Gabapentin is a new type of prescription drug medication with high prescription rates and surprisingly high addiction rates as well. Classified as anticonvulsants, this type of drug plays various roles. It appears to alter the effects of calcium on the body, and also prevents an increase in sensitivity to pain. It has also been known to affect the GABA system in the body. Since this medication is so new, researchers still don’t have a complete understanding of how gabapentin works.
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Prescribed Uses of Gabapentin
Although new, this medication has been quite effective in treating various ailments. More prescription uses are still being added. Currently, it is most frequently prescribed to treat:
- Acute pain following surgical operations
- Bipolar disorder
- Chronic pain
- Epilepsy in children who are 3 years of age and older
- Essential tremors
- Neuropathic pain
- Partial seizures in adults
- Postherpetic neuralgia, or pain from nerve damage caused by shingles
- Restless leg syndrome
- Withdrawal symptoms from alcohol and opioid addiction
Dosage varies based on the type of condition being treated and the age of the patient. For children, dosage is based on weight. Minimum strength tablets contain 100mg of the drug; however, most physicians prescribe tablets containing 300mg at a time. When used to treat seizures, adults are usually prescribed 900mg a day. Patients are to take 300mg three times a day. In severe situations, the recommended dosage increases to 3,600mg per day. Additional researches have tried to determine whether gabapentin effectively treats other ailments. Studies have shown that treatments using 900mg of gabapentin a day can help reduce psychiatric disorder symptoms.
Other Common Brand Names
Gabapentin is the generic name for the drug. This medication is also sold under an array of brand names, like:
- Gralise
- Horizant
- Neurontin
- Pregalin
The most common brand name prescribed is Neurontin. However, all of the prescription brands are prescribed for similar conditions and ailments. Generic gabapentin, Neurontin and many other brands are available in the form of immediate-release tablets and as oral solutions. On the streets, aliases include morontin and gabbies. Most drug dealers use this drug as a filler or a buffer to cut other types of drugs, particularly heroin.
Important Warnings and Findings
Neurontin is often prescribed concomitantly with opioids to treat chronic pain. New research has shown that this can be fatal because both drugs suppress breathing. Concurrent use of the two can lead to a higher absorption rate of Neurontin, which leads to higher addiction and overdose risks. These studies also show that concomitant use of gabapentin and opioid results in a 49% higher risk of a fatal opioid overdose. Patients also experience more adverse effects if they drink alcohol while taking Neurontin. This can lead to fatigue, exhaustion, dizziness and concentration difficulties. Gabapentin reacts poorly to other drugs, like stomach acid drugs. Speak to a physician to determine whether any adjustments need to be made or whether there are any specific instructions that need to be followed. For example, take gabapentin 2 hours after taking stomach acid drugs to ensure the effectiveness of both medications.
Gabapentin Side Effects
While effective, gabapentin comes with some side effects that vary with each patient. For safety reasons, patients should avoid driving or using heavy machinery at first. Patients should figure out how the drug affects their system. Common side effects include:
- Double vision
- Difficulties with speaking
- Dizziness
- Fatigue or drowsiness
- Fever
- Loss of coordination and jerky movements
- Nausea and vomiting
- Swelling of the legs and arms
- Tremors
- Unusual eye movements
In most situations, these side effects will completely disappear within a few days to a couple of weeks of taking the medication.
Serious Side Effects
Some side effects are more serious than others. Those who experience the following side effects should seek medical help immediately:
- Anxiety
- Aggressive or violent behavior
- Behavioral changes
- Changes in work or school performance
- Extreme increase in activity or talking
- Insomnia or other difficulties sleeping
- Intense mood swings, particularly anger and irritation
- Panic attacks
- Restlessness
- Suicidal thoughts
- Trouble concentration
Gabapentin can also cause allergy reactions. Serious allergy reactions that require immediate medical attention include:
- Fatigue or weakness
- Fever
- Frequent infections
- Hives
- Rashes
- Swollen glands that stay
- Swollen lips and tongue
- Unexpected muscle pain
- Unusual bruising or bleeding
- Yellowing of skin or whites of the eyes
Medical professionals will assess the situation to determine whether it is safe to continue taking the drug.
