Gabapentin is a prescription anticonvulsant drug commonly known by the brand name Neurontin. Gabapentin is found in several different forms, each of which can be used to treat different conditions. In tablet, capsule, and oral solution form, this medication treats epilepsy and postherpetic neuralgia. The extended-release tablets are sometimes used to treat restless legs syndrome. This drug is also sometimes used to treat pain associated with diabetic neuropathy and to prevent hot flashes. By decreasing abnormal activity in the brain, this drug can prevent seizures and muscle spasms, as well as change the way the body responds to pain signals.
Who Abuses Gabapentin?
Gabapentin is not a controlled substance, meaning it is considered to have little abuse potential. However, it does share characteristics with some drugs of abuse; for example, it can lead to withdrawal symptoms when stopping use, and it has certain psychoactive effects. A vast majority of the individuals who use gabapentin for legitimate purposes do not go on to abuse the drug; however, a small percentage may misuse or overuse gabapentin.
Some of the individuals who abuse gabapentin seem to be using the drug to replace or supplement other drugs of abuse. According to the British Columbia Drug and Poison Information Centre, several cases have been reported of individuals who are addicted to cocaine or alcohol using gabapentin to avoid withdrawal when their preferred substance of abuse was not available. Further evidence supports the argument that gabapentin is primarily a drug of abuse among those already addicted to opioids. A study published by Psychiatric Quarterly reports that 26 percent of individuals with an opioid use disorder had also abused gabapentin, a much higher percentage than those with other drug use disorders.
A study published by the British Journal of General Practice states that some people who abuse gabapentin report pleasurable effects of the drug, including a “high” similar to that achieved by marijuana, euphoria, improved sociability, and feelings of calmness. These effects have led to increase in the abuse of gabapentin. Prescriptions written for gabapentin have risen in number in recent years at a rate that cannot be fully explained by the number of people requiring treatment for neuropathic pain – the condition for which gabapentin is most often used. Because gabapentin is not a controlled substance, it is fairly easy for those who abuse the drug to receive it.
There have also been reports of gabapentin being used as a “cutting” agent for heroin, meaning gabapentin is mixed with heroin and sold as a street drug. Gabapentin can cause fatal overdoses, and there is no antidote to a gabapentin overdose. These factors have combined to make gabapentin a dangerous drug of abuse.
Individuals with a history of drug abuse are among the most likely to abuse gabapentin, according to an article published by the journal Addiction. Approximately 1 percent of the population currently misuses gabapentin. Individuals originally prescribed gabapentin for legitimate uses make up about 40-65 percent of those who misuse the drug, while people who abuse opioids make up 15-22 percent of gabapentin abusers. Those who abuse this drug reported doing so for recreational purposes, self-medication, or to cause intentional self-harm. It is often misused alone, or in combination with opioids, benzodiazepines, or alcohol. The sedating effects of gabapentin may be exacerbated by central nervous system depressants, such as alcohol and benzodiazepines, increasing the risks associated with abusing this drug.
Effects of Gabapentin Abuse
Gabapentin can affect mood and mental state. According to the National Library of Medicine, a small percentage of people who take this drug experience suicidal thoughts and behaviors while being treated with this medication. The following side effects of gabapentin indicate a dangerous shift in mental state:
- Panic attacks
- Agitation or restlessness
- Dangerous, impulsive behavior
- Difficulty sleeping
- Aggressive or violent behavior
- Suicidal thoughts
- Withdrawing from others
- Preoccupation with death and dying
In addition to affecting your mental state, gabapentin can cause many other side effects. Some of these effects are mild and tend to resolve on their own; however, abusing gabapentin can exacerbate these effects. Common side effects include:
- Uncontrollable shaking
- Blurred vision
- Difficulty with memory
- Uncontrollable eye movements
- Nausea and vomiting
- Increased appetite
- Weight gain
- Swelling in the extremities
- Back or joint pain
- Flu-like symptoms
- Ear pain
- Red, itchy eyes
- Dry mouth
Some side effects of gabapentin are more serious. These effects are more likely to occur if gabapentin is overused or otherwise abused. Serious side effects include:
- Swelling in the mouth or face
- Difficulty swallowing or breathing
Abusing any medication can lead to overdose. An overdose is one of the most dangerous possible consequences of drug abuse. Symptoms of gabapentin overdose include:
- Double vision
- Slurred speech
Abusing any drug can have devastating effects on the major organs of the body, as they are forced to process large quantities of harmful substances. According to NIDA, drug abuse often leads to or exacerbates cardiovascular disease, stroke, cancer, HIV/AIDS, hepatitis, and lung disease.
