As the U.S. opioid crisis continues to rage, another drug used for pain is taking the stage. While it’s not in the same family of opioid drugs that are fueling the epidemic, Gabapentin, sold as Neurontin, is used to treat nerve pain and seizures and it’s a popular generic that’s been in use for 25 years, Medical Xpress reports.
Considered the seventh-most prescribed drug in the U.S. by prescription tracker GoodRX, Gabapentin has generally been considered low-risk and non-addictive. But researchers say the uptick in use is likely due to tighter restrictions which, in turn, means doctors are searching further afield for alternatives for their patients.
And Americans who abuse drugs are doing the same, researchers say.
“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Hart, who tracks drug abuse via a national data network in Colorado.
And while prescriptions for opioids like Vicodin and Oxycontin have fallen steadily since 2012, there’s been a few surprises — with overdoses of some rather unexpected drugs on the increase — like Imodium, which is used to treat diarrhea, for instance.
Now the Food and Drug Administration (FDA) is studying the patterns involved in the prescription of, and illicit use of the drug and will make its findings available soon, said commissioner Scott Gottlieb.
“One of the lessons from this whole opioid crisis is that we were probably too slow to act where we saw problems emerging and we waited for more definitive conclusions,” he said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”
More than a few doctors are unaware of Gabapentin’s potential for misuse, especially among patients who are habitual drug abusers, noted Rachel Vickers Smith, of the University of Louisville. Vickers Smith has researched the issue and those who abuse Gabapentin call it a “cheap high” that is almost “always available,” she said. The drug is often mixed with opioids, marijuana, or cocaine to enhance the high, giving users effects that range from “increased energy,” to “mellow” numbness.
But those who combine Gabapentin are increasing their chances of overdose, according to some medical journals. The journals further note that some 15 to 25 percent of users combine Gabapentin with opioids.
Because Gabapentin, available since 1993, is not considered addictive it isn’t tracked as closely drugs considered to be riskier — like opioids, for instance. Calls to poison control centers show a sharp rise in abuse and the number of overdoses, however.
The abuse rate of the drug rose 400 percent between 2006 and 2015 poison center data, which was analyzed by the RADARS research group that’s associated with the Denver Health and Hospital Authority, a state-owned agency. The agency is funded by drug makers and government agencies that reportedly don’t participate in analysis or the publication of the data.
But some states are increasing surveillance and adding new restrictions. Kentucky is one such state and last year it labeled Gabapentin a “scheduled substance” placing it in the realm of other high-risk medications that are subject to restrictions and tracking. Kentucky medical examiners detected the drug in one-third of all fatal overdose cases in 2016. Now the drug can only be prescribed by health practitioners registered with the federal government and patients can only receive five refills.
Other states, including Ohio, Minnesota, and West Virginia, are adopting other methods to track the drug via prescription databases. Ohio began doing this because Gabapentin is now the most prescribed drug in the state. And drug users surveyed in other states say that the drug, with a street price of only $1.50 per capsule, is easy to obtain.
At least one researcher is suggesting that it’s time for a federal response that’s more comprehensive, even if that means the drug has to be reclassified nationwide. Alyssa Peckham, a researcher at Midwestern University in Arizona, says Gabapentin, by itself, isn’t dangerous, but that can change if it’s combined with opioids and other drugs that can suppress breathing.
But if you’re looking for any consensus on what to do next, or even how to do it, or just how bad the problem really is, well…good luck. Because there’s next to none of that information available.
And with hospitals, insurers, and government authorities placing additional restrictions on opioids, physicians are becoming increasingly reluctant to limit any other medications that can help reduce pain. Gabapentin is recommended as part of the Centers for Disease Control and Prevention’s prescribing guidelines which say it’s a good choice for nerve pain.
Fortunately, questions are being raised about how much is being prescribed for proven uses — and just how much patients are benefiting from these uses.
One recent review of such research by the Cochrane Group showed that Gabapentin helped reduce nerve pain but didn’t do much for muscle and joint pain.
But traditionally, Gabapentin has been prescribed for uses that haven’t been okayed by the FDA as either safe or effective.
“This drug was kind of unusual in that it was prescribed as a kind of ‘miracle pill’ that could be used for anything,” said Dr. Joseph Ross, a researcher at Yale University’s School of Medicine.
Much of Gabapentin’s popularity can be attributed to heavy marketing by the drug’s original manufacturer, Warner-Lambert. That, in itself, stirred much controversy. The company pleaded guilty in 2004 and forked over a $430 million settlement amid allegations that it promoted the drug for a profusion of uses that it wasn’t approved for. The list included migraines, attention deficit disorder, Lou Gehrig’s disease and bipolar disorder. It’s okay for doctors to prescribe medications for any kind of use, but drug manufacturers are only allowed to market products for uses that are approved by the FDA.
According to Dr. Chad Brummett, an opioid researcher at the University of Michigan in Ann Arbor, the side effects of gabapentinoids include sedation, dizziness, and trouble thinking. And the risks escalate with higher doses, he wrote in an email to Reuters.
So obviously, like so many drugs invented by Big Pharma, Gabapentin has added a few additional and unpleasant side-effects to America’s ongoing opioid crisis.
You can watch this discussion from the television show The Doctors for more information.