Gabapentin Addiction: Risks, Signs, and Treatment

What Is Gabapentin?

Gabapentin is an anticonvulsant medication originally developed to treat epilepsy. It is also widely prescribed for neuropathic pain, restless legs syndrome, and off-label for anxiety, insomnia, and alcohol withdrawal. Brand names include Neurontin, Gralise, and Horizant.

Although gabapentin was long considered to have minimal abuse potential, growing evidence has revealed significant misuse patterns, particularly among individuals with opioid use disorders and those seeking alternatives when other substances are unavailable.

How Is Gabapentin Misused?

• Taking doses much higher than prescribed (therapeutic doses typically range from 300-3,600 mg/day; misuse may involve 5,000+ mg)
• Combining with opioids to enhance the high and extend the duration of effects
• Using it as a substitute when preferred drugs are unavailable
• Staggering doses (taking one pill every 30 minutes) to increase absorption and intensify effects
• Obtaining from multiple prescribers or purchasing on the street

How Gabapentin Affects the Brain

Despite its name suggesting it works on GABA, gabapentin primarily binds to the alpha-2-delta subunit of voltage-gated calcium channels. This reduces excitatory neurotransmitter release, producing calming and pain-relieving effects. At higher doses, this mechanism can produce mild euphoria, dissociation, and sedation.

Signs of Gabapentin Misuse

Physical Signs

• Excessive drowsiness and sedation
• Dizziness and poor coordination
• Swelling in the hands and feet (edema)
• Blurred or double vision
• Tremors and unsteady gait
• Weight gain

Behavioral Signs

• Taking more gabapentin than prescribed
• Running out of prescriptions early
• Seeking prescriptions from multiple doctors
• Combining gabapentin with opioids, benzodiazepines, or alcohol
• Using gabapentin obtained from illicit sources
• Becoming anxious or agitated when the medication is unavailable

Risk Factors for Gabapentin Misuse

• Current or past opioid use disorder
• History of polysubstance abuse
• Chronic pain conditions
• Anxiety disorders
• Social environments where gabapentin is readily available

Health Risks

Respiratory Depression

When combined with opioids, benzodiazepines, or alcohol, gabapentin significantly increases the risk of fatal respiratory depression. The FDA issued a warning in 2019 about this danger.

CNS Depression

• Profound sedation and cognitive impairment
• Increased risk of falls and injuries, especially in older adults
• Impaired driving ability

Other Health Effects

• Suicidal thoughts and behavior (FDA Black Box Warning for all anticonvulsants)
• Kidney damage with chronic high-dose use
• Hormonal disruption
• Worsening of depression

Gabapentin Withdrawal

Withdrawal from gabapentin can be medically serious and should not be attempted without medical supervision.

Withdrawal Symptoms

• Anxiety and agitation
• Insomnia
• Nausea and sweating
• Pain and body aches
• Rapid heart rate
• Seizures (in severe cases)
• Confusion and disorientation

Withdrawal Timeline

• Days 1-2: Anxiety, insomnia, and nausea begin
• Days 3-5: Symptoms peak; seizure risk is highest during this period
• Days 6-10: Gradual improvement in most symptoms
• Weeks 2-4: Residual anxiety and sleep difficulties may persist

Safe Discontinuation

A gradual taper over 1-4 weeks is recommended, reducing the dose by no more than 300 mg every 3-4 days. Individuals on very high doses may require slower tapers.

Treatment for Gabapentin Misuse

Medical Management

• Supervised gradual taper to prevent seizures
• Treatment of underlying pain conditions through non-addictive alternatives
• Monitoring and management of co-occurring opioid use disorder

Behavioral Therapies

• Cognitive Behavioral Therapy (CBT): Addresses thought patterns driving misuse and develops alternative coping strategies
• Motivational Interviewing: Builds commitment to change
• Pain management counseling: Develops non-pharmacological pain management skills

Structured Programs

• Partial Hospitalization (PHP): Intensive monitoring during taper and stabilization
• Intensive Outpatient (IOP): Ongoing structured support
• Integrated treatment: Addressing gabapentin misuse alongside co-occurring opioid or other substance use disorders

FAQ

Is gabapentin a controlled substance?

Gabapentin is not federally classified as a controlled substance, but several states including Kentucky, West Virginia, Tennessee, Michigan, and Virginia have reclassified it as a Schedule V controlled substance due to rising misuse.

Can you overdose on gabapentin?

Yes, particularly when combined with opioids, benzodiazepines, or alcohol. Gabapentin alone rarely causes fatal overdose, but the combination with CNS depressants is increasingly being identified in overdose deaths.

Why do people abuse gabapentin?

At high doses, gabapentin produces relaxation, euphoria, and a dissociative "floaty" feeling. It also enhances the effects of opioids, making it attractive to individuals with opioid use disorders.

How long does gabapentin withdrawal last?

Acute withdrawal symptoms typically last 5-10 days, with residual symptoms potentially persisting for several weeks. The duration depends on the dose, length of use, and individual factors.

References:

• https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-gabapentin-and-pregabalin
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492296/
• https://www.dea.gov/sites/default/files/2020-06/Gabapentin-2020.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595229/

Valley Spring Recovery Center Editorial Team

Our team of behavioral health experts includes licensed counselors, addiction medicine specialists, and certified recovery professionals. We provide accurate, evidence-based information to support your path to lasting recovery.