Gabby: the ‘New’ Drug of Abuse?

Question: What was the most prescribed medication in Ohio last December? Answer: Gabapentin.

• Have you seen a rise in Gabapentin prescriptions?
• Are you finding it being used as a drug of abuse among injured workers?
• Have you had concerns about this drug?

The fact that it eclipsed oxycodone prescriptions by more than 9 million doses comes as good news in the battle against opioid abuse. But the drug is increasingly raising concerns because of its own potential for abuse — especially among those already at risk for addiction.

Gabapentin, sold under the brand name Neurontin, can enhance the ‘high’ from opioids, making it appealing to some injured workers who are already abusing narcotics. While it comes with its own set of withdrawal symptoms, it helps ward off problems caused by decreases in other drugs of abuse. Because it can bypass the blocking effects of special medications used to treat addicts, those in recovery are finding it a new way to get high while still testing clean.

Most drug testing does not include gabapentin, as many physicians are unaware of the concerns. The workers’ compensation industry would be wise to take a closer look at the drug and take precautions to avoid problems associated with it.

What Is It

One of the most popular drugs in the U.S., gabapentin is approved by the Food and Drug Administration to treat epilepsy and neuropathy, or pain related to nerve damage. It is similar to gamma-aminobutyric acid, or GABA, a neurotransmitter in the central nervous system that slows down the activity of nerve cells in the brain. It does not bind to GABA receptors in the brain.

Think of our body producing GABA as the ‘anti-anxiety’ neurotransmitter of our personal brain medicine cabinet. Cognitive Behavioral Therapy techniques that promote a relaxation response stimulate GABA production.  That is why techniques such as mindfulness, progressive muscle relaxation, autogenic training and biofeedback are the cornerstone of the behavioral techniques that we teach to patients, and insist they practice regularly as non pharmaceutical techniques to COPE with pain.

The drug comes in tablets, capsules and oral solutions; is considered non-addictive; is not a controlled substance, and is touted as a ‘safe’ alternative to opioids for chronic pain. For many people, it is.

However, it seems to also have the potential for abuse, dependency, and withdrawal symptoms. Users report a sense of euphoria when they take the drug along with opioids, muscle relaxants or anxiety medications. Some report a marijuana-type high while others report feeling like zombies. Experts say for those reasons, it is being subverted to a drug of abuse.

Injured workers who lose their access to the drug and abruptly stop taking it may experience trembling, sweating, excitation, pallor or exophthalmia — an abnormal protrusion of the eyeballs. Other withdrawal symptoms reported include disorientation, confusion, tachycardia, and excessive sweating.
Problems

Various studies have documented abuse stories. In one, prison inmates were inhaling the powder from gabapentin capsules. All had psychiatric or pain diagnoses and histories of cocaine abuse. They reported getting a high similar to that from cocaine when they used gabapentin.

In another, patients said they took non-prescribed gabapentin to heighten the effects of methadone.

The Ohio Automated Rx Reporting System’s 2016 annual report said pharmacies in the state dispensed 29,618,930 doses of gabapentin in the month of December. Recently, the Ohio Substance Abuse Monitoring Network issued an alert about the increased misuse of the drug.

A report in the journal Addiction said about one fifth of patients who abuse opioids misuse gabapentin. One report said it was in the top five list of most prescribed medications in the country in May.

Among the increasing concerns about the misuse of gabapentin is that it is not a controlled substance, is very readily available, and is often prescribed as a first line treatment for chronic pain.

What to Do

For most injured workers, gabapentin is not a problem. Since including the drug in testing adds expense, it may be difficult to identify and intervene with those who are adversely affected.

Informing and educating physicians and others in the workers’ compensation system is an important first step. The concerns about the drug make it even more important for prescribers to carefully assess injured workers for any history of drug abuse when they prescribe gabapentin as well as opioids.

Signs of abuse or misuse among injured workers prescribed gabapentin should not be ignored.  For example, those who become tolerant, or seek early refills or increased dosages should raise a red flag. While including gabapentin in urine drug monitoring tests is not typical, it should be considered if abuse is suspected.

Conclusion

The evidence of gabapentin abuse among at-risk injured workers is yet another reason alternatives to medication should be considered first for those with chronic pain. Cognitive behavioral therapy and other types of non-pharmaceutical interventions have been proven to be effective, and overall less costly than dangerous medications.

We’d like to hear if others have experienced any concerns with this medication. For example:

• Have you seen a rise in Gabapentin prescriptions?
• Are you finding it being used as a drug of abuse among injured workers?
• Have you had concerns about this drug?

Please share your thoughts with us.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at https://theimcsgroup.com, or http://www.cope-with-pain.com. Please join our LinkedIn group, COPE with Pain at https://www.linkedin.com/groups/8540640 .