Gabapentin: What Is It and Why Is It Abused

Gabapentin, often sold under the brand name Neurontin, is a prescription medication primarily used to treat nerve-related conditions. While it’s a legitimate and effective treatment for several medical issues, gabapentin is increasingly being misused — sometimes intentionally, sometimes accidentally — by individuals seeking relief or a high.

Understanding gabapentin’s unique properties, its role in the brain, and why some people misuse it is essential in helping you or someone you care about stay informed and safe.

Gabapentin at a Glance

• Drug class: Anticonvulsant / Gabapentinoid

• Common brand names: Neurontin, Gralise, Horizant

• FDA-approved uses: Seizures, postherpetic neuralgia, and restless legs syndrome

• Off-label uses: Anxiety, insomnia, and alcohol withdrawal

• Forms: Capsules, tablets, oral solutions

Though not a controlled substance in most U.S. states, gabapentin has drawn attention in recent years for its growing presence in drug misuse cases. You might not think of it in the same category as opioids or benzodiazepines, but in some contexts, it’s used in similar ways — and with serious risks.

How Gabapentin Affects the Brain

To understand why gabapentin can be misused — and why it's risky — it's important to look at how it interacts with your brain and nervous system. Gabapentin was originally developed to mimic the neurotransmitter GABA (gamma-aminobutyric acid), which helps calm nerve activity. However, despite its name and structure, gabapentin doesn’t bind to GABA receptors directly.

What Does Gabapentin Do

Gabapentin works by affecting calcium channels in the nervous system, specifically binding to the alpha-2-delta subunit of these channels. This process reduces the release of excitatory neurotransmitters like glutamate and substance P — chemicals that amplify pain and increase anxiety or seizures.

Here’s a simplified breakdown of gabapentin’s action:

• Not a true GABA enhancer: Unlike benzodiazepines or alcohol, gabapentin doesn’t increase GABA directly.

• Modulates nerve activity: It calms overactive nerves by influencing calcium channels.

• Reduces excitability: By limiting overstimulation, it helps prevent seizures and reduce nerve pain.

• Lowers pain perception: Particularly effective for chronic neuropathic pain like shingles or diabetic nerve pain.

Why This Matters in the Context of Abuse

Gabapentin’s sedative-like effects can lead some individuals to misuse it. These effects can include:

• Mild euphoria

• Sedation

• Disosiation

• Enhanced effects of other substances (like opioids or alcohol)

Though it doesn’t produce a traditional “high,” the subtle psychoactive changes it creates may be addictive to people with a history of substance abuse. This is especially true if you’re trying to self-medicate or manage withdrawal symptoms from another drug.

Scientific Uncertainty Adds Risk

One of the biggest concerns is that scientists still don’t fully understand gabapentin’s precise mechanism of action. While we know it modulates neurotransmission, the exact brain regions and long-term neurological impacts are not completely mapped.

That uncertainty can make the drug feel deceptively safe, especially when it's prescribed, even though it has a high potential for dependence and misuse.

Medical Uses of Gabapentin

Gabapentin has a well-established place in modern medicine. It’s prescribed to millions of people worldwide, particularly those suffering from nerve-related issues. While its core applications are FDA-approved, it’s also commonly used off-label, meaning doctors prescribe it for conditions outside its original intended use. These legitimate medical uses can provide powerful relief, but they also create pathways that, for some individuals, may lead to misuse.

FDA-Approved Uses of Gabapentin

Gabapentin is approved by the U.S. Food and Drug Administration (FDA) for the following conditions:

• Partial seizures: Used alongside other medications to control seizures in adults and children over age 3.

• Postherpetic neuralgia (PHN): A chronic nerve pain that persists after shingles.

• Restless legs syndrome (RLS): Specifically, the extended-release form (Horizant) helps reduce symptoms of RLS.

Common Off-Label Uses

Doctors may prescribe gabapentin for several other conditions based on clinical judgment and patient need. These include:

• Anxiety disorders

• Insomnia

• Migraine prevention

• Fibromyalgia

• Hot flashes (especially in menopause)

• Alcohol withdrawal symptoms

• Chronic pain syndromes not caused by nerve damage

These off-label uses are often supported by studies and clinical experience, but they haven’t gone through the same rigorous FDA approval process. If you’ve been prescribed gabapentin for one of these conditions, it’s not uncommon, but you should be aware of the potential risks.

The risks of taking Gabapentin can be mitigated by taking the medication exactly as prescribed.

Why It’s Prescribed So Often

Gabapentin is frequently favored by physicians because it is:

• Non-opioid: A safer-seeming alternative to opioid painkillers, especially in today’s climate of opioid addiction.

• Low initial abuse profile: Originally believed to have little to no abuse potential.

• Mild side effects: When taken according to doctor’s orders, Most users tolerate it well with few severe reactions.

• Useful for dual symptoms: For instance, it can help a patient manage both anxiety and pain simultaneously.