Signs of an Overdose
Drug overdoses are becoming a huge epidemic in the U.S. In 2015 alone, anywhere between 59,000 and 65,000 Americans died from an overdose. Overdoses have become the leading cause of death for Americans under the age of 50. Unfortunately, it is possible to overdose on gabapentin. Risks increase if the medication is taken with other drugs and intoxicants. The overdose is quite similar to an overdose caused by heroin. Even more troubling is that, unlike with opioids, there is no antidote available yet for an overdose. Neurontin overdoses are similar to opioid overdoses. The addicts’ respiratory system shuts down, and they often forget to breathe. Common signs of an overdose include:
- Abnormally slow heart rate
- Diarrhea
- Dizziness
- Double vision
- High or low blood pressure
- Loss of control over body movements
- Rapid heartbeat
- Slurred speech
- Tremors
While doctors can attempt to treat immediately life-threatening symptoms of an overdose, permanent damage to the brain or body is almost imminent. In worst-case scenarios, Neurontin use can lead to coma or death.
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Neurontin Misuse and Addiction
When taken by itself, Neurontin is not too addictive. It has a low addictive potential, which results in little potential for abuse. The problem begins when patients take Neurontin with other medications, like:
- Anxiety medications, like Valium and Xanax
- Opioids
- Muscle relaxants
When this happens, the addictive potential increases. The most common drug used concomitantly with gabapentin is opioids. A recent study found that 56% of illicit gabapentin use happened concurrently with opioid use. When taken with other medications, the gabapentin acts as a mild tranquilizer and produces a euphoric high. Some patients claim the high is similar to the one experienced when smoking cannabis. Other claims that the high is similar to snorting cocaine, especially if the Neurontin is crushed and snorted. The abuse potential of Neurontin when it is mixed with other drugs is extremely high. In fact, emergency room visits caused by the misuse or abuse of this narcotic increased by nearly five times between 2008 and 2011. It’s clear that this drug is on the rise for becoming a national epidemic.
Signs of Neurontin Addiction
As Neurontin is still a fairly new medication, identifying signs of misuse and addiction can be difficult. Many addicts are quite talented at hiding their addiction. Worrisome behavioral signs of a prescription medication addiction include:
- Attempting to get extra doses with multiple doctors
- Being obsessed over the drug
- Changing social habits and circles in drastic ways
- Craving the drug constantly and persistently
- Exaggerating symptoms to get the prescription
- Failing to maintain personal hygiene and grooming habits
- Failing to quit taking the drug
- Feeling uneasy or anxious at the thought of being cut off
- Lying about symptoms to doctors in hopes of having the medication prescribed
- Refusing to quit despite negative impact or consequences
- Switching doctors if the primary doctor refuses to continue prescribing the medication
Concerned patients should take an addiction quiz. The answers to these questions reflect on whether addiction may be a concern.
Testing for Neurontin Use
Testing for Neurontin use is incredibly easy. This drug lacks significant drug interactions in the body. It is not metabolized in the liver and does not induce liver enzymes, which can break it down. It also does not bind to plasma proteins like many other prescription medications. Because of these reasons, the drug is usually excreted from the urine unchanged. The easiest way to test for Neurontin is through a urine analysis. The urinalysis should give a good idea of whether the drug medication was recently taken.
Is Gabapentin Going to be a Controlled Substance?
As of right now, gabapentin is not scheduled as a controlled substance. This is mostly because it has a low addictive potential when used by itself in monotherapy. However, as new studies and researches on the potential for misuse and abuse are being published, more attention is being drawn to the growing concerns on this medication. One of the most enlightening studies so far showed that 1 in 5 rehab patients were taking the medication without a prescription. With all this attention directed towards gabapentin, some states have started to take action. The State of Ohio Board of Pharmacy require all drug distributors to submit dispensing or wholesale information on all products containing gabapentin to the Ohio Automated Rx Reporting System as of December 1, 2016. This is significant. It means that Ohio is officially recognizing the potential of abuse with this drug. Although each state has its own regulations, gabapentin is not considered to be a controlled substance yet; this may change in the future.
