Gabapentin Abuse on the Rise

FDA, Medicare Set-Aside Blog, MSAs, Rx/Pharmacy on April 25, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

All of the focus on the opioid crisis may have overshadowed a growing trend of abuse and misuse for another drug that’s well known to those of us in the workers’ compensation industry . . . gabapentin. Ironically, the growing trend of gabapentin abuse is related to the opioid crisis. In an effort to adhere to revised prescribing guidelines that express a preference for non-opioid analgesics, physicians have been prescribing gabapentin more often. A report by IMS Health indicated that 57 million prescriptions for gabapentin were written in 2015, which represents a 42% increase since 2011.[1]  In 2016, the number of gapapentin prescriptions in the United States rose to 64 million.[2]

Gabapentin is FDA approved to treat certain types of seizures and neuralgia that follows an episode of shingles. However, due to its effects on the central nervous system, it is widely utilized in an off-label capacity to treat certain types of chronic pain and mental health conditions.  Use of gabapentin as an analgesic is particularly common in cases where pain arises due to nerve damage, as often occurs in workers’ compensation cases.  Gabapentin in its most common and generic form is an inexpensive drug, when included in Medicare Set-Asides and while the cost is relatively low, there are other emerging concerns associated with use of this drug.  In addition to its pain relieving qualities, large doses of gabapentin can produce feelings of euphoria in certain users, similar to that of cannabis. It can also produce a calming sensation, along with feelings of increased sociability. Gabapentin is nowhere near as potent as opioids and as a result, it is not often misused or abused by itself but rather it is mixed with other drugs to enhance the effects of those drugs. Most commonly, it is combined with other central nervous system depressants such as opioids, anti-anxiety medications and muscle relaxants. In some cases, gabapentin is used in an effort to reduce the symptoms of withdrawal from substances such as alcohol. Rates of gabapentin abuse are relatively low in the general population, trending at about 1%.  These rates of abuse and misuse increase dramatically in those patients utilizing opioids, to about 22%.  On the street, gabapentin is known by various names such as “morontin,” “johnnies” or “gabbies.”

Statistics from all over the country support the idea that gabapentin abuse is growing. In certain states such as Kentucky and West Virginia where the opioid epidemic has hit particularly hard, gabapentin has been surfacing at alarming rates in overdose situations. Data from the coroner’s office in Louisville suggests that gabapentin is found in nearly one-fourth of all overdose events.[3] Across the entire state of Kentucky, gabapentin is detected in about 1 in 3 overdose deaths.[4] The Charlestown Gazette-Mail reported that the number of fatal overdoses related to gabapentin in West Virginia jumped from 3 in 2010 to 109 in 2015.[5]

Several states have initiated prescription drug monitoring programs to track gabapentin prescribing, including Ohio, Minnesota, Virginia, Illinois, Wyoming and Massachusetts. Kentucky has gone one step further, by designating gabapentin as a schedule V controlled substance. The FDA issued a press release in February of 2018, where the Commissioner acknowledged that abuse and misuse of drugs such as pregabalin (Lyrica) and gabapentin (Neurontin) may be growing. At that time, the FDA Commissioner also indicated that the FDA will have more to say about it following a thorough investigation. We’ll continue to follow FDA efforts to curb abuse and misuse of this drug, and post updates here.




[4] Id.