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THENS, Ohio — On April 5, Ciera Smith sat in a car parked on the gravel driveway of the Rural Women’s Recovery Program here with a choice to make: go to jail or enter treatment for her addiction.

Smith, 22, started abusing drugs when she was 18, enticed by the “good time” she and her friends found in smoking marijuana. She later turned to addictive painkillers, then anti-anxiety medications such as Xanax and eventually Suboxone, a narcotic often used to replace opioids when treating addiction.

Before stepping out of the car, she decided she needed one more high before treatment. She reached into her purse and then swallowed a handful of gabapentin pills.

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Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state.

And it’s not just in Ohio. Gabapentin’s ability to tackle multiple ailments has helped make it one of the most popular medications in the U.S. In May, it was the fifth-most prescribed drug in the nation, according to GoodRx.

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Gabapentin is approved by the Food and Drug Administration to treat epilepsy and pain related to nerve damage, called neuropathy. Also known by its brand name, Neurontin, the drug acts as a sedative. It is widely considered non-addictive and touted by the federal Centers for Disease Control and Prevention as an alternative intervention to opiates for chronic pain. Generally, doctors prescribe no more than 1,800 to 2,400 milligrams of gabapentin per day, according to information on the Mayo Clinic’s website.

Gabapentin does not carry the same risk of lethal overdoses as opioids, but drug experts say the effects of using gabapentin for long periods of time or in very high quantities, particularly among sensitive populations like pregnant women, are not well-known.

Athens, home to Ohio University, lies in the southeastern corner of the state, which has been ravaged by the opioid epidemic. Despite experience in combating illicit drug use, law enforcement officials and drug counselors say the addition of gabapentin adds a new obstacle. As providers dole out the drug in mass quantities for conditions such as restless legs syndrome and alcoholism, it is being subverted to a drug of abuse. Gabapentin can enhance the euphoria caused by an opioid and stave off drug withdrawals. In addition, it can bypass the blocking effects of medications used for addiction treatment, enabling patients to get high while in recovery.

“I don’t know if we have a clear picture of the risk,” said Joe Gay, executive director of Health Recovery Services, a network of substance abuse recovery centers headquartered in Athens.

Gabacount
Rachel Quivey works as a pharmacist for a branch of Fruth Pharmacy, located in a strip mall beside a Dollar General in Athens, Ohio. She noticed clients were misusing gabapentin when they began picking up prescriptions early. Carmen Heredia Rodriguez/KHN

‘Available To Be Abused’

A literature review published in 2016 in the journal Addiction found about a fifth of those who abuse opiates misuse gabapentin. A separate 2015 study of adults in Appalachian Kentucky who abused opiates found 15 percent of participants also misused gabapentin in the past six months “to get high.”

In the same year, the drug was involved in 109 overdose deaths in West Virginia, the Charleston Gazette-Mail reported.

Rachel Quivey, an Athens pharmacist, said she noticed signs of gabapentin misuse half a decade ago when patients began picking up the drug several days before their prescription ran out.

“Gabapentin is so readily available,” she said. “That, in my opinion, is where a lot of that danger is. It’s available to be abused.”

In May, Quivey’s pharmacy filled roughly 33 prescriptions of gabapentin per week, dispensing 90 to 120 pills for each client. For customers who arrive with scripts demanding a high dosage of the drug, Quivey sometimes calls the doctor to discuss her concerns. But many of them aren’t aware of gabapentin misuse, she said.

Even as gabapentin gets restocked regularly on Quivey’s shelves, the drug’s presence is increasing on the streets of Athens. A 300-milligram pill sells for as little as 75 cents. Yet, according to Chuck Haegele, field supervisor for the Major Crimes Unit at the Athens City Police Department, law enforcement can do little to stop its spread. That’s because gabapentin is not categorized as a controlled substance. That designation places restrictions on who can possess and dispense the drug.

“There’s really not much we can do at this point,” he said. “If it’s not controlled … it’s not illegal for somebody that’s not prescribed it to possess it.”

Haegele said he heard about the drug less than three months ago when an officer accidentally received a text message from someone offering to sell it. The police force, he said, is still trying to assess the threat of gabapentin.

Gabacount
Quivey’s staff takes a photograph of every gabapentin prescription they dispense to keep a record of the number of pills they distribute to each client. They must report every gabapentin prescription they fill to the state drug-monitoring program. Carmen Heredia Rodriguez/KHN

Little Testing

Nearly anyone arrested and found to struggle with addiction in Athens is given the option to go through a drug court program to get treatment. But officials said that some exploit the absence of routine exams for gabapentin to get high while testing clean.

