ATHENS, 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.

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.

“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 was prescribed Gabapentin, as the doctor thought it would help my IBS symptoms, and have been taking 100 mg. twice a day since last October. It does help, but not significantly, and now I’m worried about coming off it – what side effects would I expect?

  • I am prescribed 3600mg of Gabapentin a day. I nearly lost half of my right hand in October 2016. Since being on the medication, I am no longer using heroin, meth or any other drug. I went through one of the country’s hardest drug court program. While gaba can be abused and it is, I see it as a true wonder-drug and has not only in my opinion helped me stay clean but it’s also kept me pain free. I also hear it was used to treat anxiety and depression when it first came out. I am a firm believer in the proper use of Gabapentin and will continue to take it for as long as I need it.

  • Okay, sorry…it just posted my comment before I was done writing.. But the short version is the random drug screens stopped me from using any chemicals that would show up on a standard 12 panel drug screens so that left gabapentin….and flexeril (a muscle relaxer). Some days when I was really desperate to get high, I would easily take 18,000 mg daily- but eventually, no matter how much you take- you’ll never reach a good euphoric effect once you develop a tolerance….then you can stop taking it for a month or two, and then reintroduce gabapentin to your system and boom….you get high again. The tolerance develops very quickly but also disappears quickly. Although I have abused Gabapentin (I would abuse tylenol if I could) Overall, gabapentin has helped me numerous times in the past- its great for nerve pain, depression, and anxiety. BUT, there are truly people out there that are totally dependent on this medication to survive. You shouldn’t just put a stop on this medication because it has a potential to be abused. My mother suffers with severe degenerative disc disease, spinal stenosis, severe bone spurring throughout her entire spine- she suffers with ringing, numbness, intense nerve pain…and this medication helps. She is prescribed 300 mg four times daily. Her doctor recently tried to increase the dose, but once the higher dose was administered, she had complaints of feeling “funny”, and developed a”drunk” type behavior. Her dose was then decreased immediately. So for the people that commented and said you cannot get high on gabapentin, that is totally false. I am a professional at getting high and being numb to the world around me- for example, I am in bed by 10 pm every night like clockwork. After taking 2100 mg, it is currently 4:33 am and I am in the kitchen dancing and eating ice cream out of the carton. I feel amazing- I am numb, fuzzy, a bit dizzy, blurry vision, irrational thoughts- I also experience INTENSE dreams and colors when I finally go to sleep. I abused JUST gabapentin for years and claimed to be “sober and clean” because I was not currently sticking a needle in my arm. Everyone is different. Some people may not be able to feel euphoric from gabapentin no matter the dosage but I would say a good percent of people just do not take enough to feel any high side effects, taking 300 mg a few times a day is a VERY small dose. My first script ever was for 900 mg four times daily and I did not yet feel any side effects…it wasnt until I got to a dosage of around 1200 mg at once…not per day…but 1200 mg in ONE setting. I have also talked to many people that believe the tablets (white oval tablets in doses of 400, 600, or 800) are way stronger than the tan 300 capsules. I personally feel if I take three 800 mg tablets, I feel way more “under the influence” than if I were to take eight 300 mg capsules. Big Pharma and the regulation groups are doing a TERRIBLE job at regulating controlled medications by