On a federal level, gabapentin is not a controlled substance. However, because of increasing numbers of prescriptions and reports of misuse and harm, gabapentin is a controlled substance in some US states, with certain other states requiring gabapentin prescriptions to be reported to state databases. Gabapentin can be dangerous when used in combination with other drugs, especially alcohol and opioids.
- Gabapentin is used to treat many conditions, including seizures and pain conditions.
- Gabapentin is not a controlled substance on a federal level but is controlled in some states, which limits the number of prescription refills and how it is reported.
- Gabapentin can be dangerous when used in combination with other substances, particularly opioids.
What is gabapentin and what is it used for?
Gabapentin is an anticonvulsant medication that comes as a generic medication under the brand name Neurontin. It is available in various forms, including tablets, capsules, extended-release tablets, and an oral liquid solution. It was first approved by the Food and Drug Administration (FDA) in 1993. [1]
FDA-approved uses of gabapentin include: [1][2]
- Epilepsy with partial seizures
- Postherpetic neuralgia
- Restless leg syndrome (RLS)
It is also used to treat many conditions off-label - not approved by the FDA – such as: [2]
- Mood disorders
- Anxiety disorders
- Treatment-resistant depression
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Insomnia
- Post-operative pain
- Migraine
- Irritable bowel syndrome (IBS)
- Fibromyalgia
- Neuropathic Pain
It is also sometimes used for alcohol withdrawal, to help manage withdrawal symptoms and maintain abstinence. [2]
Many of its off-label uses have not been extensively studied so the evidence and understanding of these uses is limited. However, gabapentin appears to have some efficacy when used for a variety of conditions, indicating a need for large-scale studies. Although its precise mechanism of action is not fully understood, gabapentin appears to impact neurotransmitter activity, which may contribute to its many uses. [2]
Control status of gabapentin
Gabapentin is not a controlled substance at a federal level. Structurally similar to pregabalin, which is a Schedule V controlled substance, gabapentin is not as potent and has historically been considered to have less potential for abuse and dependence. [3]
However, some states have now classified gabapentin as a controlled substance. Although it was initially considered to have no abuse potential, gabapentin is now being linked to drug-related fatalities and reports of misuse, abuse, and diversion.
States that consider gabapentin a controlled substance
At the time of writing, gabapentin is classified as a Schedule V controlled substance in: [5]
Controlled substances of Schedule I-IV are regulated by limiting the number of times a prescription can be refilled, which usually does not apply to Schedule V substances. However, many states have imposed a limit for gabapentin refills to five times in six months. State regulations also include that prescriptions must be reported to the Prescription Drug Monitoring Program (PDMP). [4]
In some states in which gabapentin is not a controlled substance, it is required to be reported to the states’ PDMP. States with this requirement include: [5]
- Connecticut
- Indiana
- Kansas
- Massachusetts
- Minnesota
- Nebraska
- New Jersey
- Ohio
- Oregon
- Utah
- Washington D.C.
- Wisconsin
- Wyoming
Why is gabapentin being monitored?
Discussions and changes around the regulation of gabapentin have increasingly occurred across the US due to rapidly increasing reports of its misuse, abuse, and diversion, and links to drug-related fatalities. [6]
Gabapentin prescriptions have reportedly more than doubled from 2011 to 2021, increasing the availability of the drug and the potential for illegal sales and misuse. [3]
Since the COVID-19 pandemic, drug overdoses, particularly those involving opioids, increased significantly. In 2021, overdose deaths surpassed 100,000 for the first time in history. [7] Since this time, deaths involving gabapentin have also increased. Reports show that 85-90% of deaths in which gabapentin was detected also involved opioids. [8]
Gabapentin is misused by those who are prescribed the drug and those who are not, and is used alone or alongside other substances such as alcohol, benzodiazepines, or opioids. It is often used recreationally for its euphoric ‘high’, to self-medicate, or to intentionally self-harm. [6]
Gabapentin can enhance the euphoric effects of opioids, contributing to its misuse. Reports suggest that around 1% of the population misuse gabapentin, with 40-60% of people who are prescribed the medication misusing it. Additionally, of those who misuse opioids, 15-22% also misuse gabapentin. [6]
Combining opioids and gabapentin can be very dangerous as it can increase the risk of oversedation, respiratory depression, and death. [2] Because of these risks, many states have regulated the prescribing of gabapentin, to help address the number of overdose deaths.
Ensuring safe use of gabapentin
If you are prescribed gabapentin, it should be used exactly as instructed. Do not take more than prescribed.
Gabapentin should only be used by people for whom it is prescribed. Selling or sharing gabapentin that has been prescribed to you is illegal and may put others at risk of harm.
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