Could Gabapentin be America’s Next Drug of Abuse?

As providers try to find non-addictive alternatives to opioids to treat pain, prescriptions for off-label use of gabapentin have been climbing. Perhaps best known for treating pain associated with shingles, gabapentin does not show affinity for the same types of receptor sites in the brain that are associated with drugs of abuse. But public health researchers are starting to sound an alarm, citing mounting evidence that gabapentin may not be as benign as once thought. Scientists point out that gabapentin does share some characteristics of drugs of abuse, such as psychoactive effects and withdrawal syndrome, and reports of gabapentin misuse are rising.

“Originally approved in 1993, gabapentin and its relative, pregabalin, are approved to treat epilepsy as well as specific types of nerve pain,” said Pete Zaharas, RPh, pharmacist in charge at Cordant Heath Solutions. “Between 2002 and 2015, prescription rates for gabapentin tripled, perhaps because it is not classified as a scheduled drug by the federal government, meaning that it is thought to have little potential for abuse.”

Yet reports show that increasing numbers of patients are self-administering higher-than-recommended doses to get high. The rise in gabapentin abuse is a recent phenomenon, with three-quarters of cases having occurred since 2012.

Recent studies also show that gabapentin has close ties to the opioid epidemic. “Gabapentinoids fit into what researchers call a ‘polydrug pattern,’ which means that someone misusing these medicines is likely to be misusing other drugs as well, which is turning alarm bells into sirens,” said Zaharas. “Early findings from the Federal Drug Administration (FDA) show a relationship between gabapentin abuse and use of opioids, benzodiazepines and other central nervous system depressants.”

2018 workers’ compensation drug testing data from Cordant shows that out of 430 patients tested who were prescribed gabapentin, 69 percent came back with an unexpected drug test result. Of those, 41 percent did not have the prescribed gabapentin in their system, 38 percent came back with a non-reported medication detected and 33 percent tested positive for alcohol or an illicit drug.

“It’s telling when almost 70 percent of workers’ comp claimants tested in 2018 with Cordant came back with an inconsistent test result,” said Michele Settel, vice president and general manager of the workers’ compensation division at Cordant. “Many physicians believe that gabapentin is a safer medication to prescribe, but the data and studies are starting to show a close association between gabapentin and higher-risk behaviors. The potential for abuse and the risk of unwanted outcomes may be higher than previously expected.”

Data in an independent study also showed that combining gabapentinoids and central nervous system depressants is highly dangerous. Overconsumption of gabapentinoids is associated with increased risk of suicidal thoughts and opioid overdose. And in reviewing dozens of published studies, one research group found that although even high doses of gabapentinoids are generally not lethal, they are also showing up more frequently in post-mortem toxicology screens. Altogether these findings suggest gabapentin is emerging as its own drug of abuse.

“With the rise in risky behavior and an eye on the opioid epidemic, some states are addressing the issue directly. In 2017 Kentucky classified gabapentin as a controlled substance, and both Massachusetts and Ohio now require gabapentinoid prescriptions to be registered in their prescription drug monitoring databases,” said Settel.

The good news is that the FDA’s preliminary findings do not show that abuse of gabapentinoids is widespread. But the data highlighted in its study, along with Cordant’s findings, show the need to be aware and diligent with prescribing protocols and monitoring for adherence to therapy.

Zaharas recommends that clinicians who are considering prescribing gabapentin should assess their patients for drug abuse history and monitor these patients for any signs of misuse or abuse, including checking frequently with their state’s prescription drug monitoring program. Prescribers should also regularly test for gabapentin in urine or oral drug screens to monitor for potential signs of abuse or aberrant behavior.

About Cordant
Based in Denver, Cordant Health Solutions™ (www.cordantsolutions.com) provides innovative tools for monitoring behavioral health, chronic pain and criminal justice cases. Our unique pharmacy and drug testing programs provide accurate, actionable results to protect prescribers, hold patients accountable and optimize quality of life.

As a leader in quality standards, Cordant is committed to developing solutions for payers, clinicians and organizations involved with substance use disorder, pain management and criminal justice agencies. Cordant is one of the only healthcare companies that offers monitoring and risk assessment tools through its innovative drug testing options and full-service, high-touch pharmacies, which specialize in the complex management and dispensing of controlled substances. Cordant’s testing protocols and digital case-management tools help clients become more efficient and effective in using drug testing programs to monitor patient adherence, reduce risk and improve patient outcomes.