Brice Johnson, a probation officer at Athens County Municipal Court, said participants in the municipal court’s Substance Abuse Mentally Ill Program undergo gabapentin testing only when abuse is suspected. Screenings are not regularly done on every client because abuse has not been a concern and the testing adds expense, he said.

The rehab program run through the county prosecutor’s office, called Fresh Start, does test for gabapentin. Its latest round of screenings detected the drug in five of its roughly 238 active participants, prosecutor Keller Blackburn said.

Linda Holley, a clinical supervisor at an Athens outpatient program run by the Health Recovery Services, said she suspects at least half of her clients on Suboxone treatment abuse gabapentin. But the center can’t afford to regularly test every participant. Holley said she sees clients who are prescribed gabapentin but, due to health privacy laws, she can’t share their status as a person in recovery to an outside provider without written consent. The restrictions give clients in recovery an opportunity to get high using drugs they legally obtained and still pass a drug test.

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“With the gabapentin, I wish there were more we could do, but our hands are tied,” she said. “We can’t do anything but educate the client and discourage” them from using such medications.

Smith visited two separate doctors to secure a prescription. As she rotated through drug court, Narcotics Anonymous meetings, jail for relapsing on cocaine and house arrest enforced with an ankle bracelet, she said her gabapentin abuse wasn’t detected until she arrived at the residential recovery center.

Today, Smith sticks to the recovery process. Expecting a baby in early July, her successful completion of the program not only means sobriety but the opportunity to restore custody of her eldest daughter and raise her children.

She intends to relocate her family away from friends and routines that helped lead her to addiction and said she will help guide her daughter away from making similar mistakes.

“All I can do is be there and give her the knowledge that I can about addiction,” Smith said, “and hope that she chooses to go on the right path.”

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  • I’ve been on 900 mg per day for years for sciatic pain and never got a high from it. Without it, I can’t sleep for the pain. I can’t imagine it would be classified as a narcotic or restricted to me.

  • This whole alarmist article by STAT was written by someone who obviously knows very little about Gabapentin. I have several bottles of it sitting on the shelf, and I quit getting it because it does nothing for me. It doesn’t help my back pain, it doesn’t get me “high”. IMO, it’s about as dangerous as Flintstones gummy bear vitamins. Just another BS article to cash in on the whole “opioid epidemic” dialogue by mentioning a benign substance that isn’t even an opiate. I’m sick of reading articles like this that contribute nothing useful, but drag other people into the whole “opioid” controversy. I’m seventy years old, my back is ruined, I hurt every day, and yes, I take “opioids,” and have been doing so for eight years with no problems because I take them as prescribed, and I’m not trying to get “high”… just survive. I’ve contributed frequently to this discussion, but today I’m unsubscribing, because all the talk in the world isn’t going to stop the ignorance being spouted by STAT or all the other alarmists out there who aren’t living with chronic, relentlessness pain every day, and would rather put us in the same category as the junkies who just want to abuse anything they can get their hands on that might make them high. Talking about it here isn’t going to change my pain or some other people’s unfounded ignorance about the topic.

  • I have been taking gabapentin for almost 2 years after getting treatment for alcohol dependency and anxiety. I have not had a drink since. But, more importantly, have never felt any addictive tendencies for this medication. Nor has it brought about euphoria. I am prescribed 600 mg three times a day. If anything I skip my afternoon dose. I am able to adjust my dose if felt needed to 900 mg once a day if needed and rarely have. Wondering if some are being to assuming about the medication and it’s effects. It has also helped with persistent generalized pain as an added bonus.

  • Wow..scary… that came out of a pharmacist’s mouth?Gabapentin has no activity at GABAA or GABAB receptors of GABA uptake carriers of brain. Gabapentin interacts with a high-affinity binding site in brain membranes, which has recently been identified as an auxiliary subunit of voltage-sensitive Ca2+ channels… I guess it binds to a different part of the brain than opiates but unfortunately this pharmacist doesn’t know that

  • So what is the alternative to Gabapentin???? What this article doesn’t discuss is that there are plenty of people prescribed this medication for very painful nerve disorders. Nerve pain is nothing like muscular pain. NSAIDs and muscle relaxers don’t work because that isnt the cause of the pain. I unfortunately found out about the abuse of this drug when I was embarrassingly treated like a drug fiend at my pharmacy. So what else?? I am not in a state that allows medical marijuana so what can I do to prevent nerve pain?? This article doesn’t cover that at all. Instead I guess I get to be treated like a common criminal just because I don’t want my legs to feel like lighting is going through them. I guess I just want to be high not seek relief from nerve pain.

