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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 think the people who abuse anything prescribed should b red flagged and not b able to get them prescribed anymore and just have to deal with it. WD servr them rite

    • Unfortunately, a big part of it is a political issue, rather than any real effort to separate people who have demonstrated a need, and the ability to manage their medication responsibility from people who can’t. I get the feeling that the majority of people just can’t resist the temptation to let themselves get carried away with something that makes them feel better.

      With an aging population, more and more people are going to have a legitimate need for pain medication at some point in their lives, so the pushback from this latest “War on Drugs” effort needs to be considered. Does it really make any sense to deny a person in their seventies relief from chronic pain because it “might” kill them? Statistically, we aren’t going to be around a whole lot longer anyway. Even if I thought that my responsible use of opioids would shorten my life by a couple of years (it won’t), why would I choose to live those extra few years in constant pain? That isn’t living as far as I’m concerned. That leaves two options: Become a junky and drastically jeopardize my health… maybe even die in prison, or commit suicide and just get it over with. I refuse to go back to living in pain again.

      As for those who insist on chasing that high and risking their own health, if they aren’t concerned about dying from an overdose, why should anyone else be concerned about them? People like that are always going to find some way to get high, regardless of the Government ‘s misguided attempts at social engineering. When will they figure that out?

    • Debra…. Why do you say that? I have tried and I can’t imagine why anyone would take such a draconian attitude toward people who are already in a horrible situation. Please tell me.

  • I’ve been on 2700 milg of gabapentin for almost 2 years now. I’ve got bad nerve damage in my back. And without that and my oxys I wouldn’t have any quality of life. Wish people would stop abusing these meds. Make it hard for people who really need them.

    • Any particular reason, Nick? Your comment isn’t the slightest bit helpful without an explanation. I’ve asked my doctor about it, and he says it’s safe. the only reason I don’t take it, is because it doesn’t work for me, but apparently it works for some people. Would you care to tell these people WHY you feel they should not take this medication… under any circumstances?

  • I am surprised that this article does NOT mention the fact that one of the side effects of Gabapentin can be suicidal ideation. I lost my husband to a combination of increased doses of Gabapentin and alcohol. So even if the Gabapentin does not kill by overdose, it can cause a person to take his own life.

    • Sharon, one of the biggest causes of suicidal ideation, is being in constant, unrelenting pain every minute of your life, and then have the quality of your life dictated by people who have been lucky enough NOT to have to experience that constant torture. They have no clue, and they don’t give a damn. I’m getting old anyway. Take away my pain medication and see how much longer I decide to stick around here in Paradise.

    • You aren’t supposed to drink alcohol while taking gabapentin first off. They prob do not mix well. And not to be insensitive in your loss but pretty sure doc didn’t prescribe your husband alcohol. People have to eventually take some responsibility. And Jim is spot on here and also what about people who are born with chronic pain. Drs prescribed gabapentin to my 7 yr old son cause he has cerbral palsy. He was born with it along with thousands of children daily. So people need to start thinking more wisely before they blame and speak. Btw I gave my son couple doses and realized it may be giving him headaches so stopped. I knew cause I’d been subscribed it fit fibromyalgia and chronic pain myself and at first it did give me headaches. He was young so more than likely, he could need it in future at some time since cerbral palsy isn’t going to go away, and he shouldn’t have hard time getting it or whatever he needs if so. People who really really need these meds are NOW having very hard time getting them due to drug addicts misusing them and overdosing.

  • Was on darvcet for breast cancer then she put me on tramadol. Then the opioid scare and now gabapentin!! Sooo tired soooo depressed never in my life have I been depressed!! Now cymbalta added to gabapentin!!! Why??? The Tramadol lifted my mood and killed my pain. But now she thinks these sideeffects are not from the last2 medications!!!! Sooo disgusted!!! Been with her for20 years.

    • I to take tramadol. My doctor fought me tooth and nail about not taking them. I told him without I would not be able to function at work. I’m in maintenance and have herniated disc. They help me make it through the day. Also my orthopedic dr. Put me on gabapentin. I stopped taking them because something is causing me to be tired all the time. Like passing out very easily. That was only for like 3 days then I saw my pain management Dr and he told me to get back on them. So what do you do?

