Gabapentin (Neurontin) Addiction: Signs, Symptoms, & Treatments

What to Know About Gabapentin

Gabapentin (Neurontin, Horizant, and Gralise) is FDA-approved for treating epilepsy and shingles-related pain. However, off-label gabapentin can help treat many medical and mental health conditions.^{1, 2, 3} Gabapentin has since emerged as a drug with substantial risk for misuse among those experiencing comorbidities (e.g., substance use and mental health disorders).

When taken as prescribed for an intended medical condition, gabapentin is well-tolerated and not considered addictive. However, addiction can occur or worsen when misused illicitly, at higher doses, or combined with opioids. Although the U.S. federal government does not regard gabapentin as a controlled substance, several states have classified it as a Schedule V drug.

Individuals with opioid use disorder have notably misused gabapentin. Using gabapentin conjunctively with opioids leads to respiratory depression that can be fatal. Research has also detected gabapentin in an estimated 85%-90% of opioid-related deaths.⁴ The recent trend of illicit fentanyl use has further increased gabapentin-related fatalities. Street names may include Gabbies, Johnnies, or Morotin.

Gabapentin may be used in treatment for:

• Epilepsy/Seizures
• Neuropathic pain
• Restless leg syndrome
• Drug and alcohol addiction (especially alcohol and cocaine use disorder to ease withdrawal)
• Anxiety disorders
• Bipolar disorder
• Borderline personality disorder
• Menopausal conditions
• Vertigo
• Pruritic (itching-related) disorders
• Migraines

How Does Gabapentin Work in the Brain?

Gabapentin elicits its effects by boosting inhibitory neurosignaling (via the neurotransmitter GABA (gamma-aminobutyric acid) and decreasing excitatory neurosignaling (via the neurotransmitters glutamate and norepinephrine) in the brain. Gabapentin modulates voltage-dependent calcium channels (VGCCs), or more simply put, acts as a gatekeeper preventing neurons from sending messages to other neurons.⁵

As a treatment for seizures or pain, calming excitatory activity with gabapentin is effective. However, when used with other depressants, particularly opioids, the combined effect can result in too much inhibition, possibly leading to overdose and fatality.

Gabapentin in Addiction Treatment

Due to their similar physiological effects, gabapentin can (medically and illicitly) ease withdrawal from benzodiazepine dependence and vice versa.^{6, 7} Gabapentin has been useful as an alternative to ease alcohol withdrawal when seizures are a risk, but the application is short-term and then tapered off. The drug also has the potential to reduce use and withdrawal from marijuana addiction.⁸

Conversely, gabapentin is unsafe when opioids (licit or illicit) are present or a person is at risk for opioid misuse. Despite the high risk of respiratory depression and overdose, patients receiving opioid use disorder treatment have reported using non-prescribed gabapentin to augment the effects of methadone or reduce withdrawal symptoms from opioid dependence.^{9, 10}

Signs of Gabapentin Abuse

Gabapentin can result in physical dependence.¹¹ When prescribed for medical use, healthcare providers will taper dosage to avoid or ease gabapentin withdrawal symptoms associated with abrupt termination. However, feelings of relief (from pain or anxiety) and wanting to avoid withdrawal (e.g., insomnia, agitation) can sometimes lead to continued use beyond medical tenure (i.e., dependence).

Addiction differs from dependence in that addiction involves intensely wanting or craving the drug, while dependence means using a drug to feel normal and avoid withdrawal symptoms. While physical and psychological dependence can result from licit use of gabapentin, the dosage is usually not high enough to induce the “euphoria” or “high” that can feed addiction (although gabapentin addiction reportedly occurs in 2.9%-10% of therapeutic users).^{12, 13}

Gabapentin misuse of higher than normal dosing can result in a “high.” However, people will not necessarily experience addiction because gabapentin does not activate the typical dopamine-mediated reward pathway in the brain like other addictive drugs. Gabapentin abuse most often occurs supplementary to other substance addictions.

