Gabapentin Abuse & Addiction

gabapentin pill bottle

Gabapentin can be used to treat a variety of conditions, but in some cases it has the potential for abuse. Currently, however, the Drug Enforcement Administration (DEA) has not classified gabapentin as a controlled substance per federal law.

Evidence suggests that gabapentin abuse and addiction in Washington state is on the rise. The Pharmacy Quality Assurance Commission and the State of Washington Poison Control Center tracked the use of gabapentin abuse and addiction in Washington for the past three years. Based on these findings, authorities in Washington state are considering including gabapentin as a “drug of concern” in the state.

What Is Gabapentin Used For?

Gabapentin is prescribed to treat certain medical conditions. The FDA approved gabapentin to treat seizures, but doctors commonly use the medication “off-label”, or in ways that the FDA did not approve. Off-label indications for gabapentin include:

  • Alcohol use disorder
  • Alcohol withdrawal seizures
  • Bipolar disorder
  • Fibromyalgia
  • Menopause symptoms
  • Migraine
  • Neuropathic pain, or nerve pain
  • Postherpetic neuralgia, or the pain associated with shingles
  • Restless legs syndrome
  • Severe, persistent cough
  • Severe, persistent hiccups
  • Social anxiety disorder

Doctors may choose gabapentin over opioids for people with chronic pain conditions. Gabapentin is sold under the brand name Neurontin.

How Long Does Gabapentin Last?

Gabapentin’s effects usually last for 6–8 hours in most people. Despite the relatively short duration of action, the drug stays in the body for much longer. Gabapentin’s half-life is 5–7 hours for healthy adults. Since drugs take five half-lives to clear from the body, this means that gabapentin sticks around for 25–35 hours. Even if the effects are not obvious, the person taking it may still be impaired for over a day.

A major factor to consider is that gabapentin is almost entirely cleared by the kidneys. For people with kidney problems or impairment, gabapentin will stay in the body for much longer. In people with severe Chronic Kidney Disease (CKD), gabapentin’s half-life extends to 52 hours. This extended half-life means a single dose of gabapentin in someone with CKD can stay in the body for over ten days.

How Long Does Gabapentin Stay in Your System?

The length of time gabapentin stays in the system depends on kidney health. Overall, Gabapentin can stick around in the body for anywhere from 1–10 days.

Gabapentin can be detected in the urine 2–4 days after the most recent dose. Urine tests are the most common type of drug test because they are inexpensive and non-invasive compared to other tests. They can be administered in many settings.

Other common types of tests include blood and hair. Gabapentin is detectable in the blood until five half-lives have occurred, meaning it can be detected within 1–2 days of the most recent dose in healthy adults. Hair tests are uncommon because they are relatively expensive, but they can provide the largest window of use. Results from a hair test could reveal gabapentin use for up to 90 days after the most recent dose.

Does Gabapentin Show up on a Drug Test?

Most drug tests don’t look for gabapentin. However, specific tests can be ordered to check for gabapentin use. Generally, a person or organization would need to suspect gabapentin use in order for the test to be ordered.

Gabapentin Dosage

Gabapentin is available in various forms, including

  • Oral capsules
  • Oral liquid solution
  • Oral tablet, immediate-release
  • Oral tablet, extended-release

Oral capsules are the most common form of gabapentin and they are available in brand or generic formulations. Dosages include 100 mg, 300 mg, and 400 mg.

The oral solution is used for people who have trouble swallowing, like young children or older adults. The solution is available as 250 mg/5 mL, or 250 mg per teaspoon.

The immediate-release oral tablet may be used for those who need larger doses. It is available in 800 mg.

Gabapentin is also available as an extended-release tablet for those who need constant treatment. The most common brand name is Gralise, which is available in 300 mg and 600 mg.

What Does Gabapentin Look Like?

Gabapentin comes in many different shapes and sizes. The capsules may be orange, white, gray, blue, yellow or other colors. Tablets may be blue, white, yellow or other colors. Each capsule or tablet may have different markings depending on the manufacturer. If you are unsure about your prescription, ask your pharmacist.

Is Gabapentin Addictive?

There is no general medical consensus on whether or not gabapentin is considered addictive. However, many states consider Gabapentin to have the potential for abuse. Alabama, Kentucky, Michigan, North Dakota, Tennessee, Virginia and West Virginia have all classified gabapentin as a controlled substance.

When the FDA first approved gabapentin in the early 1990s, it was considered a safe medication. However, reports began to show that gabapentin could produce feelings of calmness, relaxation and even euphoria, especially at higher doses. Today’s scientists now recognize gabapentin as a substance of abuse.