the way. They are yanking them from the people that TRULY need them. The overdoses that are happening on the streets ARE NOT from prescription pain medication….it is from illicit street drugs (heroin, fentanyl). The pill epidemic ended years ago. In the past 3 years, I have lived in the top 3 cities for drug use/overdoses…I lived in the drug capitals of the United States and ran the streets for years…prescription pain medications are NOT the problem…pills are SO hard to find…and the prices of pills on the street are RIDICULOUS due to them being so scarce. A 10 mg Norco is $7-$8. Percocet 10 mg- $10 each. Morphine goes for a $1 a milligram. I can call at least 20 drug dealers RIGHT this very second and get endless amounts of heroin and fentanyl but cant find one damn Norco for my mother thats dying of pain and cant find a doctor to prescribe her pain medication due to the “extreme pill epidemic”….thats not even true. Wouldnt you rather addicts in your community take a PILL that was made in a lab and approved by the FDA….or would you rather your addict community buy an unknown powder, putting it in a spoon, pulling it up in a needle (rig) and shooting it in a vein…..in the alley behind your house…or at your local gas station parking lot. I personally would RATHER the U.S have a severe prescription pain medication problem than heroin/fentanyl. Wouldnt you? Because lets face it….theres no stopping the dealers and addicts…I mean, do strict gun laws decrease illegal gun use? NO. Did prohibition stop alcohol consumption in the United States? NO. Did originally making marijuana illegal help decrease THC use? NO. Giving a 60 year old woman with severe chronic pain a few norcos/perocet a month is not going to effect what’s going on in these streets…okay, its 4:55 in the morning and I am done venting and ranting about this issue. I hope at least one person reads this and gets something out of it. And a little comment to Ryan if he ever reads this, some of your comments were spot on. I agreed with most of them…except the part about comparing heroin to gabapentin, oh and gabapentin and lyrica. For one, gabapentin (street slang: nerds) and Lyrica are in the same classification. They both do indeed treat nerve pain, but they are definitely different medications. Personally, Lyrica gives me completely different side effects. Okay, and the heroin vs gabapentin issue. I know by your post you are truly struggling with addictive behavior and gabapentin users can experience withdrawal after prolonged abuse of gabapentin….but heroin, shes a beast. Unless you’ve truly struggled with a long term heroin addiction, its very hard to make an accurate assumption. Once you introduce the devil (heroin) into your veins, the journey will truly take you to the DEEPEST pits of hell and misery….at times, I would sit at the graves of my best friends…and be jealous that they were finally off the rollarcoaster of hell. Heroin takes your soul and marks it for the devil. Have you ever performed oral sex or had sex for a $5 hit of gabapentin? Probably not…but I have personally witnessed probably 60 different woman do anything and everything for a $5 hit of heroin or crack. And please dont take this as a diss, because its not meant to be. Addiction is hell no matter what substance is being abused. I just know personally, I was taking between 16,000-18,000 mg of gabapentin a day mixed with opiates and still maintained my life- worked full time as a nurse, husband, two children, and paid all my bills every month…but once I started using heroin and crack IV, my whole life came crashing down on me….fast and I could no longer function as a normal person in society..and now I attend a methadone clinic because my body and my brain have a hard time functioning with no opiates in my system. Id rather live and go to a methadone clinic everyday than to be in the trap house overdosed on heroin…and eventually found dead in a ditch. End of rant. Goodnight and be safe!

