinuation, individuals experience difficulty falling asleep or staying asleep due to heightened arousal in the brain, breeding disrupted sleep patterns.
• Rapid heartbeat: Gabapentin has a calming effect on the heart rate by modulating neural signals. When it is stopped, the body’s agitation spawns tachycardia, causing a rise in heart rate, which sometimes triggers panic-like sensations.
• Sweating: Sudden withdrawal from gabapentin shoots up the body’s stress response, activating the sympathetic nervous system. This sparks excessive sweating, as the body works to maintain balance in the absence of the drug.
• Nausea: The gastrointestinal system becomes sensitive to changes in neurotransmitter activity, especially after gabapentin is withdrawn. Nausea and vomiting are common as the digestive system struggles to return to baseline functioning.
• Headaches: Gabapentin has an analgesic effect by inhibiting certain pain signals in the brain. Once the drug is removed, users experience headaches as their body attempts to rework to the loss of the pain-relieving effects.
• Irritability: As the central nervous system adjusts to the absence of gabapentin, emotional regulation is impaired. This produces heightened irritability and mood swings, with individuals finding it challenging to manage frustrations or stress.
• Tremors: Gabapentin supports the regulation of nervous system excitability, and without it, the body encounters physical manifestations of nervous system overactivity, such as involuntary shaking or tremors, especially in the hands.

Can You Stop Gabapentin Abruptly?

No, you cannot stop gabapentin abruptly. Stopping gabapentin suddenly causes severe withdrawal symptoms including anxiety, insomnia, and rapid heartbeat. Medical professionals recommend gradually tapering the dosage to safely discontinue gabapentin. Withdrawal symptoms begin within hours to days after sudden stoppage, particularly in patients taking higher doses long-term. The safest approach is slowly reducing the dosage over weeks or months under medical supervision. This systematic tapering helps minimize discomfort and potential complications.

What Are the Treatments for Gabapentin Addiction?

The treatments for gabapentin addiction include medically supervised detoxification, therapeutic interventions, and comprehensive rehabilitation programs. From managing withdrawal symptoms through specialized medications to participating in behavioral therapies and support groups like Narcotics Anonymous (NA) or Alcoholics Anonymous (AA), various treatment approaches address both physical and psychological aspects of recovery.

The treatments for gabapentin addiction are given below:

Detox

Detoxification addresses withdrawal symptoms by allowing the body to eliminate gabapentin under medical supervision. This process is critical for managing potentially severe symptoms like seizures or confusion, and ensuring safety during withdrawal. For individuals with a history of heavy use or co-occurring substance use disorders, inpatient detox programs are recommended to provide close monitoring and immediate intervention if complications arise.

According to Tran, K. T.’s 2005 study, ‘Gabapentin withdrawal syndrome in the presence of a taper.’, gabapentin tapering should follow benzodiazepine protocols – slowly over weeks to months – as even a one-week taper causes severe withdrawal symptoms that resolve only upon reintroduction of the medication.

Medications

Medications are prescribed to alleviate withdrawal symptoms, such as anxiety or insomnia, or to prevent relapse. For gabapentin withdrawal, physicians use alternative anticonvulsants or medications targeting the nervous system to reduce discomfort and stabilize the individual. The choice of medication depends on the severity of withdrawal and any underlying medical conditions.

Inpatient Rehabilitation

Inpatient rehab provides a highly structured environment with 24/7 medical and therapeutic support. This approach is beneficial for those with severe gabapentin addiction, a history of relapse, or co-occurring mental health issues. Inpatient care focuses on intensive therapy, behavioral counseling, and life skills training, ensuring a holistic approach to recovery. However, for individuals with milder addiction or strong support systems, outpatient programs are more flexible and cost-effective option.

Behavioral Therapies

Behavioral therapies aim to address the psychological factors contributing to gabapentin addiction. Cognitive Behavioral Therapy (CBT) and other evidence-based modalities help individuals identify triggers, change harmful thought patterns, and develop coping mechanisms. Therapy is delivered in individual, group, or family settings, depending on the patient’s needs. These interventions are crucial for maintaining long-term sobriety.

Support Groups

Support groups, such as 12-step programs like Narcotics Anonymous (NA) or Alcoholics Anonymous (AA), offer peer support and accountability. Participants share experiences, build a sense of community, and gain encouragement from others in recovery. These groups have been identified as vital recovery pathways for many individuals with substance use histories. Approximately 45% of participants identified these programs as critical to their recovery, as detailed in the working draft “Pathways to Healing and Recovery: Perspectives from Individuals with Histories of Alcohol and Other Drug Problems,” prepared by Abt Associates Inc. and Hart Research Associates for SAMHSA (Substance Abuse and Mental Health Services Administration).

The best treatment approach depends on the severity of addiction and individual circumstances. While inpatient rehab is necessary for severe cases, outpatient programs combined with behavioral therapies and support groups suffice for those with milder dependence. Detox and medications serve as foundational steps to guarantee safety and stability during recovery.

How Is Gabapentin Used for Alcohol Withdrawal Syndrome?

Gabapentin is used for alcohol withdrawal by managing symptoms such as anxiety, insomnia, and cravings that arise during detoxification. Gabapentin’s mechanism stabilizes overactive neural pathways caused by the abrupt cessation of alcohol, which diminishes the peril of seizures and tremors associated with withdrawal.

Gabapentin is prescribed in outpatient settings for patients with mild to moderate withdrawal symptoms and is considered a safer alternative to benzodiazepines for individuals with a history of addiction. Gabapentin’s ability to cut cravings makes it a valuable tool in preventing relapse.

