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Gabapentin: Dependence, Withdrawals, and Effects

Gabapentin is a new type of anticonvulsant or antiepileptic used to treat a variety of conditions. No one knows exactly how it affects the body; however, it has been linked to the GABA system. This drug is believed to affect calcium levels within the body, and decrease one's sensitivity to pain. The exact mechanisms, however, are still a mystery.

This drug has an effect similar to prescription opioids. It’s been prescribed to treat pain, bipolar disorder, epilepsy, seizures, and tremors. It's also been used as an addiction treatment for alcohol and opioid addiction. It's a very versatile drug with many uses. This is probably what led to a spike in its popularity.

But despite just how useful it can be in treating certain conditions, gabapentin has recently become a substance of abuse. And misusing this prescription medication can have some deadly consequences.

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What Is Gabapentin?

Before we get into what makes this drug so addictive and potentially dangerous, let’s take a closer look at what gabapentin is and how it works.

The body uses two main chemicals to control the electrical activity in the brain: glutamate and GABA. Glutamate’s role is to excite your neurons and make them more likely to produce an electrical charge. GABA, on the other hand, does the opposite and suppresses electrical activity.

In the most basic sense, if a neuron is flooded with more glutamate than GABA, it fires off an electrical signal. And if there’s more GABA, it doesn’t.

Some disorders have been linked to having far too much electrical activity in the brain. Seizures, tremors, certain anxiety disorders, and more are just a few examples. And modern medicine has discovered that increasing the levels of GABA in the brain can keep these disorders under control.

Gabapentin is a unique chemical that is incredibly similar to GABA. In fact, the two are so alike that the brain usually can’t even tell the difference. And as a result, doctors have begun using it to treat the many different disorders caused by an imbalance of glutamate and GABA.

Gabapentin is the generic version of the medication. Popular brand names of medications that contain the same active ingredients include:

  • Gralise
  • Horizant
  • Neurontin
  • Pregabalin
  • Gabarone

Out of the 5 brand name medications, Neurontin is the most popular. Medications are available in the form of immediate-release capsules or oral solutions. Doses range from 100mg to 800mg. In most cases, doctors will prescribe a dose of 300mg at a time. Several doses may be taken throughout the entire day to treat the condition or disease.

When Does Gabapentin Use Become Abuse?

There’s a lot of confusion surrounding what constitutes abuse of prescription medications like gabapentin. And on top of that, many people wrongly think that physical dependence and addiction are one in the same.

Gabapentin Addiction

In order to clear up some of that confusion, let’s take a look at what these different terms mean starting with abuse.

In its most basic sense, abuse describes using a substance either illegally or in a way that it wasn’t intended to be used. For drugs like heroin, using it even once is considered to be abuse since this drug is illegal and doesn’t have a legitimate medical use.

With prescription medications, however, things get a little more complicated since they’re technically legal. With these drugs, using them in a way that they weren’t prescribed is mainly what’s considered abuse. But don’t be misled – that definition extends to an enormous number of scenarios.

Just to give you an idea, below are some of the most common ways drugs like gabapentin are abused today.

  • Taking a higher dosage than outlined in the instructions
  • Taking it at the wrong time of day
  • Taking it more often than you should
  • Taking it with other drugs like alcohol, other medications like opioids, or illegal drugs like cocaine or heroin
  • Sharing it with others, even if they have their own prescription
  • Taking it in a way that isn’t prescribed (i.e., crushing and snorting it, injecting it, etc.)
  • Using it to cope with difficult emotions, thoughts, or situations
  • Obtaining a “legitimate” prescription by lying to your doctor
  • Taking someone else’s medication, even if you have a prescription

As you can see, there are many different ways you can abuse a prescription drug today.

Unfortunately, the line between use and misuse is quite thin. Many patients who are prescribed Neurontin may end up misusing the drug. And eventually, that misuse can end up fueling a habit of abuse.

To put the problem into perspective, a recent study found 22% of opioid-dependent patients had a prescription for gabapentin. Of these patients, 40% used more gabapentin than prescribed.

But how is it abused today?

Many times, gabapentin is used in conjunction with other drugs like alcohol and opioids. That’s because this drug tends to enhance the euphoria felt during drug use.

But there’s more at play here than just enhancing the effects. Gabapentin can actually help bypass the blocking effects of certain drugs taken during addiction treatment. And that can mean that recovering addicts can get high while in recovery.

