Gabapentin is an anticonvulsant and neuropathic pain medication that is prescribed to treat epileptic seizures and postherpetic neuralgia, or nerve pain. In recent years, it has emerged as a drug of abuse, particularly among those who struggle with opioid abuse and dependence.
According to information published in the U.S. Pharmacist, gabapentin was initially considered to have low or little abuse potential. However, it is increasingly appearing as a drug of abuse, particularly in populations of people who struggle with addiction and abuse of other drugs. The journal Addiction reports that about 1 percent of the general population misuses gabapentin. About 15 to 22 percent of people who abuse opioids misuse it, and 40 to 65 percent of those with a valid prescription for gabapentin misuse it.
Gabapentin is not a federally controlled substance, so it is cheaper and easier to obtain than other pain medications, making it a target for abuse as an opioid substitute. The gabapentin high has been compared to both a marijuana high that is relaxing and calming as well as a euphoric and sedating opioid high. Gabapentin can also have psychedelic effects and increase sociability. It may also produce a numb-like state, resulting in a very negative experience, however.
The gabapentin high is followed by a “crash” that is both physically and emotionally uncomfortable. Repeated use of gabapentin builds up to drug dependence. When gabapentin is absent in the bloodstream, withdrawal symptoms can be significant and even potentially life-threatening. Gabapentin should not be stopped abruptly. Safe withdrawal requires special care and attention.
Gabapentin has a half-life of about five to seven hours, the FDA publishes. After that time, it will be around half as active as the bloodstream as when it entered. After about 35 hours, gabapentin will be mostly eliminated out of the body.
When the drug is no longer present,the substance user will start experiencing withdrawal symptoms. In the case of gabapentin, withdrawal will start about 12 hours after the last dose is taken.
Gabapentin has a similar method of action in the brain as the neurotransmitter GABA (gamma-Aminobutyric acid). GABA works to mitigate the stress response, helping to lower anxiety and slow functions of the central nervous system (CNS), like respiration, heart rate, body temperature, and blood pressure. When gabapentin is active, some of these autonomic functions of the CNS are decreased, which can cause relaxation, calm overactive nerve firings (which is what helps to minimize tremors and seizures), and act as a sedative.
In chronic use, the brain chemical balance is altered, and when gabapentin wears off, the user will begin experiencing both emotional and physical withdrawal symptoms.
Emotional withdrawal symptoms include:
In general, withdrawal will peak within two to three days, and physical symptoms will start to level out after about a week or so. Some of the emotional and cognitive withdrawal symptoms and drug cravings can persist for a few weeks or even months. Not everyone will experience all of these withdrawal symptoms, and some people may experience them more intensely than others. The severity of withdrawal and the withdrawal timeline depends on the severity of dependency, which is affected by the amount of drug use, duration of use, method of abuse, and biological, environmental, and genetic factors. Using gabapentin with other drugs and/or alcohol can exacerbate withdrawal.
Per the West Virginia Gazette, gabapentin is used in combination with opioid drugs about half of the time it is abused and with opioids as well as anti-anxiety or muscle relaxant drugs about a quarter of the time. Mixing gabapentin with other drugs, especially other central nervous system depressant drugs, dramatically increases the odds for an adverse and life-threatening overdose. It also further complicates and adds to the intensity and duration of the withdrawal syndrome.
The safest method for withdrawing from gabapentin is through a medical detox program. In medical detox, a person will stay in a specialized facility under close medical observation for up to seven days while the drug safely eliminated out of the bloodstream. Vital signs can be continuously monitored during medical detox, and trained health care professionals provide supportive care and encouragement.
A stable and calm environment is beneficial during withdrawal, as it can lower stress and minimize anxiety. It is important to eat healthy, drink lots of water, and stick to a structured sleeping and eating schedule during withdrawal as well. This can help the body to refuel and give the brain what it needs to heal.
Since thoughts of suicide and suicidal ideations are also side effects of gabapentin abuse and withdrawal, having people around who are supportive and caring is helpful. Massage therapy, spa treatments, yoga, mindfulness meditation, chiropractic care, and acupuncture can all be beneficial to alleviate stress, manage pain, and promote the detox process.
One of the most important things to be aware of during gabapentin withdrawal is the potential for the return or onset of epileptic seizures, which can be life-threatening.
During a gabapentin taper, the dosage is lowered a little bit each day until the drug is no longer needed.
As an example, a slow gabapentin taper lowers the dosage by 25 percent per week while a faster taper may reduce the dosage by 10 percent every day or every other day.
The dosage reduction can vary from person to person, depending on how long they have been taking the medication and the average dosage. The higher the level of dependence on gabapentin, the more slowly the dosage will likely need to be reduced and the longer the taper may take.
Watch a person closely during a gabapentin taper. If withdrawal symptoms seem to increase or worsen, the dosage likely needs to be increased, or the taper rate slowed. Sometimes a person may need to return to a previous dosage level to balance the body and brain.
Drug cravings can occur during withdrawal, and the surrounding support system should offer ongoing encouragement to minimize the risk of relapse. When other drugs are taken simultaneously, this can affect withdrawal and the tapering schedule. Medical conditions and mental health disorders can influence the safety of withdrawal, and they need to be managed with additional medications during detox.
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The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a Behavioral Health Treatment Services Locator. This is a web-based tool individuals can use to find treatment options for mental health, drug addiction, and co-occurring disorders. The tool is location specific, and users can enter their ZIP code to find local providers.
The National Survey on Drug Use and Health (NSDUH) showed that close to 7.5 million adults, aged 12 and older, in the United States struggled with illicit drug addiction in 2016. This includes the misuse of prescription drugs like gabapentin. Prescription drug misuse is common, and it can quickly progress to substance abuse and addiction.
Small Study Reports Troubling Abuse Potential for Gabapentin. (March 2018). U.S. Pharmacist. from https://www.uspharmacist.com/article/small-study-reports-troubling-abuse-potential-for-gabapentin
Gabapentin Misuse, Abuse, Diversion: A Systematic Review. (July 2016). Addiction. from https://www.ncbi.nlm.nih.gov/pubmed/27265421
Opioid Alternative Linked to Spike in WV Overdose Deaths. (January 2017). West Virginia Gazette. from https://www.wvgazettemail.com/news/health/opioid-alternative-linked-to-spike-in-wv-overdose-deaths/article_6e29cb9d-f143-55d9-ac0f-1a0bc680d969.html
Neurontin (Gabapentin). (2011). U.S. Food and Drug Administration. from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020235s036,020882s022,021129s022lbl.pdf
Behavioral Health Treatment Services Locator. Substance Abuse and Mental Health Services Administration. from https://findtreatment.samhsa.gov/
Drug Addiction Treatment in the United States. (January 2018). National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states
Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. (September 2017). Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#sud3