    • Hello nicole,

      thank you for sharing your story. Im personally struggling with alcoholism. I started drinking to deal with my anxiety. I have been diagnosed with major depressive disorder and general anxiety disorder. Im currently prescribed 600mg of gabapentin daily. I am in athens and would love to speak with you and get more insight from your. contact me at aa052414@ohio.edu and hopefully we can arrange something. thanks again for sharing your story.

    • That story is not at all believable. I have used Gabapentin on a few occasions and it never made me “high” and in the doses this person says they ingested, it would put you too sleep. The only “high” Gaba offers is cognate and indistinct from overdosing on Diphenhydramine… Gaba abusers have serious Psychological addictions…

  • This is my personal story and journey related to neurotonin (gabapentin) if any cares to read. A little background information: I am a 27 year old female, history of chronic asthma, tachycardia, heart murmurs, endometrial cancer led to total hysterectomy, and severe anxiety/depression resulting in a diagnosis of bipolar type 2. My life was completely on track despite severe untreated anxiety- I refused to throw medication at my issues at first due to a strong gene of addiction in my family history. I was 20 years old, married, two children, and a very successful career as a Registered Nurse. When I was diagnosed with cancer at 23 years old, I received a total hysterectomy and immediately developed a severe case of shingles 24 hours after my total hysterectomy. My body was in shock- I was 23 years old in menopause. It caused my already severe anxiety/depression to become unmanageable. I didnt want to live like that anymore. I couldnt go anywhere. My nights were either spent IN the hospital convinced I was dying or I was sleeping in my car in the hospital parking lot. I cant even describe how miserable my life became. I was prescribed norco/vicodin for pain related to shingles, Ativan for anxiety, Lexapro for depression/anxiety, and 900 mg of gabapentin 4 times daily. I became addicted to opiates, benzos, and gabapentin within a year. Gabapentin is described as a “potentiator”. This means that I could either take four opiate tablets (example: norco, Percocet, methadone) to feel relief and intense euphoria or I could take two opiates and a heavy dose of gabapentin and feel INTENSE euphoria. This is because gabapentin is a potentiator- it increases the “high” effects of opiates/benzos and makes them much stronger. So to state the obvious, I would take a bunch of gabapentin, wait for their peak time, and then shoot a half gram of heroin….this is what causes overdoses. That is why it states jt is related to 109 deaths. Lets say, not on gabapebtin, I can do a half gram shot of heroin and still function normally…but if I have a bunch of gabapentin active in my system, if I shot that same half gram shot, I would definitely overdose. If gabapentin is active in my system, I do half the heroin I would normally do so I don’t overdose. Now almost 6 years later, I have had a VERY hard road of heavy drug abuse- I am a recovering IV heroin addict. I have done EVERY drug available in the United States- and done all of them many many times. I feel I am quite educated in the addiction department due to my career in the medical field and a history of substance abuse. I am currently attending a methadone clinic daily- but today, I skipped my methadone dosing and took 2,100 mg of gabapentin 4 hours ago. I have not taken gabapentin in roughly a year. I am currently higher than a kite- feeling intense euphoria and hyperactive. I do currently have mild chest pain and noticable heart palpitations which is common when abusing gabapentin. Gabapentin abuse (in myself) also causes tachycardia/abnormal heartbeat, glossy eyes, abnormal pupil size, uncontrolled movements, hard to control motor functions (my fingers are struggling to hit the right keys on my phone), and I also have very jerky movements and dry mouth. These side effects I am describing have occured everytime I have abused gabapentin. The reason I abuse it is soley due to the potentiator affect and the euphoria. I never felt a euphoria/happiness feeling until I reached a dose of about 1200 at one time…but I have taken up to 8,000 mg at one time. The problem with gabapentin that I have personally experienced was your body develops a tolerance VERY quickly. I used to feel euphoria around 1200, then 3 days later…I had to take 1800 mg to get that same feeling…then it was 2400 mg. So what I used to do is get my script, eat them all within 3-5 days then buy them here and there on the street (they are cheap where I live- $0.50 for a 300 mg, $1.00 for an 800 mg. When the article described that it gives addictd the ability to stay high while having clean urine screens- I believe this to be true due to my personal history. While on probation, I was required to take random urine screens. My probation office uses a 12 panel drug screen with instant results on the front panel of the cup- this does not test for gabapentin BUT urine/blood can be sent to the lab and a gabapentin level can be discovered…but again, its a soeciak

    • Hello Nicole, I don’t have any reason to reply because…well, where would I start! While I have sympathy for your many struggles, I find your story to be most likely embellished? Seriously, you’re a nurse and the hospital had no idea what signs of abuse you were exhibiting? Patients under your care?!! Are your children still in your care because to sleep in your car and be out of the home…while you continued your soul destination to be “high” at all costs.
      And to believe you made these choices is even most disturbing. Your input on Gabapentin is a sorry excuse to draw attention as Queen of drug abuse, and I resent that..”bragging”…because it’s a sick indulgence. Nobody can tell you what you can ingest. But you made choices and sound happy with your lifestyle, even if it will be cut short in due time. PLEASE try to make a better future. I’m sad for your family. I’m sad for all of us who are trying to receive pain medication for disabilities that we can’t reverse. Refrain from joining conversations that your input is not relevant.

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