Gabapentin can be addictive. Search for gabapentin abuse or pregabalin abuse on Google Scholar and you’ll turn up 18,000 entries in less than a second. Pubmed is a little more specific finding 249 papers related to the subject. Vaults of Erowid has over 100 gabapentin and pregabalin ‘experiences’ detailed by users.
I wrote a while back that it now seems almost mandatory for clients coming to addiction treatment to be on opioids and gabapentin for pain despite experts warning that opioids and gabapentin are best avoided in those with a history of addiction. Gabapentin and pregabalin are increasingly being implicated in overdoses, misuse and drug deaths in a range of different countries.
Gabapentin and its more expensive, faster acting cousin pregabalin, act on nerve cells to reduce release of ‘excitatory’ neurotransmitters. Used in epilepsy, they ‘soothe’ the nervous system. They also may have a direct or indirect effect on the dopamine reward/salience/motivation system. That’s the same pathway that most addictive drugs end up stimulating. These drugs can certainly induce euphoria and relaxation, especially at higher than prescribed doses – and what group of people are most likely to take mind altering medication at elevated doses?
Gabapentin has been found to decrease heavy drinking (increased abstinence rates from 4% (placebo) to 17% though the trial was of medication vs. placebo rather than medication vs. (e.g.) social networking interventions, which have been associated with reduced relapse rates of 27%). Gabapentin may have therapeutic impact on seizure activity and neuropathic pain, but these potential benefits need to be balanced against the risks in addicted populations.
Unfortunately, our clinical experience suggests that gabapentin is now prevalent as a drug of abuse…In primary care, an increasing number and urgency of prescription requests cannot necessarily be explained by the increased number of cases of neuropathic pain. In the substance misuse service, the numbers admitting to using gabapentin (local street name: ‘gabbies’, approx £1 per 300 mg) are also growing.
That may well have changed in the last two years, but I’m willing to bet, based on experience, that it’s not for the better. The article goes on:
Prescribing data from the Tayside region of Scotland show a rise in the number of patients receiving gabapentin, and an exponential rise in the total number of prescriptions issued, particularly since it was licenced for postherpetic neuralgia in 2002. In the substance misuse services in Tayside in 2009, we found that of those who had been attending for at least 4 years (n = 251), 5.2% were currently receiving gabapentin on prescription, with a mean dose of 1343 mg, and were >3 times more likely to admit to non-medical use of analgesics (P = 0.006). Meanwhile, of 1400 postmortem examinations in Central, Tayside, and Fife regions of Scotland in 2011, 48 included gabapentin in their toxicology report, with 36 also including morphine and/or methadone, indicating recent possible opioid dependence.
And its relationship with drugs of abuse and safety profile?
A recent police report indicates the increasing tendency to use gabapentin as a ‘cutting agent’ in street heroin (and to recover gabapentin on the street and in prisons), further adding to the abuse and danger potential. Like opiates, gabapentin is fatal in overdose; unlike opiates, there is no antidote and the long half-life instils the need for prolonged, intensive management of overdose.
Dr Des Spence writing on the subject in the BMJ makes powerful points:
There are currently over 5 million prescriptions for Gabapentin and Pregabalin annually, with a 350% rise in Pregabalin use in only 5 years. Could pathology really have changed that much in 5 years? The only conclusion is that they are being prescribing widely, freely and potentially inappropriately. These medications may have an important therapeutic role but if we are complacent these drugs will be abused and eventually demonized. A situation in nobody’s interest.
People with addictions have enough problems without adding to them. “Chasing pain” is almost certainly not in the best interests of patients and we need to be smarter at relieving suffering in addicted populations without first reaching for the prescription pad.
Smith, B., Higgins, C., Baldacchino, A., Kidd, B., & Bannister, J. (2012). Substance misuse of gabapentin British Journal of General Practice, 62 (601), 406-407 DOI: 10.3399/bjgp12X653516
Spence, D. (2013). Bad medicine: gabapentin and pregabalin BMJ, 347 (nov08 3) DOI: 10.1136/bmj.f6747
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