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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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  • Such a thin skin, Jim !!

    I guess everyone needs someone to feel better than.

    For some that’s “junkies,” if only because there is no one ‘lower.’

    If I have insulted the Ignorant, by pointing out that they don’t know things that they really ought to know … or the Vicious, by pointing out the this blame-the-victim approach to the disease of addiction has been a big part of the problem problem, at least since the Harrison Act of 1914 — 1) that’s NOT “everyone here” … and 2) I’m not in the least sorry.

    MY G.P. (under the NY “I-Stop program”)now wants me to pee in the cup and meet with a physician once a month in order to receive prescription for a Schedule 4 non-narcotic, every other month. Inconvenience and humiliation aside … that $187 (the taxpayers pay $120) for the visit and $20 for the test, for which the taxpayers pay ALL — twelve times a year.

    Do the math! Then calculate how many people in a state of nineteen million people, are taking sleep aids, anti-anxiety drugs, (and at least one anti-nausia drug) which are “scheduled.” Pretty soon, “we’re talking REAL money!”

    Then … do the research and inform yourself how, why and by whom drugs are “Scheduled.”

    • Hi, Adam. I’ve been taking opioids for a wrecked back for the last 8 years, and not once has any doctor required me to pee in a cup. I know a guy who used to live across the street from me who was a true addict. Meth rotted out all his teeth. He has a wrecked back too, but he can’t manage his opioid use responsibly. If he has it, he takes it, and supplements it with more drugs off the street. He’s told me he gets asked to pee in a cup all the time. Maybe there’s something about you that puts you in that same category… ya think? That’s MY main issue with junkies. I don’t give a rat’s ass if junkies overdose on something, when they don’t give a rat’s ass either. I only care about the fact it screws things up for the rest of us who aren’t just looking to spend their whole life getting high.

  • As far as junkies go they have been doing that for a long time, taking too much and overdosing , dying. NOW something else is going on; someone (US?) is putting fentanly in the heroin that junkies buy. 1 grain of it will knock down an elephant & people are unknowingly shooting this up. And I am chronic pain patient but observe that a drug dealer does not want to kill off his clients. But, for population control & giving out benefits to the people who abuse or are addicted; well isn’t that the best interest into this new heartless ‘democracy” yea right try oligarchy. Things seem to be swinging around towards those with true pain that do not abuse; they are being political about Gababentin; as I have Fibro (& C6 Cf herniation so I Still need the opioid based stuff) and it works; I can now sleep with feet under covers not hanging off side of bed the touch of sheets kept me sleepless. However big pharma has politics in their pockets so we can only try to vote the a’ holes out of office or move to a better land.

    • Hi Jim …

      “Maybe there’s something about you that puts you in that same category” ?

      Really?

      Would that be the same category as “Junkies,” Jim, you’re imagining that there must be something wrong with me to trigger a higher level of surveillance ?

      Why bless your heart! Of course you would think that, because finger pointing and victim-blaming are kind of your thing, aren’t they ?

      But as it happens: “no” … no arrests, no bad urine tests, not so much as a traffic ticket in the past 30 years — and I’ve been taking the same medications at the same dosages for the past 10 years or so. But y’know “Policy”. Partially state law. Partially insurance underwriter’s requirements . Partially how the Practice’s office manager chooses to interpret the other two. (And it does fill up the appointment book with easy consults, don’t it?)

      New York State has had the “I-Stop” program since 2013. Urine testing for the renewal of “scheduled” medications has been SOP for everyone for the last 4. What is NEW is the “meet with a physician monthly” requirement.

      Meanwhile … each year there are more recorded “opioid overdoses” than the year before. So obviously the stricter surveillance program is selling drug test kits and doctors’ office visits … but isn’t doing much of anything about “curbing the epidemic.” But the good news is that many localities are finding the funding to equip police and first responders with Narcan nasal spray

      I just wanted to mention: … your understanding of addiction and addict psychology is something right out of Dr. Harry J. (Reefer Madness) Anslinger’s 1931 playbook. (You should Google him sometime.) But, in brief: no data, no compassion, much opinion: so unhelpful!

    • Unless you mean “and now they’re coming for the chronic pain patients” … I wouldn’t say that “things” aren’t swinging around towards “those who do not abuse.” Rather … there’s a strong groundswell to re-defined the Standard of Care, so that what used to be “relief” will now be defined as Abuse. (And when I look at my probable medical future, that scares the bayjaysus out of me.)

