Gabapentin, often known by the brand name Neurontin, is a prescription medication primarily approved for managing certain types of seizures and postherpetic neuralgia (nerve pain following a shingles infection). It is also commonly used off-label to treat conditions like diabetic neuropathy, restless legs syndrome, and anxiety. Despite its legitimate medical uses, gabapentin has seen a significant rise in non-medical use and abuse over the past decade, raising concerns among public health officials. The reasons people misuse this anticonvulsant are rooted in the psychoactive effects it can produce at high doses, its widespread availability, and its utility for enhancing the effects of other substances.
The Psychoactive Effects Sought
The primary motivation for gabapentin abuse is the subjective experience of a generalized “high” that users describe as pleasurable. At doses exceeding the therapeutic range, the drug can produce feelings of euphoria, which is a key driver for recreational misuse. Many users also seek the deep relaxation and calmness the drug provides, often referred to as anxiolysis. These effects are often likened to the intoxication caused by alcohol or the sedating effects of benzodiazepines. The desired state can also include improved sociability, reduced inhibition, and sometimes a dissociative feeling. Gabapentin’s mechanism involves binding to the alpha-2-delta subunit of voltage-gated calcium channels, which reduces the release of excitatory neurotransmitters, contributing to these calming and intoxicating effects.
Accessibility and Vulnerable Populations
The high rate of gabapentin prescription has directly contributed to its widespread availability for diversion and abuse. With tens of millions of prescriptions written annually in the United States, the drug is easily accessible through sharing or theft. This high volume of prescribing is partly due to physicians seeking alternatives to opioids for pain management, leading to increased exposure and opportunity for misuse.
Gabapentin has become particularly popular among individuals with a history of substance use disorder, especially those dealing with opioid use disorder. These users often turn to gabapentin as a substitute for preferred drugs when they are unavailable or to manage the intense symptoms of opioid withdrawal. Furthermore, gabapentin is frequently misused to potentiate, or boost, the effects of other central nervous system depressants, such as opioids and benzodiazepines.
Even though gabapentin is not a federally controlled substance, states like Kentucky, Tennessee, and Virginia have classified it as a Schedule V controlled substance to help curb diversion and track prescriptions. This scheduling difference contributes to the perception that gabapentin is a “safer” or less regulated alternative compared to federally controlled medications.
Methods of Misuse and Administration
To achieve the desired psychoactive effects, abusers typically take doses significantly higher than those prescribed for therapeutic use, which rarely exceed 3,600 milligrams per day. A common practice is “stacking,” where users ingest multiple capsules at once or stagger doses over a short period to maximize absorption and effect. Gabapentin’s absorption into the body is limited by a saturable transport system in the gut, meaning that taking a very large dose all at once is inefficient.
By staggering doses—for example, taking a capsule every 30 to 60 minutes—users circumvent the body’s natural absorption limit, leading to higher drug concentrations in the bloodstream and more intense effects. While the primary route of non-medical use remains oral ingestion, some users crush the tablets or capsules to snort the powder, aiming for a more rapid onset.
The most dangerous method of misuse involves combining gabapentin with other sedating substances, such as alcohol, benzodiazepines, or opioids. This synergy significantly potentiates the effects of the other drugs, which is the primary reason for co-ingestion. Taking gabapentin in these combinations often leads to doses far exceeding what the body can safely handle.
Health Consequences and Dependence
The misuse of gabapentin, particularly at high doses or in combination with other substances, carries serious negative health consequences. The most significant physical risk is respiratory depression, which is a dangerous slowing of breathing. This risk is dramatically amplified when gabapentin is combined with other central nervous system depressants, especially opioids.
Post-mortem studies have indicated that a large majority of fatal gabapentin-related overdoses also involved the presence of an opioid, highlighting the danger of this combination. Chronic misuse leads to the development of physical dependence, meaning the body adjusts to the constant presence of the drug and requires it to function normally.
Abruptly stopping gabapentin use after prolonged misuse can trigger a severe withdrawal syndrome. Withdrawal symptoms can include intense anxiety, agitation, insomnia, confusion, and in some serious cases, seizures. Unlike an opioid overdose, for which an antagonist like naloxone exists, there is no specific antidote to reverse the effects of a gabapentin overdose, making medical intervention more challenging.