Gabapentin is not a federally controlled substance, and for years it was regarded as non-addictive [2]. That view has changed. Misuse and dependence are documented, and concern has grown alongside prescribing [2]. It also carries a specific danger when taken alongside opioids [1].
Maybe you have found pills that are not accounted for. Maybe you are worried about your own use. This page explains what gabapentin is, what misuse looks like, and what treatment involves. It will not tell you what to do about your own medication. That conversation belongs with a clinician who knows your history.
What Gabapentin Is and Why It Is Prescribed
Gabapentin is an anticonvulsant. It was built for seizures. It is now prescribed far more widely than that. CDC reports that in 2019, 69 million gabapentin prescriptions were dispensed in the United States, making it the seventh most commonly prescribed medication nationally [6]. Its approved uses include nerve pain that follows shingles, plus add-on therapy for partial seizures. A related form, gabapentin enacarbil, is approved for restless legs syndrome [2].
Beyond those approvals, doctors use it off-label for a long list of conditions. The list includes fibromyalgia, anxiety, mood disorders, irritable bowel syndrome and alcohol withdrawal [2]. Off-label prescribing is legal and often sensible. It also means many people hold a prescription for a medicine never studied for the reason they take it.
Scheduling is where gabapentin differs from most drugs on this site. Federal law does not treat it as a controlled substance [2]. Several states have separately moved gabapentin into their own Schedule V category [2]. The rules therefore depend on where you live. A prescription drug that is lightly regulated in one state may be a controlled substance in the next.
Is Gabapentin Addictive?
The honest answer is that it is more complicated than yes or no.
Two different things get called addiction. Physical dependence means the body has adapted to a medicine. Stopping it then produces symptoms. That happens with many prescribed drugs. It does not mean anything has gone wrong. A substance use disorder is different. It describes a pattern of use a person struggles to control, and that keeps going despite harm.
Gabapentin can produce both. Misuse and dependence are documented in the medical literature, and concern has grown as prescribing has grown [2]. The risk is also not spread evenly. Reference summaries of the misuse literature describe the great majority of people misusing gabapentin as current or former users of opioids or sedatives [5]. Someone taking gabapentin for shingles pain, with no such history, is in a very different position from someone taking it in recovery from an opioid use disorder.
That difference matters at home. Finding a gabapentin prescription in a relative’s cabinet is not evidence of anything. Running out early, filling from more than one prescriber, or using it long after the pain resolved is a different signal.
Why Gabapentin Is Misused
Two features explain most of it.
The first is what it does alongside other drugs. Gabapentin can intensify the euphoria produced by opioids. It can also blunt some withdrawal symptoms [2]. That is why it tends to appear with opioid use rather than on its own.
The second is detection. Gabapentin does not appear on a standard urine drug screen [2]. That matters clinically, because a negative screen does not rule it out, and a prescriber or treatment team may have no signal that it is in the picture at all.
None of this makes gabapentin a harmless stand-in for anything. It makes it a drug whose risks are easy to miss, both for the person taking it and for the people around them. Because it turns up alongside opioids, the breathing risk set out in the next section is the one to know about before anything else.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
Treatment for gabapentin and polysubstance use
Gabapentin misuse rarely happens on its own, and treating it alone rarely holds. The Recovery Village Columbus in Groveport, Ohio publishes medical detox, residential inpatient rehab, a partial hospitalization program, an intensive outpatient program, aftercare planning and inpatient mental health care on its own page, so the full picture can be assessed in one place.
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The Recovery Village Columbus is part of our family of treatment centers. See the Recovery Village Columbus campus.
The Risk When Gabapentin Is Combined With Opioids
This is the part of the page that matters most.
In December 2019 the US Food and Drug Administration warned that serious breathing difficulties may occur in people taking gabapentin or pregabalin [1]. The agency named when this happens. One trigger is the use of opioid pain medicines and other drugs that depress the central nervous system [1]. Another is a condition that reduces lung function, such as chronic obstructive pulmonary disease [1]. Older adults were also named as being at higher risk [1]. The FDA told manufacturers to add new warnings about respiratory depression to the prescribing information [1].
The symptoms the agency listed are worth knowing by sight. They are confusion, unusual dizziness, extreme sleepiness, slowed or shallow breathing, unresponsiveness, and skin that looks blue or tinted around the lips, fingers or toes [1].
How often the two turn up together has been counted, in one federal dataset covering 23 states and the District of Columbia between 2019 and 2020. Among 58,362 deaths with documented toxicology results, 5,687 (9.7%) had gabapentin detected on postmortem toxicology, and gabapentin-involved deaths occurred in 2,975 of those 5,687 decedents (52.3%) with a positive gabapentin test result [6]. The percentage of deaths with gabapentin detected that were opioid-involved remained consistently high, ranging from 85% to 90% [6]. Those are not national figures, and they describe the two years the study covered.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
One point is often missed. Naloxone only reverses an overdose in people who have opioids in their system [3]. It is not a general antidote, and it does nothing for a drug that is not an opioid [3]. Federal guidance is direct about what follows from that: call 911 immediately in the event of an overdose [3].
Signs That Gabapentin Use Has Become a Problem
There is no test a family member can apply at the kitchen table. There are only patterns worth noticing.
Behavior usually shifts first. A prescription runs out well before the refill date. Prescriptions arrive from more than one clinician. Use carries on long after the condition it was written for has settled. Someone gets guarded about this one medicine, in a way they are not about anything else in the cabinet.
Physical signs are vaguer and easier to misread. They include drowsiness, unsteadiness, slurred speech, memory trouble and a flattened mood. Each of these can have other causes, including the condition being treated.
