Abuse Potential of Gabapentin & Pregabalin

Special Report: The Abuse Potential of Gabapentin & Pregabalin – By Max Buscaglia, PharmD Candidate, Haley Brandes, PharmD Candidate and Jacqueline Cleary, PharmD, BCACP June 2019

The inevitable dark side of these “preferable to opioids” medications is becoming harder to ignore:

Key Takeaways:

Gabapentinoid abuse may rise as the prescribing and use of opioids decreases, but the biggest concern may come when these agents are combined with other prescribed medications or illicit street drugs.   

Gabapentinoid use has been associated with an amplification of a “high” feeling when used in combination with opioids. Therefore, the use of gabapentinoids in a population already receiving opioids may lead to a greater risk of abuse for both substances.

Gabapentin and pregabalin may be used more safely as alternatives after a patient has been rehabilitated off of opioids or before they start using them in the first place.

So now we’ll have to choose between only 1 of 3 options: opioids or benzodiazepines or gabapentoids, but no combination.

Again and again, a medication is deemed “harmful” for us because *other* people are abusing it for “fun”; people who are *not* pain patients.

Because gabapentin has a higher potential for abuse in patients with a history of SUD and patients concurrently taking opioids, it is prudent to be cautious when prescribing gabapentin or pregabalin in this population.

There are a few precautions healthcare providers can take to identify possible abuse.

Prescribers can monitor patients for

  • changes in mood,
  • frequent requests for early refills, and
  • requests for rapid increases in doses.

They can also include gabapentinoids in urine monitoring to ascertain whether their patient is actually taking the prescribed medications.

Pharmacists can watch for patients taking multiple doses and/or and receiving prescriptions from multiple prescribers, and counsel patients.

Another sign to watch for is frequent early refill requests and asking to pay out of pocket instead of billing insurance.

Reporting gabapentin to prescription drug monitoring programs may be useful in identifying patients who may be abusing or diverting gabapentin.

By increasing awareness of abuse potential and reporting to prescription monitoring programs, healthcare providers may help to prevent and/or reduce overall abuse of gabapentinoids.

6 thoughts on “Abuse Potential of Gabapentin & Pregabalin

  1. peter jasz

    “Gabapenetentiary” will kill you. It is a poison. STOP using it. It has ABSOLUTELY NO analgesic impact. It’s Shit -and deadly. Don’t wait for the “official” reports to come out soon -or at all. But most of all, don’t become a Victim/Stat of this BS poison making pharma billions. UGLY.

    pj

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  2. GZB

    Geez, what the hell do you believe? I’m sure like most, I do not trust in the “do no harm “ myth anymore. I am tested (UA) bimonthly to check for illicit and prescribed medication. Is it possible to have a good outcome when you disagree with your PM doctor? I think not. I have been dismissed as a patient for asking too many questions. Please excuse me while I go play in traffic.

    Liked by 1 person

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  3. leejcaroll

    I benefit from gabapentin it stops my “tics” from trigeminal neuralgia/anaesthesia dolorosa (phantom pain of the face) We have to stop saying its a terrble drug stop it because someone had a personal bad experience with it or some patients abuse it with/without opioids. My docs have been prescribing codeine and gabapentin for years. My personal experience is there is no issue. For me. By the same token I find it concerning that folks like the author of the paper would like it to be dealt with the same way opioids now are, with the monitoring, not trusting us etc

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  4. Kathy C

    They were freely prescribing these drugs to people who were already in Methadone programs. When they showed up at the ER, after “overdosing” by taking maximum uncontrolled amounts of these drugs to try to replace the heroin high, they were counted as “opioid overdoses.”

    It is pretty scary how little factual information they base any of this on. They marketed the heck out of Lyrica, and Neurontin as replacements for opioids. They not only hurt people with chronic pain, but the addicted as well. It illustrates how all of the current prescribing and guidelines and addiction treatment, is not based on facts, it is based on marketing, and corporate profits.

    We are living in Alternate Fact America.

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    1. peter jasz

      So true. ….. We are “living” in a crumbling ‘America’.

      Damn shame.
      Damn time, for some serious change.
      Its been building/growing for some time. The “fallout”, on its way …

      pj

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      Reply
  5. canarensis

    “healthcare providers may help to prevent and/or reduce overall abuse of gabapentinoids.”
    Will this stupid country EVER figure out that prohibition does not work, ever, & that you cannot legislate or monitor the recreational abuse of ANY potentially recreationally abused substance? Will we ever have the sense & sanity to follow the clear lead of, say, Portugal…where both drug use/abuse & deaths from abuse dropped drastically after all drugs were made legal & safely available, as well as making addiction treatment easily available & worked real hard to eliminate the stigma of drug use?

    I seriously doubt it. Damn it. Basic Puritanism & profit motives are against it.

    Liked by 2 people

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