Gabapentin (Neurontin): Misuse, Withdrawal & Addiction Treatment
What is Gabapentin?
Gabapentin is a prescription anticonvulsant drug available in a variety of formulations and marketed under several brands, including Neurontin. Supplied in tablet, capsule, and oral solution form, this medication is indicated for the treatment of partial seizures and the management of postherpetic neuralgia.1 An extended-release tablet formulation—Horizant—is also indicated for the treatment of restless legs syndrome.2 Off-label uses for gabapentin include the management of pain associated with diabetic neuropathy, fibromyalgia, migraines, and hot flashes.2,3
Who Misuses Gabapentin?
As of 2019, gabapentin was not a federally controlled substance,2 however some states—including Tennessee and Kentucky—have moved to independently designate the drug as Schedule V, given the mounting evidence for diversion and misuse of this drug (particularly in the context of opioid use, as gabapentin is frequently misused to potentiate the opioid high).4,5
Though it remains a non-controlled substance for now, gabapentin does share characteristics with more commonly recognized drugs of abuse; for example, it has certain sought-after psychoactive effects in large enough doses and, in people who develop physical dependence to the drug, it can lead to the onset of withdrawal symptoms when use abruptly stops.6
Some individuals who misuse gabapentin nonmedically have previous histories of other types of drug abuse or dependence.6,7 Case study evidence reveals that gabapentin is frequently a drug of abuse among those already struggling with opioid addiction. A review article published in the journal Addiction estimated that the prevalence rate for the misuse of gabapentin among those people who also abuse opioids may be as high as 15-22%.7 Other reviews have pointed to prevalence rates amongst opioid abusers running as high as 68%.9
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.8 These effects have led to an 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—one of the conditions for which gabapentin is approved for use. Because gabapentin is not a controlled substance, it is relatively easy for people to obtain prescriptions and to subsequently divert to the black market for nonmedical use.8
Other individuals who have misused gabapentin have 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 certain risks associated with abusing this drug—such as overdose.7
Potential Effects of Gabapentin Misuse
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 may be indication of a potentially dangerous shift in mental state:10
- Agitation or restlessness.
- Panic attacks.
- Dangerous, impulsive behavior.
- Aggressive or violent behavior.
- Withdrawing from others.
- Preoccupation with death and dying.
- Suicidal thoughts.
In addition to these potential mental health issues, gabapentin use is associated with several other side effects. The misuse of gabapentin in higher-than-prescribed doses may exacerbate some of these effects and/or increase the likelihood of them developing:10,11
- Muscle weakness.
- Muscle tremor.
- Abnormal eye movements (e.g., nystagmus).
- Blurred vision.
- Difficulty with memory.
- Dry mouth.
- Nausea and vomiting.
- Bowel changes (e.g., constipation or diarrhea).
- Increased appetite.
- Weight gain.
Some of the potentially more severe side effects associated with gabapentin include:10,11
- Diminished white blood cell count (i.e., leukopenia).
- Widespread skeletal muscle tissue damage (i.e., rhabdomyolysis).
Though much less common than opioids, gabapentin can result in fatal overdose.3 Gabapentin overdoses may be particularly dangerous when the drug has been used in combination with opioids, alcohol, or other CNS depressant drugs. There is no pharmacologic antidote for a gabapentin overdose.12
Symptoms of gabapentin overdose or combination overdose could include:1,10,12
- Profound sedation.
- Over-drowsiness or lethargy.
- Respiratory depression.
- Coma (in people with chronic renal failure).
Gabapentin overdose and combination overdoses can result in serious injury or death. If an overdose involving gabapentin is suspected, call for emergency medical help immediately.
Gabapentin Detox and Withdrawal
In addition to the aforementioned risks of gabapentin misuse, physical dependence is increasingly likely to develop. Once significant physical dependence has been established, an individual is at risk of experiencing an acute withdrawal syndrome upon abrupt discontinuation of gabapentin use.
Potential withdrawal symptoms of gabapentin include:1,12
- Rebound seizures.
A case study review published by the journal Annals of Pharmacotherapy reported that the appearance of withdrawal symptoms from gabapentin occurred within 12 hours to seven days of stopping use.6 Suddenly stopping gabapentin use may also be associated with seizure activity, particularly if the medication was being used to control a seizure disorder to begin with.1
Because of the risks associated with stopping gabapentin use, many people will detox in a medically supervised environment at the start of longer-term recovery efforts. Medical detox provides constant supervision and care, and facilitates medical/pharmaceutical intervention for any complications should they arise during the withdrawal management period.