And this is made all the more dangerous by the fact that gabapentin is notoriously easy to get your hands on. According to StreetRx, street gabapentin pills (also known as Gabbies or Johnnies) can be as cheap as a dollar per 100mg.

Methods of abuse are typically confined to ingesting it orally or crushing and snorting it similar to cocaine.

Long-term use of gabapentin can lead to physical dependence. Dependence is marked by the body needing a drug in order to function normally. If you’re physically dependent and you try to quit gabapentin, you’ll experience withdrawal symptoms.

Identifying a gabapentin addiction can be difficult. Many patients don't exhibit any outward signs of an addiction. They're able to hide it with ease.

This is also because gabapentin addicts do not exhibit strong drug-seeking behaviors. They are not compulsive and impulsive.

To determine whether a person is addicted to gabapentin, pay attention to the details. Common signs of a Neurontin addiction include:

  • Being obsessed with the drug
  • Exhibiting constant mood changes
  • Failing to quit due to the withdrawal symptoms
  • Isolating oneself in favor of taking the drug
  • Purchasing gabapentin from illegal sources
  • Seeking a larger dosage from the doctor
  • Taking a larger dosage of the prescription
  • Taking the medication even without a prescription
  • Treating emotional pain with Neurontin

Often times, even those who are close to addicts won't realize what's happening. Those who suspect that a loved one is addicted to gabapentin may not easily get the answers they seek.

Those who need some help in this department should check out our addiction quizzes. Some of these quizzes are self-assessments, whereas others are for loved ones.

While the quizzes might help point addicts and their family members in the right direction, they may not provide a concrete answer. Those who are looking for more insight and information should contact one of our counsellors. A thorough professional assessment may be needed.

Off-Label Prescriptions for Gabapentin

One of the factors that have led to an increase in gabapentin abuse lately is just how often this drug is used for conditions that it wasn't originally designed to treat. This is what's known as prescribing "off-label."

Now, it’s important to remember that just because a drug is prescribed off-label doesn’t mean it’s being used illicitly or even illegally. Off-label prescribing is common in many doctor’s offices today.

However, it is a practice that has led to this drug being far more available than many others – especially because it’s been believed to be non-habit forming. In fact, one study found that as much as 83% of gabapentin prescriptions are used for off-label purposes.

Some of the conditions that gabapentin is used to treat that are considered to be off-label are:

  • Bipolar disorder
  • Neuropathic pain
  • Diabetic neuropathy
  • Complex regional pain syndrome
  • Attention deficit disorder
  • Restless legs syndrome
  • Trigeminal neuralgia
  • Periodic limb movement disorder of sleep
  • Migraine headaches
  • Alcohol withdrawal syndrome

Using Drugs Like Neurontin in Addiction Treatment

With the ever-growing opioid epidemic and increasing rates of addiction all around the country, addiction researchers are working feverishly to find new ways of preventing and treating substance use disorders. And recently, gabapentin has emerged as a possible treatment for reducing the severity of certain drug withdrawals.

Since gabapentin is similar in shape and structure to GABA, it makes it a particularly useful compound for treating drug addictions that deal specifically with this chemical. This includes treating alcohol withdrawals and those experienced while detoxing from benzodiazepines.

With both alcohol and benzodiazepines, the brain becomes so used to their GABA boosting power that when addicts stop using them entirely, GABA levels tend to drop dramatically. Researchers believe that gabapentin may help fill that gap and reduce the severity of withdrawal symptoms.

Surprisingly, gabapentin has also been shown to be effective in making detox from opioids far more manageable as well. With proper use of this drug, symptoms like coldness, diarrhea, dysphoria, yawning, and muscle tension all decreased in severity quite a bit.

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Gabapentin Addiction Withdrawal Symptoms

While gabapentin may be becoming more popular as an addiction treatment medication, the unfortunate reality is that this drug itself is quickly becoming a substance of abuse.

And as with any addictive drug, the first step towards getting clean from Neurontin requires you to detoxify your body.

During this process, your body will readjust to functioning normally without the help of gabapentin while flushing out the last traces of the drug. While this part of recovery is entirely necessary, it can end up being quite painful due to the withdrawal symptoms involved.

Gabapentin withdrawal symptoms are quite similar to alcohol and benzodiazepine withdrawal symptoms. This is probably because gabapentin affects GABA levels within the brain, as do alcohol and benzodiazepines.