      Nor does it help matters that mainstream media, and police P.R. persons, like to speak of “Pills” and “Street Drugs” interchangeably and together. “The Story” is that ALL heroin addicts started as pain medication users. “If there were no Oxycontin there’s be no heroin use”. The only thing wrong with that construction is: long before there was “Oxy” , people were abusing ‘injectables’.

      Now … “who is to blame” for the fentanyl component of the Opioid Pain Pill Epidemic ? Well, the surgeons wanted a strong, fast acting sedative with a super-short half life. So … “damn doctors, again”! But how the drug got from the operating theater to the streets is another story.

      The laws and regulating the importation of narcotics for medical use are very very precise about which molecules are forbidden … but less exact about chemically similar substances. In practice, this means that a criminal importing heroin made from opium faces draconian punishments, but importing the SYNTHETIC fentanyl (which is ‘an opioid’ but not made from actual opium) is a somewhat lesser charge … and chemo-similar substances (until distributed to addicts) may not be illegal at all.

      Then, there’s the “elephant tranquilizer” CARfentanyl. It’s about 1000 times more powerful than morphine. It too is used as an additive in street heroin. Both these substances are easier to smuggle than heroin and cocaine … because for a given dollar value, the stronger drugs take up less space in whatever is being used to transport them.

      No, it used to be that drug pushers “cut” their heroin with more or less inert substances … milk sugar and quinine powder being two old standards. The powerful synthetics allow them to mix a nearly heroin-free substance that addicts will accept. But getting the proportions just right is not a kitchen-table operation, by a long shot … and the illegal laboratories don’t do quality control very well — so “overdoses.”

      Now there ARE test kits that allow a layperson to detect fentanyl in their heroin. But some social workers have reported that a significant subgroup of addicts are actually ATTRACTED to notoriously dangerous ‘brands’ of already-dangerous drugs. “Death Wish?” It’s not like there’s a lot of research into addict psychology, as such. Those in the Helping Industry like the 12-Step stories they make up for themselves too much to want to probe the thoughts and lifestyles of “clients” very thoroughly.

      So … we’re not at all sure about the “who, how, why” of the Overdose Epidemic.

      But this much is obvious … in the last 87 years ” legislating and incarcerating ” has only served to make narcotics trafficking more profitable, better organized, and more violent, while simultaneously making the drugs themselves more potent, more available and more dangerous.

  • Not every one abuses their medications. Why do you want to take away a medication that is needed? Scroliosis, arthritis, torn L4-L5 All down my back from neck to the sciatic nerve damage as well as severely compressed nerve canals down both legs into feet. Also, a crushed elbow that had to be rebuilt and a year later the hardware was removed. The pain is only controlled with my percocet. Why would you subject someone to that kind of life? The quality of life will be gone. All because you want control over the medication? I have been on these medications for at least 18 years. And now you want to take it away??? That shows how uncaring the people are who want to take them away. What do you plan on for a alternative? Shots don’t work, ablation of the nerves only last 2 years and it has to be done again. This is not right, it is totally immoral to make people suffer day in and day out BECAUSE YOU DON’T CARE. I fell on a frozen concrete floor, this is the beginning. The company Pilgrim’s Pride payed off doctors to say that it is all in my head.
    Well, no it is not, it’s very real and very difficult to lead a normal productive life. I am sure if you needed this you would have it. So tell me what do you plan on doing for the pain??? Aspirin and heating pads are a joke for the pain I have

  • I would think the actual REAL problem is the government sticking it’s nose where is doesn’t belong. Show me ONE place in the Constitution where is says this government is supposed to be a NANNY STATE and hold our hands constantly.
    BACK OFF and LEAVE US ALONE. WE ARE ADULTS!

  • Thanks for abusing this now. I cant tqke narcotics because of the addicts that ruined it for us. I am now trying neurontin because of it and now they are abusing this. I am sick of drug addicts ruining it for people with pain that take their meds as prescibed and dont abuse them nor get high. Thanks for ruining it for people who need to treat pain.

    • The real problem is the Government failing to make any attempt to draw a distinction between drug-abusing addicts, and bonafide patients with chronic pain problems. There will always be addicts chasing after some way… ANY way to get high. History shows that there is no way to prevent a certain element of society who is determined to live this way. It’s sheer laziness and stupidity to lump us in with the drug abusers. This is why doctors should be able to practice their profession without interference from politicians who don’t understand the problem and aren’t interested in anything other than banning drugs for everyone and locking people up. It’s so much easier than actually putting any thought or effort into addressing the real issues.

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