“It is important that doctors and people dependent on opioids are aware that the number of overdose deaths involving the combination of opioids with gabapentin or pregabalin has increased substantially and that there is evidence now that their concomitant use – either through co-prescription or diversion of prescriptions – increases the risk of acute overdose deaths,” said Matthew Hickman, a Professor of Public Health and Epidemiology
The idea that Lyrica and Neurontin are being abused may be surprising to many patients and doctors, but the drugs are increasingly being used by addicts.
In a small 2016 study of urine samples from patients being treated at pain clinics and addiction treatment centers, over one in five patients were found to be taking gabapentin without a prescription.
“The high rate of misuse of this medication is surprising and it is also a wakeup call for prescribers. Doctors don’t usually screen for gabapentin abuse,” said Poluru Reddy, PhD, medical director of ARIA Diagnostics in Indianapolis. “These findings reveal that there is a growing risk of abuse and a need for more robust testing.”
“Gabapentin and pregabalin are also being abused by inmates.”
-Jeffrey Keller, MD,
“Gabapentin is the single biggest problem drug of abuse in many correctional systems,” Keller recently wrote in Corrections.com. “There is little difference (in my opinion) between Lyrica and gabapentin in both use for neuropathic pain or for abuse potential.”
Why would someone be so desperate to abuse them?
“If you are addicted, or even if you just like to get high once in a while, and you can’t obtain your preferred drugs of abuse because you are incarcerated, these are the drugs that can serve as an alternative in a pinch,” Keller wrote.
Gabapentin (Neurontin) is approved by the FDA to treat epilepsy and neuropathic pain caused by shingles. It is also prescribed “off-label” for depression, migraine, fibromyalgia and bipolar disorder.
About 64 million prescriptions were written for gabapentin in the U.S. in 2016, a 49% increase since 2011. Gabapentin is not scheduled by the DEA as a controlled substance.
Pregabalin (Lyrica) is a Schedule V controlled substance, which means the DEA considers it to have a low abuse potential. Pregabalin is approved by the FDA to treat diabetic nerve pain, fibromyalgia, epilepsy, post-herpetic neuralgia caused by shingles and spinal cord injury.
It is also prescribed off label to treat a variety of other conditions. Lyrica is Pfizer’s top selling drug, generates over $5 billion in annual sales, and is approved for use in over 130 countries.
The CDC’s opioid prescribing guidelines recommend both pregabalin and gabapentin as alternatives for opioids, without saying a word about their potential for abuse or side effects.