  • I have to speak up for some of us who deal with nerve pain because I am a diabetic dealing with chronic never pain from diabetes….I have been taking gabapentin for over 15 years I do not experience the high effect… however it helps with my nerve pain to some degree…I also get hydrocodone for my topical pain issues…I can not afford my diabetic insulin at all so my nerve pain just keeps getting worse…my insurance only covers a small amount of my diabetic insulin….so the system charges sky rocket dollar amounts which leaves a person like me In a catch 22…my doctor can only give me limited quantity of insulin…so I said all that to say we all have to keep function as normal as we possible can…so guess what it is a cheaper method….for the ones of us who can’t afford our insulin….so if the law passes guess what …Lyrica….is what would be way more higher than gabapentin….the only people who would benifit is pharmacists….why do people feel like their studies are so accurate…. people abuse soda is it illegal…no…. people abuse fast food restaurant are they illegal…people abuse liquor have they banned liquor…answer is no…so someone please tell me what is wrong with that picture….I wouldn’t want anyone to have to feel my nerve pain it is passed a 12 and that is on a scale of 1-10….these test are determined by people who only take a small dose…this puts me in the mind of the fashion magazines promoting Lane Bryant clothes on a 0-10 size model.. really….

    • Sheila, DON’T ignore your insulin requirements! You can buy a vial of Novalin R for about $25 at Walmart, and you don’t even need a prescription (at least not in my State). Sav-On wants around $100 for that same vial of insulin… it’s crazy!

  • When someone is on probation or in any legal situation, they will find a way to get high on a prescription drug. Once being addicted to something called heroin, so I know a HIGH, not gloating; I did get high off of 4500mg or more gabapentin. When you’re in active addiction and need to beat a drug test you will find ways. I am not proud of or condoning my actions, I am simply trying to advise addicts that this drug can definitely become addicting if misused.

    • Jeez, Jessica! I have 600 mg Gabapentin tablets here, but I don’t take them because they don’t work. Are you telling me if I took 7 or 8 of them, they’d get me high? No thank you! They’d probably get me sick or damage my liver. Gabapentin, oxycodone, or huffing spray paint can become “addictive if misused”, but you can’t, and shouldn’t, ban everything in the world that “could” get people high. Why should chronic pain sufferers whose only idea of getting “high,” is to live a normal life with a tolerable amount of pain, have to be treated as addicts too? I realize I’ll always have some pain, but this is exactly what a lot of us are so pissed off about. I could get “high” right now if I wanted to, but then I’d run out of oxys, I’d need an ever-increasing dose to get them to do anything, and I’d soon be out on the street trying to buy more illegally. In eight years, I’ve never tried to do that, because I know better. It’s too bad that the Opioid Warriors can’t distinguish between legitimate, responsible use, and people who will always find something to get high on. I don’t mean to pick on you personally, hopefully you’re past all that now, but this is the only real problem with anything that has the potential to make people feel better. Everybody is being judged by people who may have good intentions, but they just don’t get it. All they see is the people that are unable to resist the urge to abuse their drugs, and they think everyone who takes them is going to behave the same way. That’s not true, it’s just another form of discrimination. Discrimination is a lazy person’s way of assessing a situation, because it involves very little actual thinking.

  • I am a person who has been living in chronic pain for many years. Opioids helped me be functional for years but my drs will no longer prescribe them even though I have the serious diagnoses to justify their use. I am paying a heavy price now all because of the abusers of the “opioid epidemic”, which is a misnomer. An epedimic is not the annual death toll of 64,000. Now the only med that enables me to walk or sleep at night (because of intense neuropathy) is gabapentin. I take 300mg 4x’s daily. Never once have I ever noticed a “high” from its use, but now the multi-media has found a new med to use for its storylines. You’ve already compromised the health of the patients who need these meds and can no longer get them. Don’t do it again. Be a responsible journalist and research this carefully before maligning another important drug. Gabapentin has been used successfully for many years without addiction issues.

    • I agree with you Gayle. I’m allergic to all narcotics so finding a medication that works is difficult. I’ve never experienced the “high”, I barely get relief from the medication. I have been put on a new medication that is an anti inflammatory and for the first time in years I’m almost pain free. The name of it is Diclofenac Sodium. It is a non steroidal anti inflammatory. It has worked wonders for me and now thinking of coming off the Gabapentin.

    • Exactly! Something else they are gonna take away from us now. Pretty soon the people that have actual pain will be left with nothing in an attempt to stop people from abusing medication. I don’t know what I will do if they take this away too.

    • Hi- there are groups of MDs, scientists, chronic pain patients who are fighting EA/FDA/CDC and Dr. Kolodny (the MAIN man calling the shots- with a cause- his son died from abusing drugs) who are causing this ridiculous national paranoia. An ‘epidemic’ is totally the WRONG WORD- epidemics are cholera, malaria, or something you CATCH, so ‘crisis’ with MULTi-drug abusers is the the problem.. most are the young who steal meds, then add in alcohol, then street drugs to become addicted…but we CPP are swept into the ‘basket of deplorable addicts’..people are dying, people have suicided due to the loss of meds. The CDC now has power to deny meds, do pill counts, and the pharmacies are the next layer of ‘overlord’- denying patients scrips they have had for years-filling just 1 week, forcing an ill patient to drive more, pay more to get their meds. I have seen so many reports of abusing US, the non-addict, making life miserable.