Signs of gabapentin misuse include:

1. Lying about symptoms to a doctor (exaggerating actual symptoms in search of a higher dose or refill, or fabricating non-existent symptoms)
2. Specifically requesting gabapentin
3. Medication seeking with multiple doctors
4. Claiming the medication was lost
5. Irritability when the drug is not available
6. Frustration when the doctor is unwilling to refill prescriptions
7. The individual has a history of substance use disorder (especially opioids or benzodiazepines)
8. Sleep problems
9. Changes in social groups or activity
10. Anxious about the possibility of running out of medication

Gabapentin Addiction Statistics

Gabapentin itself is addictive for a relatively low percentage of prescription users (3%), but is more commonly misused or abused. Misuse is even higher for pregabalin, a similar gabapentinoid.¹³

The most problematic concern is misuse among opioid users and the ensuing surge in overdose and fatality in recent years. According to addiction facts and statistics, medicinal and illicit opioids were the most common substance exposure reported to poison control centers.^{4, 14}

Below are current gabapentin addiction statistics:

• 1% of the general population misuses gabapentin. This estimate is substantially higher for people with opioid use disorder (22-40%).^{5, 6}
• 6% of new prescription users end up misusing gabapentin, and 83% of gabapentin misuse starts within the first two years of prescription commencement.¹³
• Among opioid users, 85%-90% of fatalities involve gabapentin.⁴
• An estimated 38% of substance misusers take gabapentin to augment the effects of methadone.¹⁰
• Most overdose fatalities involving gabapentin occurred in non-Hispanic White persons (83%) and individuals 35-54 years old (52%).⁴ There is no significant difference in gabapentin use between men (49.7%) and women (50.3%).⁴
• Gabapentin-related fatalities doubled between 2019-2020, likely due to increased prevalence of illicit fentanyl use. However, deaths from gabapentin overdose alone (without any other drug use) occur in approximately 1% of users.^{10, 15}

Side Effects of Gabapentin Misuse & Abuse

Gabapentin abuse mostly occurs in cases of opioid addiction where individuals seek to mitigate withdrawal symptoms, substitute opioids, or enhance the effect of opioids. However, gabapentin misuse can develop in a more subtle fashion among drug-naive individuals.

Whether gabapentin can be an on- or off-label drug to relieve physical discomfort like pain or psychological discomfort like anxiety. Still, some individuals may take more than the prescribed dose as they develop tolerance–this is misuse. As doses escalate, side effects can develop. While some adverse effects are pleasant (euphoria, reduced anxiety), others can impair and disrupt daily functioning.

Adverse effects of excessive gabapentin use include:

• Euphoria
• Sleepiness/Fatigue (insomnia during withdrawal)
• Increased sociability (while intoxicated)
• Respiratory distress
• Hallucinations
• Dissociation
• Injury
• Vehicular or machinery accidents
• Mood changes (agitation during withdrawal, depressive symptoms, suicidality)
• Death

Risk Factors & Causes of Gabapentin Addiction

Approximately 18% of people prescribed gabapentin for pain may abuse the drug. Being single, living alone, drinking alcohol, using nicotine, and taking antidepressants increase the risk of gabapentin misuse. Exceedingly high (i.e., suprathreshold) doses increase the likelihood of abuse and possible cross-addiction with other substances.

Risk factors that may contribute to gabapentin misuse, dependence, and addiction include:

• Co-occurring addictions: Substance use disorder (especially opioid use) is a major risk factor because gabapentin augments and mimics the effects of opioids like heroin and fentanyl.
• Chronic pain: Gabapentin and opioid use often begin with an intent to reduce pain. As tolerance develops, users may seek higher doses to achieve the same level of pain reduction.
• Family history: Genetic factors, addictive personalities, and environmental aspects put some people at greater risk for addiction. These individuals often have a dysregulated neural reward system and neurotransmitter levels.^{16, 17}
• Young age: A developing adolescent brain is particularly susceptible to the effects of psychotropic drugs. Teenage addiction is particularly concerning because gabapentin can be fatal when combined with other opioids.
• Mental health symptoms: Individuals with severe depression may be more susceptible to misusing gabapentin for anxiolytic and dissociative properties.
• Stress: Those experiencing chronic or toxic stress may seek relief through the anxiolytic and sedative qualities of gabapentin.
• Trauma: Individuals who have experienced trauma may use gabapentin to calm dissociative experiences or as a sleep aid.
• Sleep problems: The sedative properties of gabapentin may appeal to some as a sleep aid. However, dependence can develop, and insomnia can return upon cessation as a withdrawal symptom or fear of future sleep disturbances.
• Environment: Greater availability and easy access within a household or social circles increases the likelihood of frequent use.
• Poverty: Indigence can also be a condition people want to regularly “check out” from. Thus, some misuse gabapentin because it is less inexpensive than opioids.

