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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 have been taking gabapentin for about 2 yrs for leg and hand pain..i dont abuse them only take 1 or 2 a day..i tried going without but the pain got so bad…I hope ill be alright..

  • What won’t they find addicting? Anyone with an additive personality will find a way to get high. I was prescribed in hospital for anxiety or the cause I learned I had was was from digestive issues.i. e. ( gastritis, acid in stomach severe. ). I didn’t notice any help with symptoms like, shaking in legs, itching and I read what NOT to take it with ( acid medication for stomach and digestive system problems. So I stopped at home. It was supposed to be 3 a day. Oh and also allergy meds. Confusing huh? No difference in nerve pain. It’s parked away with seroquil.

  • I’ve taken gabapentin for years. I had severe sciatic pain. I went to neurologist. Tried a few things, regular doctor before was giving me muscle relaxers & pain meds, couldn’t work or function. He put me on neurontin ( gabapentin), started out taking high dose, went Dow as pain stopped. Now I am prescribed 3 600 mg a day and just take 1 each day. I would think if it was addictive I would take all, sometimes if lower back hurts especially bad I take one but not on regular basis. So, I never feel like ending my life, just thankful this helped my sciatic pain, it was bad and really don’t want surgery.

    • I’m glad it works so well for you, Vicki. I have chronic major lower back pain, and Gabapentin has never helped. I wish it did, because it would certainly simplify matters over taken Oxycodone. I’m always scared somebody who’s never had to live through what I experience every day, is going to take away my meds. If that happened, I really would have to reason to stick around and suffer every day. It’s hard enough as it is. I’m seventy years old and still have to work for a living. Oxycodone makes the pain at least bearable. Take that away, and I might as well check out. I’m not going to live a whole lot longer anyway.

  • I have taken neurontin for nerve pain for years. I take 600mg up to 3x a day. It works quite well and never have I found it sedating or to have a “speed” affect. I took mega doses of Oxycontin and hydrocodone for years. I had enough and went off them about a year ago. Neurontin beats being addicted to opiaoids. I’m guessing if people are taking abusive doses they might get high, but in my experience never has that happened.

  • Such hogwash! If Gabapentin does make for a better high taken with other drugs, good for it! Abusing drugs may be stupid, but more stupid is branding as dangerous drugs that work to relieve people from their pains and other conditions regardless of any accompanying euphoria. (And what’s wrong with euphoria anyway?)

    I have RLS–restless leg syndrome–which unchecked keeps me awake all night, stops me from enjoying a movie in a theater, or a plane ride. (All right, I know there is nothing enjoyable about a plane ride these days with or without drugs, but untreated RLS makes it far worse, particularly in the cheap seats.) Before I started using Gabapentin, I seriously considered having my legs amputated if that would have relieved the restlessness. Doctors and pharmacologists should consider all the information about a drug before pushing the panic button.

    • Ron, you are so right. RLS is more like torture, is torture, when you get no rest. I have always said I will spill the beans, hand over my SSN, bank numbers, admit to anything, just keep me awake past 18-24 hrs!!! There is no enjoyment of life when you are never refreshed with sleep. And I agree, what is wrong with euphoria? I believe that is the point of alcohol. With all the current bad news on acetaminophen (Tylenol) and how it causes long term abuse of organs there are few, ‘safe’ alternatives to offer. NSAIDs kill off your kidneys, and putting 500 mg of Tylenol with some Vicodin, or oxycodone, and prescribing equivalent of 2,000 to 4,000 mg a day is now revealed to cause harm. Then the limit of Tylenol was set to 2,000 mg a day, now even 1,000 may be too much, and worse. So the “national paranoia” over helpful opiod pain meds for chronic pain is taking away any possible aid to patients living any quality of life. Just because people are stealing and mixing drugs..THAT is the ‘opiod’ crisis not the dose that allows people to have a life. Add in Gabapentin, which has some drawbacks of raising blood sugar, and slowing weight loss, but at least does what it is supposed to do for RLS and similar issues.

  • There’s this drug I heard about called Tylenol. It’s just like this, but worse! You can get Tylenol at Target. In large doses, Tylenol can reduce pain — just like Gabapentin! And since Gabapentin isn’t a controlled substance, it is easily available. Oh heavenly days!

    • Tylenol is the worst part of Percocet IMO. It damages the liver. The oxycodone part just makes my back quit hurting. I’m glad they lowered the acetaminophen from 500 mg to 325. Anybody who wants to further poison their liver can buy extra Tylenol over the counter.

  • @ Jim

    I’ve got a few extra bottles, too. I kind of wish the stuff DID get one high because then, I might be able to make some money off it.

  • This is ludicrous! Gabepentin to get high? Surely you jest. This crap barely eases the pain from nerve damage. I can’t imagine expecting a high from it.

    • You’re right, Lisa. I will admit that I did experience a slight amount of euphoria the first three days I took it, after that, it did nothing. What was strange, is I tried it again a year or two later, and it did nothing right from the start. Since that initial 3-day period, Gaba has never helped my pain or had any other noticeable effect on me. I’ve got a few bottles of it around the house, but I don’t even bother taking it anymore. Too bad the Government can’t simply ban chronic pain, but that would work about as well as their ban on anything that might make any of us feel normal and functional again. Let’s just lock everyone up, because that works so well…

    • You got that right about the nerve pain..i srill have it but not as bad as when i stopped taking gabapenrin

  • I tried Kratom over a year ago, and it might as well have been parsley. It did nothing, although I hear my State has now decided to ban it, which doesn’t surprise me. If you could get high eating carrots, they’d ban them too.

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