The road to addiction recovery is a long and difficult one. After all, dependency is often as much a physiological condition as it is a behavioral and psychological one. That means that even as you face the mental and emotional toll of abstaining from the substance that seems to have become necessary to your existence on the one hand and so incompatible with your survival on the other, you must also endure the physiological sufferings of withdrawal.
It is little wonder, then, that those in recovery, as well as the healthcare teams dedicated to helping them, have searched so assiduously for a way to mitigate the particular challenges of early recovery. In recent years, physicians and addiction specialists have begun to look to the anticonvulsant medication, gabapentin, to ease withdrawal symptoms in people experiencing addiction.
Despite some studies suggesting that the off-label use of gabapentin could help prevent relapse in early alcohol recovery (1, 2, 3), a significant and rapidly growing body of research urges extreme caution. Indeed, there is mounting evidence that the beneficial effects of gabapentin on cravings and withdrawal symptoms appear to be only moderate at best and generally pertaining not to relapse prevention but to the number of heavy drinking days versus the placebo group for those in early recovery (3, 4).
The relatively modest evidence of the benefits of novel gabapentin use for alcohol withdrawal and craving reduction in those experiencing AUD is offset by another, more concerning issue: The increasing number of studies exploring the risk of gabapentin use by persons with substance use disorder (SUD) in general and AUD in particular. So, what exactly does the current research reveal about the potential harms of gabapentin for persons experiencing addiction, as well as for those in recovery?
Intoxication, Dependency, and Withdrawal
The prescribing of gabapentin for a range of purposes beyond the off-label use of the drug for persons in recovery, including the use of the drug to mitigate seizure activity and to manage chronic pain, has long been based on the presumption that it is safe and non-addictive. Though the mechanisms of the drug remain largely unknown, it has been assumed that gabapentin operates principally on GABA neurotransmitters, rather than through the brain’s opioid receptors. Thus, it was believed that gabapentin produced few, if any, intoxicant effects and that recreational abuse, dependency, and withdrawal were highly unlikely.
Currently, however, the evidence refuting this presumption is substantial and alarming. In a 2019 study of gabapentin use among persons with known SUD, Lennox and Mangin found that the study population reported psychoactive effects of extra-therapeutic doses of gabapentin to be similar to the intoxicating effects of opioids, alcohol, and other drugs (14). Specifically, the study subjects reported that they felt a sense of euphoria and well-being. The authors also found that the “high” associated with high doses of gabapentin were associated with continued misuse, including intranasal and intravenous consumption.
There’s also mounting evidence that not only can the drug produce intoxicant effects similar to those of drugs of abuse, and opioids in particular, but also that dependency and withdrawal may be commonplace. This is especially true with high doses (greater than 3000 mg daily) and/or long-term use (15, 16, 17, 18). Evidence of dependency is further supported by studies describing withdrawal symptoms similar to those of benzodiazepines, opioids, and alcohol withdrawal (16, 17, 18), including altered mental states, restlessness, pain, shaking, and nausea.
One of the most alarming risk factors of gabapentin use by persons with an addiction disorder or those who are in recovery pertains to the effects of the drug on the respiratory system. For instance, a 2017 study found that patients with SUD, active heroin and/or opioid users in particular, were at significantly greater risk of a fatal overdose due either to the reversal of opioid tolerance or the additive effect of the drug in depressing respiration (5).
However, evidence of potentially fatal respiratory depression when gabapentin is combined with other central nervous system (CNS) suppressants, including alcohol and opioids, does not end with Lyndon et al.. An array of subsequent studies seem to support Lyndon et al.’s findings (6, 7, 8).
Misuse, Dependency, and Overdose
In addition to the risk of respiratory depression in those experiencing addiction or in early recovery, there is mounting evidence that gabapentin misuse, dependence, and overdose is of significant concern (9). This is particularly true for those with SUD and AUD and who, thus, may be genetically, psychosocially, and behaviorally predisposed to addiction.
Buttram and Kurtz (2020) found that the potential for gabapentin misuse is especially high for patients in residential addiction treatment centers. The authors noted that patients often referred to the concept of “freelapse,” in which the use of the drug at higher than prescribed doses was perceived to be a safer or otherwise preferable alternative to breaking one’s abstinence from alcohol, opioids, or other illicit substances (10).
The potential for gabapentin misuse was further supported by a 2021 study (11). In their post-mortem analysis of gabapentin-related poisoning deaths, the authors found that the deceased generally had gabapentin blood concentrations substantially higher than levels considered safe or therapeutically efficacious.
However, the authors noted that there was little, if any, evidence of intentional overdose in these patients, suggesting that the overdose was likely accidental, a result of misuse.
Impaired Judgement and Accidental Injury
As alarming as the threat of potentially fatal outcomes of off-label gabapentin use may be, the research suggests that there are other important points of concern. Specifically, there is increasing evidence that gabapentin users may experience significant impairment in judgment and cognition and that these deficits put patients at an elevated risk of accident-related injuries.
For instance, in a study of adverse neurological effects of prescribed gabapentin for US veterans both with and without AUD, Rentsch et al. (2020) found that patients prescribed 600 mg or higher per day were far more likely to experience altered mental states, as well as falls and fractures related to these neurological effects (12). Similarly, in a study of patients with Alzheimer’s Disease, Pisa et al. (2021) found that the introduction of antiepileptic drugs, including gabapentin, substantially increased the risk of fall-related hip fractures (13).
How Bayshore Can Help
If you or someone you love is experiencing AUD or SUD, our multidisciplinary team of addiction recovery experts will work with you to devise a treatment plan tailored to your needs. If you are struggling with cravings or withdrawal symptoms, for example, our medical and psychiatric specialists can design a safe and effective plan to help manage these symptoms and support you through the early stages of recovery. Depending on your needs and goals, this treatment protocol may include a combination of short-term, closely-supervised pharmaceutical therapies and integrative approaches. At Bayshore, we offer nutritional education, massage therapy, yoga and meditation courses, and family and individual counseling, to name only a few of the resources we provide to help you detoxify your body and heal your mind and spirit.
Contact us today to discuss how we can help you manage cravings, mitigate withdrawal symptoms, and build the happy, healthy, dependency-free life you and your loved ones deserve.