None of it is a diagnosis. Treating it as one tends to end a conversation rather than start it. A pattern is a reason to call the prescriber, or to set up an assessment. It is not proof of a substance use disorder, and it is not proof that opioids are involved either. The people best placed to judge that are the ones who can ask follow-up questions.
Gabapentin Withdrawal
Withdrawal after sustained gabapentin use is documented. This is also where the pull to give advice is strongest, and most dangerous.
Here is what can be said plainly. Stopping an anticonvulsant abruptly carries real risk. Guidance on this class of medicine describes gradual tapering, specifically to avoid withdrawal-related seizures or prolonged seizure activity [2]. That is a medical process. It is planned by a prescriber who knows the person’s history and everything else they take.
This page will not give a schedule, an amount or a timeline. Those depend on the person. A number read online is worse than no number at all.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988.
Where withdrawal management is clinically indicated, it happens under supervision. Medical detox means monitoring, symptom relief, and a clinician who can act if something changes. It is also where other substances come into view, because gabapentin is rarely the only thing involved. The same holds for benzodiazepines, another class where stopping without support carries risk.
How Treatment for Gabapentin Misuse Works
Treatment begins with an assessment, not a program. The assessment establishes what is being used, in what pattern, and for how long. It also asks what else is going on, in body and in mind.
That last part is not a formality. Gabapentin is often prescribed for chronic pain or anxiety. It is often misused alongside opioids. Treat one and leave the rest alone, and the original driver is still there. Federal guidance is that where a person has a substance use disorder alongside another health condition, it is usually better to treat both at the same time rather than separately [4]. That is what a program addressing the co-occurring condition is for.
A recommendation follows from the assessment. Medical withdrawal management, where it is needed. Residential care, where someone needs distance and round-the-clock support. A partial hospitalization program or intensive outpatient care, where clinical hours are long but the person sleeps at home. Or standard outpatient treatment, where sessions fit around work and family.
Levels of care are not a ladder everyone climbs. They are options matched to a person’s situation, and the match is a clinical judgment rather than a self-assessment.
Talking to a Prescriber or Starting Treatment
If gabapentin was prescribed to you, the prescriber is the right first call. That talk is easier than most people expect. Clinicians would far rather hear that a medicine is not working as intended than find out later.
Bring the full list of everything being taken, including anything not prescribed. The risk the FDA warned about depends on the whole picture, not on gabapentin alone [1].
If there is no prescriber to go back to, an assessment can be booked directly. A first call covers what is being used, what has been tried before, what insurance covers, and what level of care fits. Medication-assisted treatment may be part of the plan where opioids are also involved.
The Substance Abuse and Mental Health Services Administration also runs a national helpline, and findtreatment.gov is its treatment locator if you would rather search than call. If someone is struggling right now, call or text 988. If breathing is affected, call 911.
Frequently Asked Questions
Is gabapentin a controlled substance? Not under federal law. Gabapentin is not federally scheduled. Several states have separately moved it to their own Schedule V category, so the rules depend on where the prescription is written and filled. Federal status is not the same as a clean bill of health, and the misuse literature has grown considerably.
Can you become dependent on gabapentin? Yes, physical dependence can develop with sustained use, and misuse and dependence are both documented. Dependence is not the same as a substance use disorder. The first means the body has adapted; the second describes a pattern of use a person cannot control that continues despite harm. A clinician can tell the difference; a website cannot.
Why is gabapentin dangerous with opioids? The FDA warned in 2019 that serious breathing difficulties may occur in people taking gabapentin or pregabalin, and named opioid pain medicines and other central nervous system depressants among the risk factors. Reduced lung function and older age raise the risk further. Naloxone only reverses an overdose in someone who has opioids in their system, so emergency care is still needed: call 911.
What are the signs of gabapentin misuse? The clearest signals are behavioral: running out before a refill is due, obtaining prescriptions from more than one clinician, and continuing use long after the original condition resolved. Drowsiness, unsteadiness, slurred speech and memory problems can accompany these, but each has other explanations. A pattern is a reason to seek an assessment, not a diagnosis in itself.
Is gabapentin withdrawal dangerous? It can be. Guidance for anticonvulsants describes gradual tapering under medical supervision specifically to reduce the risk of withdrawal-related seizures or prolonged seizure activity. If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental health crisis, call or text 988. That is why stopping is planned with a prescriber rather than attempted alone, and why supervised withdrawal management exists as part of inpatient treatment.
What does treatment for gabapentin misuse involve? It starts with an assessment of everything being used and any co-occurring physical or mental health conditions. Where a substance use disorder sits alongside another health condition, federal guidance is that treating both together usually works better than treating them separately. Depending on what the assessment finds, care may include medically supervised withdrawal management, residential treatment, a partial hospitalization program, intensive outpatient care or standard outpatient therapy.
Sources
- US Food and Drug Administration. (2019, December 19). Neurontin, Gralise, Horizant (gabapentin) and Lyrica, Lyrica CR (pregabalin): Drug Safety Communication — Serious Breathing Problems. https://www.fda.gov/safety/medical-product-safety-information/neurontin-gralise-horizant-gabapentin-and-lyrica-lyrica-cr-pregabalin-drug-safety-communication
- Yasaei, R., Katta, S., Patel, P., & Saadabadi, A. Gabapentin. StatPearls, National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK493228/
- National Institute on Drug Abuse. Naloxone DrugFacts. https://nida.nih.gov/publications/drugfacts/naloxone
- National Institute on Drug Abuse. Treatment. https://nida.nih.gov/research-topics/treatment
- Wikipedia. Gabapentin. https://en.wikipedia.org/wiki/Gabapentin
- Centers for Disease Control and Prevention. (2022, May 13). Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019-2020. MMWR Morbidity and Mortality Weekly Report, 71(19), 664-666. https://www.cdc.gov/mmwr/volumes/71/wr/mm7119a3.htm
This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