      I am a veteran, we have a HARSHER policy than the CDC police (these are ‘guidelines’ now taken as rigid fact) – vets forced to taper off meds (mine went to 90% reduction!!!) and treated like addicts. So the older I get and more pain I have due to legitimate need, the less pain meds they will give, it is insane. I am now refusing to ANSWER on the ‘pain chart 1-10″ since they say I don’t know what’s good for me, and don’t listen to me about real pain, then I will play ‘stupid’.

      a LV NV reporter is doing an excellent report series:
      http://www.lasvegasnow.com/news/i-team-the-opioid-conundrum/803064908

      Here is a site with many resources for pain patients-this group is active with Gov.
      http://face-facts.org/lawhern/

  • I just quit Gabapentin Morphine and Oxycodone, and thank GOD I did. I would rather live with pain than be hooked on these meds which I was for 7 years, which I now consider a drugged up waste. I had over 80% of my body covered in 3rd degree burns, which is widely considered to hurt worse than childbirth. It is THE most painful experience a human can have. Along with spinal injuries broken limbs etc I had it all….. I got hooked. I told myself I deserved a little euphoria because I’d been through a lot. It’s stupid how you justify it to yourself. I had to have the pills just to feel okay. The monthly song and dance of going to the pharmacy a week early to refill, the withdrawals from running out early, trying to scam my doctor by saying trust me I hurt a lot I need more…. I AM DONE!! FOREVER!!!!! I quit after a slow taper 12/3/16 and will never look back. Life is so beautiful now and I am shocked to realize the pain is actually not even that bad. At all. Being on pain meds exaggerates the pain greatly. It sensitizes your opiate receptors and nerves. I’m here and life is beautiful. Good luck to all in my position.

    • Wow! Jamie, with injuries like that, what you’ve done is nothing short of a miracle. I know all too well, the hassles and anxiety that comes with having to manage never-ending pain… having a bad day and fighting the urge to take an extra pill, knowing that means you’ll have to make it up somewhere before your next refill, worrying that the doctor will abruptly cut you off with no warning, making sure you don’t forget to have some with you if you go somewhere. I’m sick of all of it, but I’m 70 and still have to work everyday to get by. I simply can’t imagine how I could function with that much pain.. I’m almost inclined to doubt your story, but if you really found a way to live with that much pain and actually feel better, I’d love to know the secret, because I don’t like the daily hassle of pill management, but without them I’d be bed-ridden. I don’t even fear death anymore. I’d almost welcome it over the constant pain. The way I have to live, isn’t “living” at all.

    • Jamie, I just love your experiences ending💕 Or shall I say beginning? You made my heart rejoice this morning! I hope you continue with your beautiful life and may blessings abound!❤️

    • Congratulations!! We do recover!! And amen. I also suffered years chronic pain in my spine and intractable migraines; I had plenty of radiographic evidence and none of my providers had any doubts. I was also a highly respected professional- a licensed practicing counselor with a Masters in Rehabilitative Counseling, and I knew all about addiction.

      So every month I received epidural steroids along with a ‘responsibly dispensed’ Rx for 90 Soma and 120 10/325s. After a couple years taking them ‘responsibly’ I caught a raging case of ‘I need more’ , convinced my doc to increase my Rx, learned how to doctor shop and joined the anti-opiate-police brigade. Flash forward a few years later I found myself without the truck, the car, and the 6 figure job, going from ER to dealer to scrape up enough to not be sick.

      Good news was that pain was no longer the big problem for me. I lost my family, my friends, my career and my home; those were the problems I had now. How does that happen? Perhaps because the disease of addiction is insidious, cryptic and idiopathic.

      I chose recovery and gave that life up over 4 years ago, and dreaded the return of the pain. Miraculously, I’ve only had a handful of migraines and a few backaches since. How can that be? Maybe pain meds DO have a mechanism by which pain is amplified, or maybe my pain receptors had become distorted by my growing addiction. All I do know is that I’m free from the addiction and able to manage pain with only Motrin. Ten years ago I would’ve read the article on Gabapentin with the same indignation and alarm as many of you on this forum.
      Experience revealed that alarm, in it’s raw truth, was my fear of not being able to feed my ever growing addiction. Hope that helps someone here.

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