Most Neurontin withdrawal symptoms are not considered dangerous. However, seizures can cause injuries and even death. As a result, those who experience gabapentin withdrawals should speak with a doctor or addiction professional.

Medical support help keep you safe should any complications occur. Plus, it may also help reduce the intensity of the symptoms too, making detox even easier.

The intensity of the withdrawal symptoms is also based on the dose taken. Those who have taken higher doses will usually experience more intense withdrawal symptoms. As most patients develop tolerance to the drug, it's not unusual for most patients to need a large dosage.

In short, many patients will experience intense, and even unbearable, withdrawal symptoms. These symptoms may cause relapses to happen.

Long-term gabapentin users will experience a whole array of withdrawal symptoms when quitting. The withdrawal symptoms will be more intense for those who try to quit cold turkey. Slowly tapering off of the drug is usually a better option, and is highly recommended by experts.

Even patients who used the medication as prescribed may experience withdrawal symptoms. Whether withdrawals will kick in is dependent on the length of the Neurontin use.

Some common gabapentin withdrawal symptoms include:

  • Abdominal pain
  • Agitation
  • Anxiety
  • Changes in appetite
  • Confusion
  • Crying spells
  • Depression
  • Diaphoresis
  • Difficulties sleeping
  • Dizziness
  • Fatigue
  • Headaches
  • Insomnia
  • Irritability
  • Itching
  • Muscle pains or spasms
  • Nausea
  • Pain
  • Restlessness
  • Sweating
  • Seizures
  • Suicidal thoughts
  • Tachycardia, or an increased heart rate

Gabapentin Withdrawal Timeline

Withdrawal symptoms can begin to kick in as soon as 12 hours of the last dose. In most cases, however, withdrawal symptoms will begin to emerge 1 to 2 days after last use. The exact timeline will differ from patient to patient.

Most symptoms will begin to peak after 3 to 4 days and will take up to a week to subside.

Some patients will experience psychological symptoms for up to a month. These symptoms are otherwise known as Post-Acute Withdrawal Symptoms (PAWS). PAWS is more likely to affect children and young adults.

The best way to avoid experiencing debilitating withdrawal symptoms is to gradually taper off of the drug. Most experts recommend a taper treatment that is similar to a benzodiazepine taper. The tapering process should happen over a period of several weeks to several months.

Factors that Affect the Neurontin Withdrawal Timeline

The withdrawal timeline for gabapentin will differ from patient to patient. This is because there are many factors at play. Some factors that affect the intensity of the withdrawal symptoms, as well as the length of the withdrawals, include:

  • Whether the patient was dealing with co-occurring disorders
  • Whether there was concurrent use of alcohol or other drugs
  • The patient's health and age
  • The length of the drug use
  • The dosage taken
  • How slowly the patient will gradually taper off of the drug

Medical professionals can estimate what each patient should expect after a thorough assessment. Our staff can walk addicted individuals through the process of detoxing from gabapentin, so the process feels less scary. We will also explore all of the possible treatment options with people who are addicted to gabapentin. Some popular options include residential treatment programs and intensive outpatient programs.

Gabapentin Abuse Short-Term Effects

On top of withdrawal symptoms, both short-term and long-term use can lead to some side effects. The drug will affect each patient in a different manner. This is why most doctors recommend each patient to take some time to figure out how the drug affects their body.

Some patients may experience more intense side effects than others. This may simply be due to one's own biological makeup. Some common side effects to expect after taking gabapentin include:

  • Double vision
  • Difficulties speaking
  • Dizziness
  • Fatigue or drowsiness
  • Fever
  • Jerky movements
  • Loss of coordination
  • Nausea and vomiting
  • Swelling of the limbs
  • Tremors and seizures
  • Unusual eye movements 
  • Cold or flu-like symptoms
  • Delusions
  • Lower back or side pain
  • Dementia
  • Lack or loss of strength

Usually, the body will adapt to the gabapentin use. As a result, the side effects will tend to either disappear or lessen in intensity within time.

Serious Side Effects of Neurontin

Gabapentin is not suitable for all patients. In rare cases, some patients will experience serious side effects. When this happens, the patients should seek immediate medical help.

Some of the more serious side effects include:

  • Anxiety
  • Behavioral changes
  • Changes in work or school performance
  • Difficulties concentrating
  • Insomnia or other difficulties sleeping
  • Intense mood swings, particularly anger and irritation
  • Overly talkative behavior
  • Panic attacks
  • Restlessness
  • Suicidal thoughts
  • Violent or aggressive behavior

The doctor may need to switch the patients to a different medication or to a lower dosage. It will depend on the intensity of the side effects, among many other factors. A thorough assessment will be needed to make an informed and calculated decision.