  • I find it unfortunate that the author spoke to drug abuse specialists, pharmacists and law enforcement but no prescribing physicians? Perhaps as a result, there’s no mention that the precise reason many individuals are on gabapentin is because they and their physicians are trying to AVOID opioids. Unfortunately there just aren’t that many options to choose from to treat neuropathy and nerve pain. I pinched a nerve 2 years ago and was in excruciating pain for 3 weeks until a spine specialist put me on 1200 mg of gabapentin. It finally gave me relief and allowed me to avoid an invasive and expensive spinal injection. I did not get any sort of high, so the effects may be limited to those individuals who are already addicted to or weaning from narcotics. I also have a friend who has gone through 3 surgeries for her back condition and has been in chronic pain for the better part of a decade. Gabapentin allows her to minimize the narcotics she needs to take.

    STAT dedicates a lot of page time to the opioid crisis, which admittedly is a huge problem in this country. But I hope all that coverage isn’t compromising the objectivity in which it reports issues such as this. This article could have been just as interesting if it had been focused on the rise of gabapentin use and what’s driving it and not just positioning it as “the latest pain drug to be abused.” Maybe they’ll do a follow up that explores the former– I’d love to read it.

    • I was just put back on gabapebtin today for nerve damage. I had encephalitis that was not diagnosed for months, and brain surgery. I have nerve pain in a few areas including my head. That leaves me with a headache 24/7. The other major area is my hip. That had always been sporadic until recently. I was put on what I think is a pretty low dose and not sure if it will work. I happened across this article while researching it and side effects. I was familiar with it before, (I have been on so many different meds) but I never realized that it was abused. It has no “high” effect. It just goes to show you addicts will abuse anything and make it difficult for those who really need it.

  • I find this article extremely disturbing, especially for those of us who take Gabapentin for neuropathy issues. What makes me angry is that Gabapentin is not an opioid, but the article makes it seem as if it is and should be classed the same.

    Part of this article states that a majority of Gabapentin users misuse it and request more before their prescription is due for renewal. I was diagnosed in March of 2018 with trigeminal neuralgia. I started out on the lowest dose, and slowly increased until I found a level that keeps the pain manageable. Note that I stated manageable, because I still fell pain, but it isn’t debilitating. A misunderstanding occurred between my neurologist and his nurse to up the prescription, which caused issues at the pharmacy. Why does it seem weird that doctors need to tweak medications up or down? It happens all the time. I’m still on a fairly low dose.

    As for the “sedative” effect of Gabapentin, I think Nyquil is much more in the sedative category than Gabapentin.

    From my perspective, this is very dangerous reporting.

    • It’s inaccurate and sensationalized reporting, and this story doesn’t do anything but fuel the fire and make legitimate pain sufferers endure unnecessary anguish… at least those who actually derive some benefit from this drug. I’ve got Gabapentin sitting on the shelf, and I don’t even bother to take it anymore because it does nothing for my chronic back pain. It doesn’t get me “high,” and it’s not an opiate. Everything about this article is wrong and irresponsible reporting.

    • Christin, I find your comments to be dead on. The current slash and burn tactics used to combat the ‘Opioid Epidemic’ are instances of the pendulum swinging back far enough to break it. There are plenty enough ‘real’ opioids to track, assess, and limit now without adding gabapentinoids to the list, and anyone who says, “well, it’s better safe than sorry” should have to spend 24 hours with trigeminal neuralgia. They don’t call it “the suicide disease” for nothing. I say this as someone who has never had TN (and who is SO thankful for that!) but who honestly tries to walk in others’ shoes before deciding to summarily point a finger of blame at them any time a medical matter is at issue….either at someone specifically, or at a group – and most importantly, I always do my very best to realize that in any stigmatized group, there are always victims who are double suffering, if you will, first with their ailment and the strictures placed on their treatments, and then by being wrongly lumped in with ______________ (fill in with your pejorative term of choice of group here). You see, it’s extremely easy to cope with pain…as long as it’s someone else’s!! Oh, and let’s not forget your bonus prize, as if your knuckles aren’t white enough already – now, you get to worry that at any given time you may get your gabapentin prescription jerked away from you so fast it’ll make your head spin – but, it’ll be “for your own good” (yeah!).

      I wish you well, and I truly mean that.

  • I think it’s a damm shame when a person has had 4 strokes 2 back surgeries and soon will have to have another 1. We can’t not get no relief for the pain we are going through for the drug addicts and their dealers. We are the ones that suffer for their addictions. I never ask to be put on Gabapentin all i want is for something to relief the pain, until they can do surgery down the road. Another recent stroke has delayed my surgery for another 6 to 9 months.

    • I don’t know it was like that never bother me but made my feet and leg hurt and I jumped in my sleep just like someone use the shocker like for a heartache I stopped on my own my daughter seen it on tv and asked me to stop and I did. And no deep pain in my legs

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