Gabapentin Addiction, Addiction Treatment and Prevention

What Is Gabapentin Prescribed For?

Gabapentin is FDA-approved for:

• The treatment of postherpetic neuralgia in adults.
• Use as an adjunctive therapy in the treatment of partial-onset seizures, with and without secondary generalization, in pediatric and adult patients with epilepsy age 3 and older.

What is gabapentin prescribed for? In addition to its FDA-approved uses, gabapentin is often prescribed off-label (i.e., non-FDA-approved) for other purposes, such as:

Is Gabapentin Addictive?

Yes, gabapentin has been shown to lead to dependence, withdrawal, and addiction in some people as well as in animal studies. Case reports have indicated that most people suffering from gabapentin addiction had a history of other substance misuse, including alcohol, cocaine, or opioid misuse, and were taking more than the recommended doses.

Gabapentin can cause dependence, which refers to a physiological adaptation that occurs due to repeated administration of a substance, resulting in withdrawal symptoms when you stop using it.  People can be dependent but not addicted, although these two tendencies often occur together. Addiction refers to a pattern of compulsive substance misuse that often continues despite the harmful consequences.

Gabapentin, while not traditionally considered highly addictive like opioids or benzodiazepines, does carry a risk for misuse, dependency, and addiction, especially among individuals with a history of substance use disorders.

Due to gabapentin’s sedative effects, it has potential for recreational misuse, often in combination with other depressants, to intensify its sedative and euphoric effects. Awareness of its addiction potential is essential for safe use.

Gabapentin Addiction Risk Factors

1. History of Substance Use Disorders: People with a history of alcohol, opioid, or other drug abuse are at higher risk of developing a dependence on gabapentin.
2. Higher Doses: High doses of gabapentin, especially above the therapeutic range (900–3,600 mg/day), increase the risk of misuse and dependence.
3. Combination with Other Drugs: Mixing gabapentin with opioids, alcohol, or other depressants heightens both the risk of addiction and potential respiratory depression.
4. Chronic Pain Conditions: Patients with chronic pain may develop a psychological dependency on gabapentin due to its calming and pain-relieving effects.

Signs and Symptoms of Gabapentin Addiction

Withdrawal Symptoms From Gabapentin

People can experience Neurontin withdrawal symptoms when gabapentin use is abruptly stopped, especially if they have used higher than recommended doses.  Stopping gabapentin may result in gabapentin withdrawal symptoms, such as:

Addiction to gabapentin may present with behavioral, psychological, and physical symptoms:

1. Behavioral Signs:
   • Taking gabapentin in higher doses or more frequently than prescribed.
   • “Doctor shopping” to get multiple prescriptions.
   • Engaging in deceptive behaviors to obtain more gabapentin.
2. Psychological Signs:
   • Feeling anxious, irritable, or depressed when unable to take gabapentin.
   • Experiencing cravings for the drug.
3. Physical Signs:
   • Developing tolerance (requiring higher doses to achieve the same effects).
   • Experiencing withdrawal symptoms such as anxiety, nausea, sweating, or seizures when not taking the drug.

Treatment for Gabapentin Addiction

Stopping gabapentin use abruptly can have detrimental consequences. A medical detox program may be advisable to help you safely stop taking gabapentin and deal with Neurontin withdrawal symptoms; it can be especially beneficial if you also use other substances, like opioids, benzodiazepines, or alcohol.  If you’re struggling with gabapentin or other substance misuse, you may also benefit from a formal treatment program, such as an inpatient or outpatient rehab.

Addiction treatment for gabapentin generally involves a multi-step approach, often within a structured addiction treatment program:

1. Medical Detoxification:
   • Gradual tapering of gabapentin under medical supervision helps to avoid severe withdrawal symptoms. Medical detox centers can monitor for complications such as seizures, which may occur if gabapentin is suddenly stopped.
2. Therapy and Counseling:
   • Cognitive Behavioral Therapy (CBT): CBT helps patients recognize and change patterns of behavior and thought that contribute to addiction.
   • Group Therapy: Group settings can provide peer support and accountability.
   • Family Therapy: Helps family members understand addiction and provides support to aid the patient’s recovery.
3. Medication-Assisted Treatment (MAT):
   • In cases where gabapentin was used alongside other substances, such as opioids, medications like methadone, buprenorphine, or naltrexone may be used as part of MAT.
4. Aftercare and Support Groups:
   • Programs like Narcotics Anonymous (NA) or substance-specific support groups help individuals maintain sobriety post-treatment.
   • Aftercare plans, including continued therapy, support groups, and lifestyle changes, are essential for preventing relapse.

Prevention of Gabapentin Misuse and Addiction

1. Strict Prescription Guidelines:
   • Prescribe gabapentin only when truly necessary and at the lowest effective dose. Physicians should regularly reassess the patient’s need for continued gabapentin use, especially for off-label uses.
2. Screening for Substance Use History:
   • Before prescribing gabapentin, healthcare providers should screen patients for a history of substance use disorder, as this population has a higher risk of misuse.
3. Education on Proper Use:
   • Patients should be informed about the risks of misuse and instructed to avoid taking gabapentin in higher doses or combining it with other depressants.
4. Close Monitoring:
   • Regular follow-ups with patients can help detect signs of misuse early. Physicians can monitor refill requests and check for any signs of dose escalation.
5. Using Alternative Therapies When Possible:
   • Non-pharmacological treatments, such as physical therapy, acupuncture, or mindfulness practices, may be effective for managing pain or anxiety and should be considered when possible.

Addressing the Growing Concern of Gabapentin Misuse

Due to the increase in gabapentin misuse and addiction cases, some regions are implementing tighter control measures, such as reclassifying it as a controlled substance. Education for both healthcare providers and patients can reduce misuse by raising awareness of gabapentin’s risks and helping to promote safer use practices.

In summary, gabapentin addiction, while less common than with opioids or benzodiazepines, is still a significant risk, especially when the medication is misused. Treatment involves medical detox, therapy, and support, while prevention relies on careful prescription practices and patient education.