Co-Occurring Disorders With Gabapentin Addiction

Gabapentin may be misused to relieve physical (e.g., chronic pain) or psychological (anxiety, depression) symptoms. The calming, stress-relieving properties can understandably be desirable in the short term. Sometimes, what begins as licit, prescribed use for such conditions slips into misuse as the individual develops a tolerance that requires increasingly higher doses their doctors eventually refuse to provide.

As misuse progresses, the individual may seek illicit sources or use manipulative strategies (e.g., doctor shopping) to avoid unpleasant withdrawal symptoms. Withdrawal symptoms often take the form of the very thing the drug relieves, such as anxiety, insomnia, and agitation. Cross-addiction with other addictive substances with similar calming effects (like benzodiazepines, alcohol, and opioids) becomes a risk.

Gabapentin addiction may occur comorbidly with conditions such as:

• Pain-related conditions: What starts as a prescription for pain relief can easily merge into misuse if relief is insufficient at the prescribed dose or tolerance develops with extended use.
• Sleep disorders: As a less addictive alternative to benzodiazepines, gabapentin is sometimes prescribed off-label as a sleep aid for insomnia and on-label for restless leg syndrome. However, upon gabapentin withdrawal, insomnia will likely exacerbate, and an individual may misuse gabapentin or other sleep aides to fall asleep.
• Depressive disorders: For treatment-resistant major depressive disorder and bipolar disorder, doctors have prescribed gabapentin off-label as an add-on treatment. However, research has shown limited efficacy in reducing symptoms \and increased risk of suicidality.^{3, 18}
• Social anxiety disorder: Gabapentin misusers have reported using gabapentin to reduce social anxiety.⁶
• Post-traumatic stress disorder (PTSD): While research has shown notable improvement in sleep-related symptoms of PTSD, some may misuse the drug to relieve additional symptoms or sleep disturbances.³

Symptoms of Gabapentin Withdrawal

While gabapentin modulates neurotransmitter levels that elicit euphoria and relaxation, unpleasant symptoms like anxiety, agitation, headaches, and insomnia can occur upon withdrawal. Typically, withdrawal symptoms begin 24-48 hours after discontinuation and can last up to 10 days. Severity may depend on doses and duration of misuse.¹⁹

Healthcare providers will taper prescribed gabapentin doses over a week or more to avoid or ease withdrawal symptoms. However, when misused, withdrawal will likely be more sudden and severe when the drug becomes unavailable. Local and online resources can help if you or a loved one needs help overcoming drug dependence.

Symptoms of gabapentin withdrawal may include:

• Agitation
• Confusion
• Disorientation
• Gastrointestinal upset
• Tremor
• Elevated heart rate
• High blood pressure
• Insomnia
• Sweating

Signs of a Gabapentin Overdose

A daily therapeutic dose of gabapentin is usually between 800 and 1,800 mg but can be as high as 3,600 mg. The prescription will often depend on the condition treated, but drug effects tend to cap around 1,800 mg.

When taken alone, overdose on gabapentin is unlikely. However, overdose is more likely when taken with other substances that depress respiration, particularly opioids. Combined use of prescription opioids and gabapentin increased the risk of death by 60% in one study.²⁰

Seek immediate medical attention for signs of a gabapentin overdose, such as:

• Changes in breathing
• Rapid heartbeat
• Low blood pressure
• Vomiting/diarrhea
• Bluish or tinted skin (notably on lips, fingers or toes)
• Dizziness
• Double vision
• Movement problems
• Loss of coordination
• Confusion
• Trouble speaking
• Drowsiness/Sluggishness
• Unresponsiveness

Treatment for Gabapentin Addiction

Gabapentin use must taper gradually, and individuals should not go “cold turkey.” Tapering the dose over the course of at least a week is the first step toward recovery. When gabapentin misuse and abuse are comorbid with other dependencies and addiction, a rehabilitation program will likely be necessary for recovery.