The reason why gabapentin is addictive is less related to its calming effects and more related to the effects of combining it with other substances. People who misuse opioids may prefer the feeling of calmness they experience when misusing gabapentin.

As people develop an addiction to an opioid, they also crave the sensations that are caused by simultaneously taking gabapentin. This craving is the major reason why gabapentin is addictive.

Gabapentin Side Effects

Common side effects of gabapentin are reportedly similar to the effects of alcohol use. They may include:

  • Ataxia
  • Dizziness
  • Fatigue
  • Hostility
  • Nausea
  • Nystagmus
  • Peripheral edema
  • Somnolence
  • Vomiting

The most common side effects of gabapentin are drowsiness and fatigue.

Gabapentin and Alcohol

Gabapentin’s chemical structure is similar to a neurotransmitter known as gamma-aminobutyric acid (GABA). Like GABA, gabapentin reduces the activity of nerve cells in the brain. This inhibitory effect causes a sense of relaxation and calmness.

Alcohol works in a similar way. It is not shaped like GABA, but it enhances its effects, so  a person greatly increases the inhibitory signals in their brain when gabapentin and alcohol are mixed.

Misusing the two together increases the risk of overdose, alcohol poisoning, coma, impairment and death.

Gabapentin Overdose

The risk of gabapentin overdose is extremely low on its own, and incidents of death related to gabapentin overdose are rare. However, Gabapentin is implicated in a large number of overdose deaths, up to 57% in some states, allowing medical experts to conclude that gabapentin overdose is much more likely when taken with other substances like opioids.

Those who overdose on gabapentin can expect its usual side effects to be amplified. Gabapentin overdose would have similar effects as an alcohol overdose, including sleepiness, fatigue, loss of consciousness, coma, loss of coordination and loss of memory.

Gabapentin Withdrawal

To experience withdrawal, a patient must be dependent on gabapentin. Dependency occurs when the person has been taking enough of the drug for long enough that their body has “rewired” to be unable to function without the drug.

Since gabapentin mimics GABA and increases the activation of GABA receptors, the body responds by making fewer GABA receptors, leading to dependence.

As a consequence, fewer GABA receptors cause withdrawal symptoms once someone stops taking gabapentin. For some people, gabapentin may need to be slowly tapered to prevent these symptoms.

Gabapentin Withdrawal Symptoms

Gabapentin withdrawal is similar to withdrawal from alcohol. In fact, they are often confused with one another. Common symptoms may include:

  • Agitation
  • Anxiety
  • Chest pain
  • Confusion
  • Disorientation
  • Headache
  • High blood pressure
  • Light sensitivity
  • Nausea
  • Nervousness
  • Restlessness
  • Vomiting

Gabapentin Detox

Gabapentin detox is the process of stopping gabapentin so that it is completely cleared from the body. During this time, the nerve cells in the brain and body attempt to repair themselves. The most severe withdrawal symptoms may also occur during the detox period.

Detox can happen in a few different environments, including at home or in an addiction treatment center. Detoxing at home can be challenging: the potential for severe withdrawal symptoms can make it difficult to stop taking the drug or avoid relapse. Gabapentin detox often requires a slow taper, which is better achieved in a treatment facility. A taper is when the dose of the drug is slowly reduced to limit the occurrence of withdrawal symptoms.

Medical detox in a treatment facility is much safer because withdrawal symptoms can be addressed as they happen. Medical professionals can adjust the rate of the taper and provide supervision and assistance.

Gabapentin Addiction Treatment

The time it takes to get addicted to gabapentin depends on several factors, the most significant being the dosage. At lower doses, the risk of gabapentin addiction is low.

A substance use disorder may develop more quickly if someone is taking higher doses of gabapentin. Another factor that can speed up the rate of gabapentin addiction is the presence of other drugs or substances. Muscle relaxants, opioids or anxiety medications such as benzodiazepines increase the risk and quicken the development of a gabapentin use disorder.

Addiction treatment can happen in the outpatient or inpatient setting, depending on the level of care needed. Outpatient treatment is generally better for those with milder addictions and supportive home environments, or those who are graduating from a higher level of care. Inpatient or residential treatment is a higher level of care that can begin with detox. Inpatient treatment is also more effective for someone with multiple substance use disorders or co-occurring conditions.

If you or someone you know is misusing gabapentin or may have a substance use disorder, treatment is available. Contact The Recovery Village Ridgefield to speak to a representative and learn more about individualized treatment programs for substance use disorders and co-occurring mental health disorders. Begin your healthier future today

Sources

Medical Disclaimer: The Recovery Village 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.

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