Gabapentin Detox and Withdrawal
Dosages of gabapentin should always be slowly increased and decreased over time, rather than started or stopped suddenly. Stopping use of this drug too suddenly can lead to withdrawal symptoms. The National Library of Medicine lists the following withdrawal symptoms of gabapentin:
- Difficulty sleeping
A study published by the journal Annals of Pharmacotherapy reported that withdrawal symptoms from gabapentin typically first appeared within 12 hours to seven days of stopping use. Suddenly stopping gabapentin use can also trigger seizures, particularly if the medication was being used to control a seizure disorder like epilepsy. Because of the dangers associated with stopping gabapentin use, it is best to detox in a medically supervised environment. Medical detox provides constant supervision and care, which helps to prevent any complications and offers immediate treatment if it is needed.
Withdrawal from gabapentin may be complicated by other drugs of abuse. If all drug use is stopped, withdrawal from other substances like opioids may occur simultaneously with gabapentin withdrawal. Opioid withdrawal can be severe, but it is not usually life-threatening.
Some people abuse gabapentin in combination with central nervous system depressants like benzodiazepines. In such a case, withdrawal must take place within medical detox in order to avoid serious complications. CNS depressant withdrawal can be deadly and should always occur under medical supervision.
As mentioned, polysubstance abuse can complicate the withdrawal process. Medical detox is the safest option for both gabapentin withdrawal and polysubstance withdrawal.
Treating Gabapentin Addiction
There are currently no addiction treatments specifically for gabapentin abuse; however, several evidence-based treatments exist for other prescription drug addictions. Because a majority of people who abuse gabapentin are also addicted to other substances, it is important that any treatment plan addresses all substances of abuse. Some people may abuse gabapentin in an attempt to self-medicate mental health disorders or physical diseases. An effective treatment plan will also address these co-occurring disorders and offer comprehensive treatment for them.
Drug addiction treatment should follow several steps, and it can be a lengthy process. Long-term follow-up care is an important part of avoiding relapse. The National Institute on Drug Abuse recommends that drug addiction treatment follow these steps:
- Detox, or ridding the body of all substances of abuse
- Behavioral counseling
- Medication, if available for the particular addiction or for co-occurring issues
- Evaluation and treatment of any co-occurring mental health disorders, such as anxiety, depression, or personality disorders
- Long-term follow-up care to prevent relapse
These different facets of an effective treatment plan can take place in different environments, and the best treatment plans are tailored to individual circumstances and needs. Inpatient programs, partial inpatient programs, and outpatient treatment can all be effective for different individuals. Many people with severe addictions begin their treatment in an inpatient facility and eventually transition to outpatient treatment.
Residential or inpatient treatment programs may be long- or short-term. These programs offer 24-hour supervision and treatment, including both medical care and behavioral interventions. Long-term programs typically last 6-12 months, while short-term programs may last a few weeks. Residential treatment is often the most effective treatment option, and it is often recommended for individuals who abuse multiple substances, as is often the case for most individuals addicted to gabapentin. Residential treatment removes opportunities for relapse and helps the individual avoid triggers – situations or experiences associated with drug use. Partial inpatient treatment is similar to residential treatment in that a high level of care is offered, but the individual continues to live at home while spending several hours each day at a treatment center.
Outpatient drug addiction treatment can take many forms, but it typically involves several components, including individual and group behavioral therapy, and participation in support groups or self-help programs, such as 12-Step meetings. While residential treatment offers the highest level of care, outpatient treatment is often more affordable, and it can be a more effective option for individuals with a strong support system who wish to remain close to friends and family while in treatment.
Treatment for gabapentin addiction primarily takes the form of behavioral interventions, because there are currently no FDA-approved medications for its treatment. However, individuals who are also addicted to opioids may be treated with medication. Several different drugs are used for this purpose, including methadone, buprenorphine, and naltrexone. Methadone and buprenorphine mimic some of the effects of opioid drugs, which helps to lessen withdrawal and prevent cravings. Naltrexone blocks the effects of opioids, discouraging relapse. While these medications can be very effective in treating opioid addiction, they must be used carefully and under close medical supervision, particularly in cases of polysubstance abuse.
One of the most effective treatment methods for drug abuse is behavioral therapy. Many different therapy modalities have been shown to be effective for this purpose. Some methods of therapy are more effective for certain drugs of abuse than others; it is currently unknown how effective different therapy modalities are for gabapentin abuse specifically. However, opiate addiction is most effectively treated with Contingency Management interventions, the Community Reinforcement Approach, and 12-Step facilitation therapy. Other methods of behavioral therapy commonly used to treat drug addiction are Cognitive-Behavioral Therapy, Motivational Enhancement Therapy, the Matrix Model, and family therapy.