Treatment options for gabapentin addiction include:

Inpatient Treatment

In severe cases of gabapentin misuse, hospitalization or residential treatment programs may be necessary to stabilize the person and ease them through detoxification and withdrawal. Medical interventions can help reduce withdrawal symptoms during gabapentin detoxification, and the weaning process can take several days. Further recovery may continue in a residential or outpatient rehabilitation center.

Rehab

Rehabilitation programs (typically 28 days in duration) exist for several different levels of treatment, ranging from inpatient hospitalization to outpatient counseling. Cost, timeline, and treatment approaches are a few factors that may vary depending on the severity of addiction and insurance plans. An important part of rehabilitation is establishing a relapse prevention plan, as relapse is common during recovery.

Intensive Outpatient Treatment

Intensive outpatient programs (IOPs) are for individuals who require a higher level of care but cannot attend residential programs. This integrative approach provides 9-20 hours of weekly intervention as individual, group, or family therapy and other related support.

IOPs allow the person to continue their daily activities outside of the scheduled program/treatment time. However, treatment requires reliable attendance and sobriety. Partial hospitalization programs (PHPs) involve more intense day therapy than IOPs as they usually are 20 or more hours a week.

Therapeutic Interventions

Gabapentin addiction or misuse often occurs alongside other substance use disorders. While inpatient programs are best for detoxification and stabilization, ongoing psychotherapy and support groups are integral to long-term recovery.

Many therapy styles depend on the severity of the addiction, comorbid mental health disorders, and factors that led to the addiction (e.g., chronic pain, trauma, genetic predisposition). Successful recovery often involves integrative individual, family, and group therapy.

Therapy options for addressing the effects of a gabapentin addiction include:

• Cognitive behavioral therapy (CBT): CBT for addiction helps individuals identify maladaptive thought patterns and behaviors associated with misuse and develop healthy coping strategies to manage cravings. Over time, these new behaviors reinforce long-term change and relapse prevention.
• Dialectical behavior therapy (DBT): DBT is similar to CBT but focuses on emotional regulation, mindfulness, and interpersonal skills to manage emotional distress that previously led to drug misuse. A DBT therapist will help a struggling individual accept current circumstances while actively working toward change.
• Eye movement desensitization and reprocessing therapy (EMDR): EMDR uses eye movement training while recalling traumatic or stressful memories to create new associations and weaken existing neural connections involved with those memories.
• Group therapy: Support groups play a crucial role in the recovery process for many individuals and their families. Group therapy interventions provide a safe, non-judgmental space where individuals can connect with others experiencing similar struggles with substance misuse.
• Motivational enhancement therapy: This approach is particularly effective for treating substance misuse. Motivational interviewing techniques help the person develop self-awareness and intrinsic motivation for change and improvement.
• Family therapy: Family therapy focuses on the maladaptive ways in which an entire family system maintains (or enables) drug misuse and how to break these patterns. Family members may also learn to help ease the symptoms that precipitate substance misuse (e.g., anxiety, stress, depression, etc.).²¹
• Psychodynamic therapy: While not typically a first-line treatment for substance misuse, psychodynamic therapy can sometimes be helpful for patients with insight into how their substance misuse may relate to past traumas.

Psychedelic-Assisted Therapy

A recent resurgence of psychedelic-assisted therapy has shown promise for treating addiction. Gabapentin is not addictive through the same neural pathways as other drugs but is misused overwhelmingly by individuals with opioid use disorder. Psychedelics (e.g., psilocybin, ibogaine, LSD, ketamine) are associated with a reduced risk of opioid dependence and opioid abuse.^{22, 23, 24}

In My Experience

When used as prescribed, gabapentin is relatively safe and not addictive. However, misuse can lead down a slippery slope to dependence. There are several reasons besides recreation and addiction why someone may misuse gabapentin. As tolerance develops, more is needed for the desired effect.

If you or someone you care about is misusing gabapentin, recovery is possible. Ask for help by talking to your healthcare professional, calling the SAMHSA helpline, or seeking a mental health professional through an online therapist directory.