Gabapentin withdrawal may be additionally complicated in situations of polysubstance dependence—in other words, if other substances have been used to the point that multiple withdrawal syndromes may be at play. In such a scenario, withdrawal from other concurrently used substances like opioids may occur simultaneously with gabapentin withdrawal. Detoxification in cases of polysubstance abuse is likely to proceed by prioritizing the management of the most severe associated symptoms, to keep the individual as safe and comfortable as possible.13
Treating Gabapentin Addiction
Like other types of addiction, cases of compulsive and problematic gabapentin use will likely require more than the relatively brief of detox and withdrawal management to promote successful recovery.14 An important goal of professional detoxification is to prepare a person for a longer-period of professional rehabilitation once withdrawal has been safely and successfully managed.
What such a rehabilitation period will specifically entail is likely to vary depending on program type and patient needs. In general, however, many programs and their treatment offerings will be informed by several of the 13 Principles of Effective Treatment, as outlined by the National Institute on Drug Abuse. Some of these principles include:14,15
- Detox as the first stage of treatment.
- Treatment tailored to individual needs, even those that go beyond drug use.
- Frequent treatment plan reviews and appropriate adjustments as a person progresses through a program.
- Adequate lengths of treatment to increase favorable treatment outcomes.
- At the foundation of treatment, ample counseling and behavioral therapy.
- Evaluation and treatment of any co-occurring mental health disorders, such as anxiety, depression, or personality disorders—including medications, when appropriate.
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. Residential or inpatient programs, partial hospitalization programs, and other outpatient treatment settings 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.
Regardless of treatment program type or setting, substance rehabilitation will be structured on a foundation of both individual and group behavioral therapy. Many programs also encourage participation in support groups or self-help programs, such as 12-Step meetings. As a program progresses, an aftercare plan will be formulated prior to rehab completion. A solid aftercare plan may include various opportunities for long-term follow-up care to help prevent relapse and promote sustained recovery.14
- U.S. Department of Health and Human Services—Food & Drug Administration. (2017). Labelling-Medication Guide: Neurontin.
- Hamilton, RJ. (2019). Tarascon Pocket Pharmacopoeia, 2019 Deluxe Lab-Coat Edition. Jones & Bartlett Learning.
- Reynolds, K., Kaufman, R., Korenoski, A., Fennimore, L., Shulman, J., & Lunch, M. (2019). Trends in gabapentin and baclofen exposures reported to U.S. poison centers. Clinical Toxicology, 2019; Dec 1:1-10. [Epub ahead of print].
- Peckham, A.M., Ananickal, M.J., Sclar, D.A. (2018). Gabapentin use, abuse, and the US opioid epidemic: the case for reclassification as a controlled substance and the need for pharmacovigilance. Risk Management and Healthcare Policy. 2018 Aug 18;11:109-116.
- Institute for Research, Education & Training in Addictions. (2018). Gabapentin, the ‘Chameleon’ Drug: Risks and Response.
- Mersfelder, T. L., & Nichols, W. H. (2016). Gabapentin: Abuse, Dependence, and Withdrawal. Annals of Pharmacotherapy, 50(3), 229–233.
- Smith, R. V., Havens, J. R., & Walsh, S. L. (2016). Gabapentin misuse, abuse and diversion: a systematic review. Addiction; 111(7), 1160–1174.
- Smith, B.H., Higgins, C., Baldacchino, A., Kidd, B., & Bannister, J. (2012). Substance misuse of gabapentin. The British journal of general practice: the journal of the Royal College of General Practitioners, 62(601), 406–407.
- Evoy, K.E., Morrison, M.D. & Saklad, S.R. (2017). Abuse and Misuse of Pregabalin and Gabapentin. Drugs; 77, 403–426.
- U.S. National Library of Medicine—MedlinePlus. (2017). Gabapentin.
- Hamilton, RJ. (2017). Tarascon Pocket Pharmacopoeia, 2017 Professional Desk Reference Edition. Jones & Bartlett Learning.
- U.S. National Library of Medicine—PubChem. (2020). Compound Summary—Gabapentin.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse (2019). Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).