Neurontin Withdrawal Symptoms
Long-term use of Neurontin can lead to physical dependence. This can happen even if the medication is used properly and as prescribed. The key defining factor of whether a patient will develop physical dependence lies in the length of the prescription. When quitting or weaning off of the medication, patients can experience withdrawal symptoms like:
- Anxiety
- Difficulty sleeping
- Nausea
- Pain
- Sweating
The intensity of the withdrawal symptoms will depend on the dosage amount. Higher doses are often correlated with more intense symptoms. It’s important to note that patients often develop a tolerance to the medication. To get the same effects, they need to increase their dosage. Since physical dependence to the drug is quite imminent, most physicians will discuss the whether the potential of physical dependence outweighs the symptoms.
Timeline of Withdrawal Symptoms
In most cases, withdrawal symptoms begin to emerge within 12 to 48 hours of the last dose. The symptoms peak on day 3 and 4, and can last up to a week. Patients may also experience post-acute withdrawal symptoms (PAWS) for up to a month afterwards. These symptoms are mainly psychological and mental, and more likely to affect children and young adults. If the gabapentin was being used to treat seizures, quitting too suddenly can even cause the frequency of seizures to increase. The withdrawal timeline may also differ if the medication is taken with alcohol or other drugs.
Detox and Treatments for Neurontin Abuse
Since the potential for Neurontin abuse was only recently revealed, there is no FDA approved medications yet for withdrawals. When detoxing from Neurontin abuse, most rehab centers offer a two-step approach. This involves getting supportive medical care and behavioral therapy. Medications can be prescribed to combat the more intense withdrawal symptoms. However, this is at the discretion of the physician. So far, no recommendations have been made yet.
Different Types of Behavioral Therapy
Behavioral therapy is the most important treatment for Neurontin dependence. This is because most of the withdrawal symptoms will be psychological. Behavioral therapy is also useful for preventing relapses. There are many different types to choose from. Popular options include:
- Cognitive Behavioral Therapy, which examines unhealthy behaviors and find suitable and appropriate responses to triggers.
- Contingency management, which involves getting a tangible, wanted reward for accomplishing certain behaviors.
- Dialectical Behavioral Therapy (DBT), which work by validating and encouraging patients.
- Eye Movement Desensitization and Reprocessing Therapy, which is used when trauma is involved.
- Motivational interviewing, which reinforces each patient’s motivation for getting and staying sober.
- Multidimensional family therapy, which involves the entire family. This type of treatment is most recommended for young adults and children, as they are still heavily influenced by their surroundings.
- Person-centered Therapy, which believes that patients are able to resolve problems on their own when given a safe environment, words of encouragement and acceptance.
- Rational Emotive Behavior Therapy (REBT), which focuses on forming healthier beliefs and views.
Each patient should find a therapy style that works for them based on their beliefs and goals.
Levels of Care for Treating Gabapentin Dependence
In addition to choosing the type of approach, there are also several levels of care to choose from. They include:
- Detox programs, which usually only last 3 to 10 days. Patients receive around-the-clock medical and psychiatric care.
- Inpatient treatment, which combines medical and psychiatric care with individual, group, family, couple, nutritional, and recreational therapy. Patients get a safe place to recover. These programs have a length of at least 28 days and can continue for months depending on the severity of the addiction.
- Partial hospitalization program (PHP) and intensive outpatient treatment, which are usually set at hospital, private medical practices and psychiatric centers. The main focus of these programs lie in group therapy. PHP also provides medication management.
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The Rising Gabapentin Epidemic
Much like how the opioid epidemic sprung out of nowhere, many doctors and patients are now seeing the addictive effects of gabapentin. When used with other medications and drugs, there’s a big potential for abuse there. Those who believe they may be addicted should speak to one of our counsellors for more information. Don’t worry! We can help you get through this.