Nerve pain medication gabapentin is increasingly prescribed to patients in substance use disorder treatment, even as researchers note a lack of strong evidence supporting the practice, according to data published in Drug and Alcohol Dependence. Public health tracking reveals a complex picture of off-label prescribing and unprescribed use across addiction treatment centers nationwide.
Rising Prescription Rates in Substance Use Treatment
National prescribing rates for gabapentin climbed steadily over an eight-year evaluation period, according to a retrospective study led by Matthew S. Ellis, an assistant professor of psychiatry at Washington University School of Medicine. Researchers analyzed 206,161 urine drug test results collected between January 2016 and October 2023 from patients aged 18 and older across 2,053 facilities in all 50 U.S. states. The data showed that the overall proportion of patients with a documented gabapentin prescription nearly doubled, rising from 3.9 percent in 2016 to 7.6 percent in 2023.
Clinicians routinely prescribe the drug off-label to help manage withdrawal symptoms, anxiety, insomnia, and chronic pain for individuals undergoing addiction care. According to findings, gabapentin prescribing increased across all categories of substance use disorders, including alcohol, cannabis, stimulant, sedative, and opioid abuse. By the end of the study period, patients with sedative use disorders recorded the highest prescribing rates. Demographic breakdowns show that prescriptions were more common among women and patients aged 55 and older.
Unprescribed Use and Misuse Patterns
While formal prescriptions rose, the study tracked a distinct downward trend in unprescribed consumption. Researchers identified gabapentin use without a doctor’s guidance in 11.3 percent of the total sample. This unprescribed rate was nearly double the proportion of patients who held a formal prescription. However, unprescribed use steadily declined from 15.2 percent in 2016 to 9.9 percent in 2023.
Did You Know?
By 2024, gabapentin became the fifth most prescribed drug in the United States, reaching 15.5 million Americans following a 2016 recommendation by the Centers for Disease Control and Prevention encouraging its use as a non-opioid pain alternative.
Patients taking gabapentin without a prescription often reported self-medicating for pain, sleep issues, or withdrawal symptoms, while others sought euphoria or attempted to enhance the effects of other substances. Co-authors Penn Whitley and Steven D. Passik of testing laboratory Millennium Health helped evaluate these samples using liquid chromatography-tandem mass spectrometry. Their analysis revealed that detection rates for all analyzed drug classes—including cocaine, methamphetamine, heroin, and alcohol—were higher among individuals taking gabapentin without a prescription. Notably, fentanyl detection among unprescribed gabapentin users increased from 12 percent to 29 percent over the course of the study.
Comparing Prescribed and Unprescribed Gabapentin Trends
Examining the data side by side highlights a widening overlap between formal clinical management and independent street use within addiction treatment populations.
| Metric | Prescribed Gabapentin | Unprescribed Gabapentin |
|---|---|---|
| Prevalence in Study Sample | 5.9% total average | 11.3% total average |
| Trajectory (2016–2023) | Rose from 3.9% to 7.6% | Declined from 15.2% to 9.9% |
| Key Associated Diagnoses | Sedative use disorder, anxiety, mood disorders, chronic pain | Opioid and sedative use disorder, psychiatric conditions |
Despite the widespread adoption of the medication in clinical practice, Ellis emphasized that medical literature evaluating gabapentin’s effectiveness for substance use disorders remains sparse. Reviews show mixed results for reducing heavy drinking or opioid withdrawal, and clinical trials have demonstrated no benefit for treating cocaine or methamphetamine use disorders. Separate research published in the same journal noted that poison control center inquiries involving gabapentin continue to exceed those for similar drugs like diazepam and pregabalin, with most cases involving co-ingestion of opioids.
Frequently Asked Questions
What is gabapentin originally approved to treat?
The U.S. Food and Drug Administration originally approved gabapentin to treat partial seizures and specific types of neuropathic pain, such as post-herpetic neuralgia caused by shingles.
Why do doctors prescribe gabapentin in substance use treatment?
Clinicians prescribe the medication off-label to help patients manage withdrawal symptoms, anxiety, insomnia, and chronic pain during recovery from substance use disorders.
Is gabapentin addictive?
While historically viewed as a safer alternative to opioids and benzodiazepines, public health monitoring shows that gabapentin is frequently misused to enhance the euphoria of other substances or self-manage withdrawal symptoms.
How common is unprescribed gabapentin use?
National urine drug testing data published in Drug and Alcohol Dependence indicates that 11.3 percent of patients in substance use treatment tested positive for gabapentin without a documented prescription, though this rate decreased between 2016 and 2023.
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