The Possibility of an Allergic Reaction

Some patients may even be allergic to gabapentin. Patients who are experiencing an allergic reaction will become fatigued. They may also get hives, frequent infections, rashes, and swollen glands and lips. Fevers, unexpected muscle pain, unusual bruising or bleeding and jaundice can also be caused by an allergic reaction.

Signs of a Neurontin Overdose

Deaths caused by drug and alcohol overdoses are rising in all 50 states in America. Each year, more and more Americans lose their lives to drugs and alcohol. It's a major epidemic that plagues the medical industry. Unfortunately, America has yet to come up with a solution.

While not all overdoses are lethal, fatal overdoses due to gabapentin toxicity are possible. In fact, there have even been cases where people used gabapentin to commit suicide.

Some common symptoms of an overdose include:

  • An abnormally slow heart rate
  • Coma
  • Death
  • Diarrhea
  • Dizziness
  • Double vision
  • High or low blood pressure
  • Tremors
  • Loss of control over body movements
  • Rapid heartbeat
  • Slurred speech

Fatal Neurontin overdoses are similar to opioid overdoses. The systems of affected individuals will begin to shut down. They will often look like they are drifting off to sleep; however, they will stop breathing. When this happens, they may die.

Unlike for opioid overdoses, there are no antidotes for gabapentin overdoses yet. Even if emergency responders are able to treat an overdose, the affected individual will likely sustain permanent damages.

If gabapentin is used concurrently with opioids, there's a 49% increased risk of a fatal opioid overdose. Both of these drugs can cause respiratory and cardiac distress. When both are used at the same time, the effects are magnified.

Some people are more at risk of overdosing than others. Overdose risks involve factors like:

  • Whether the gabapentin was taken with other drugs and alcohol
  • One's biological makeup
  • The dosage of Neurontin that was taken

Those who have used gabapentin for an extended period of time will likely have built tolerance. This means that they will need a larger and larger dose to achieve the same effects. These people are much more likely to take a dose capable of causing an overdose.

The amount needed for an overdose will vary from individual to individual. Acute oral overdoses for this drug can require up to 49 grams. When an individual is overdosing on Neurontin, the best thing to do is to call 9-1-1 immediately. It’s also a good idea to stay with the individual to keep them calm. If they ever stop breathing at any moment in time, perform CPR.

Break the Cycle of Addiction

Not many people are aware of the dangers involved with taking gabapentin. As a result, many patients who take the drug won't realize that they're addicted until it's too late.

Once that happens, it can be incredibly tough to break the cycle of addiction without professional help. The cravings and drive for the high that gabapentin can create are certainly one thing holding addicts back from recovery. And even the most determined individuals can find themselves unable to control themselves.

But there’s more to just the desire for pleasure involved here. In fact, one of the leading factors in why so many addicts end up relapsing is because they can’t withstand the unbearable withdrawals that come with detox.

They may turn back to abusing again just to feel some sort of relief. And in some cases, it may be the only thing that makes them actually feel “normal” again.

The combination of pleasure-seeking and pain avoidance is the driving force behind the cycle of addiction. Users may go through stints of trying to get clean but find themselves entirely unable to kick the habit on their own. And thus, the cycle continues.

But it doesn’t have to be this way forever. And with the right kind of professional help and expertise, anyone can break free from their addiction and finally stop the cycle of abuse.

And the very first step is asking for help.

Ashwood Recovery

Break Free with Ashwood Recovery

Here, at Ashwood Recovery, we know that kicking any addiction takes support, expertise, and guidance along the way. And we also know that asking for help isn’t anything to be ashamed of. Instead, it signifies just how committed you are to getting back on the road to sobriety and breaking free from the shackles of addiction.

Our outpatient and intensive outpatient programs (IOPs) are designed specifically to give you the individualized treatment you need to heal, learn new methods of coping with withdrawals and cravings, and help you maintain your sobriety for the long haul.

So, if you or someone you love is struggling with a gabapentin abuse problem, it’s important to remember that addiction isn’t permanent; it isn’t invincible; it isn't something you're powerless against.

Sobriety is possible. And we can help. Call us today to start your recovery.

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