The dosage and duration of treatment depend on the severity of withdrawal symptoms and individual health conditions, requiring careful supervision by healthcare professionals.

According to Anton, R. F.’s 2020 study, ‘Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial.’, gabapentin (1200 mg/day) effectively treated alcohol use disorder, with 27% of patients achieving zero heavy drinking days versus 9% on placebo. The drug was particularly effective in patients with withdrawal symptoms, where 41% achieved total abstinence compared to 1% on placebo. With minimal side effects and kidney-based excretion, gabapentin proved to be both safe and effective for alcohol dependence treatment.

What Are the Strategies for Preventing Gabapentin Addiction?

prescribing practices, enhancing patient education, offering alternative treatments, and closely monitoring for signs of misuse. These approaches aim to balance the therapeutic benefits of gabapentin while chopping away at its abuse.

Common strategies for preventing gabapentin addiction are given below:

• Responsible Prescribing Practices: Prescribing gabapentin only when necessary and at the lowest effective dose reduces the risk of misuse. Physicians assess patient histories for substance abuse to ensure gabapentin is not prescribed to high-risk individuals.
• Patient Education: Informing patients about the risks of dependence and safe usage helps prevent misuse. Educating patients about the importance of adhering to prescribed doses and recognizing signs of addiction empowers them to use the medication responsibly.
• Alternative Treatments: Exploring non-addictive options like physical therapy or non-opioid pain relievers serve effective care without the risk of addiction. Mindfulness techniques, cognitive behavioral therapy, and acupuncture are also effective substitutes for managing chronic pain.
• Regular Monitoring: Regular follow-ups and assessments allow healthcare providers to identify and address early signs of dependency. Close communication with patients ensures early intervention and provides opportunities to adjust treatment plans.
• Prescription Drug Monitoring Programs (PDMPs): Utilizing these systems tracks prescriptions to prevent overlapping or excessive gabapentin use. These programs detect patterns of doctor shopping or overprescription, safeguarding against misuse. 

The IQVIA Smart U.S. Launch Edition and U.S. Regional Edition, NPA, tracks the distribution of prescriptions from retail pharmacies, mail services, and long-term care facilities. Data from IQVIA highlights gabapentin’s total prescription volume in the United States from 2016 to 2020, encompassing new prescriptions and refills. Over this period, 333.93 million gabapentin prescriptions were dispensed. The lowest annual volume was recorded in 2016, with 64.49 million prescriptions, while the highest volume took place in 2020, with 69.00 million prescriptions dispensed. Notably, California ranked as the state with the highest gabapentin prescription volume in 2020, totaling 5.80 million.

How Does Gabapentin Interact With Other Substances?

Gabapentin interacts with other substances like opioids, alcohol, or certain medications with a higher incidence of serious health risks such as amplified sedation, respiratory depression, and impaired motor and cognitive functions. Almost 90% of drug overdose fatalities where gabapentin was detected also incorporated an opioid, with a considerable and growing prevalence of illicitly manufactured fentanyl, as spotlighted by the Centers for Disease Control and Prevention (2022) in “Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020.”

Can Mixing Gabapentin and Opioids Kill You?

Yes, mixing gabapentin and opioids is fatal. The combination amplifies the risk of respiratory depression, sedation, and overdose. According to Gomes, T.’s 2017 study, ‘Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study.’, there is a 49% higher risk of dying from an opioid overdose when gabapentin is used concurrently with opioids. This interplay is hazardous when illicitly manufactured opioids, such as fentanyl, are entangled, as they are more potent and unpredictable.

Can You Overdose on Gabapentin?

Yes,  overdosing on gabapentin is possible, particularly at high doses exceeding 49 grams, as provided by the FDA Approved Labeling Text (2011). Overdose symptoms are extreme drowsiness, slurred speech, unresponsiveness, double vision, and respiratory depression, which cause life-threatening complications.

In some cases, combining gabapentin with other substances like alcohol or opioids exacerbates the risk of overdose by reinforcing its sedative effects. Early medical intervention is vital in suspected gabapentin overdose cases to preclude severe outcomes.

What Are the Symptoms of Gabapentin Overdose?

The symptoms of gabapentin overdose are double vision, slurred speech, drowsiness, lethargy, diarrhea, unresponsiveness, respiratory depression, and confusion. Each symptom arises due to the medication’s effect on the central nervous system and gastrointestinal tract, resulting in neurological and systemic responses that intensify with overdose levels. 

The nascence in gabapentin-related fatalities underscores the drug’s potential for severe consequences when misused. During the second quarter of 2020, 959 deaths involved gabapentin detection, nearly double the 449 deaths reported in the first quarter of 2019. By the fourth quarter of 2020, the number of deaths declined slightly to 801; however, the proportion of cases where gabapentin was implicated rose from 49.4% in the first quarter of 2019 to 55.1% by the end of 2020, as outlined by the Centers for Disease Control and Prevention (2022).

Do You Have To Wean Off Gabapentin?

Yes, you need to wean off gabapentin rather than stopping abruptly. According to Deng, H.’s 2021 case report, ‘Gabapentin dependence and withdrawal requiring an 18-month taper in a patient with alcohol use disorder: a case report.’, one patient required an 18-month gabapentin taper starting at 1,200 mg daily, with initial reductions of 100 mg monthly until reaching 300 mg, then slowed to 20-30 mg monthly, and finally to 5 mg decrements every 1-2 weeks for the last 100 mg until discontinuation at 60 mg. This careful approach was necessary due to the patient’s severe withdrawal symptoms.