However, these same benefits can mask its darker potential. As more people are prescribed gabapentin — and as some seek out its calming or pain-numbing effects without a prescription — reports of misuse and dependency are rising.

Can Gabapentin Be Abused?

While gabapentin is not classified as a controlled substance at the federal level, its potential for abuse is high, especially among individuals with a history of substance use disorders.

It’s important to understand that gabapentin misuse doesn’t always look like typical drug abuse. You might not be chasing a high, but rather trying to self-medicate anxiety, pain, or withdrawal symptoms. This qualifies as misuse, and it can be dangerous.

Who’s Most at Risk?

Studies show that gabapentin abuse is significantly more common among individuals who:

• Have a current or past substance use disorder

• Are prescribed high doses over a long period

• Mix gabapentin with other medications or substances, especially opioids or alcohol

• Use gabapentin without a prescription

You may not realize how easily misuse can start. Maybe your prescribed dose no longer feels effective, or you're tempted to take an extra pill to get through a stressful day. Over time, that pattern can evolve into physical dependence and make stopping the drug more difficult than expected.

The Rise in Gabapentin Abuse

Several U.S. states — including Kentucky, West Virginia, and Michigan — have reclassified gabapentin as a controlled substance due to rising abuse cases. This shift in policy reflects growing concern over how gabapentin is being used outside of medical guidance.

According to recent data:

• Up to 20% of people who abuse opioids report misusing gabapentin.

• Gabapentin is often found in combination with opioids in overdose toxicology reports.

• Emergency room visits related to gabapentin misuse are increasing.

Signs of Gabapentin Misuse

If you’re worried you or someone else might be misusing gabapentin, look for these red flags:

• Taking more than prescribed or running out early

• Mixing gabapentin with alcohol or other drugs

• Using it without a prescription

• Feeling withdrawal symptoms between doses

• Obsessing over access to the medication

Even though gabapentin is often considered "safe" compared to other drugs, misuse can have serious — even life-threatening — consequences.

Gabapentin Overdose: Is It Possible?

Gabapentin is generally considered to have a wide safety margin, meaning it’s difficult to overdose by accident. However, that doesn’t mean overdose is impossible. In fact, when gabapentin is taken in very high doses — especially in combination with other substances like opioids, alcohol, or benzodiazepines — the risk of overdose increases significantly.

How Gabapentin Overdose Happens

On its own, gabapentin doesn’t typically suppress breathing or heart function the way opioids do. But when it’s mixed with other central nervous system (CNS) depressants, the sedative effects can compound, leading to life-threatening complications.

Common scenarios where overdose risk increases:

• Combining with opioids or alcohol

• Taking significantly more than the prescribed dose

• Using gabapentin as part of a polysubstance abuse pattern

• Taking extended-release forms improperly (e.g., crushing or snorting pills)

Symptoms of Gabapentin Overdose

If you or someone you know may be experiencing a gabapentin overdose, it’s important to seek emergency medical attention immediately. Symptoms may include:

• Extreme drowsiness or sedation

• Slurred speech

• Double or blurred vision

• Loss of muscle coordination (ataxia)

• Labored breathing

• Unresponsiveness or coma

Gabapentin is often perceived as a safer alternative to other prescription drugs, but that perception can be dangerously misleading when it leads to misuse or mixing with other substances.

Is Gabapentin Lethal?

In most cases, gabapentin overdose is not fatal when taken alone, but fatalities have been documented, particularly when gabapentin is used in combination with opioids.

For this reason, the FDA issued a warning in 2019 about the potential dangers of mixing gabapentin with other CNS depressants, noting the increased risk of respiratory depression and death.

If you believe someone is experiencing an overdose, call 911 immediately.

How Long Does Gabapentin Stay in Your System?

If you’ve taken gabapentin — whether for medical reasons or not — you might wonder how long it lingers in your body. Gabapentin’s presence in your system depends on several factors, including your metabolism, age, kidney function, dosage, and frequency of use.

Gabapentin’s Half-Life

The half-life of a drug is the amount of time it takes for half of the substance to be eliminated from your system. For gabapentin, the average half-life is around 5 to 7 hours in healthy adults.

What this means:

• After 6 hours: About 50% of the dose remains in your body.

• After 12 hours: About 25% remains.

• After 24 hours: Only trace amounts remain, but not enough for therapeutic or recreational effects.

Because of this short half-life, gabapentin must typically be taken multiple times a day to maintain consistent levels in the bloodstream. Most prescriptions involve 2 to 3 doses daily.

Factors That Influence How Long Gabapentin Stays in Your System

Everyone metabolizes drugs differently. Several key factors influence how long gabapentin stays in your system:

• Kidney health: Gabapentin is processed through the kidneys, not the liver. Poor kidney function can slow elimination significantly.

• Age: Older adults tend to process medications more slowly.

• Dosage: Higher doses take longer to fully leave your body.

• Frequency of use: Regular users may accumulate more of the drug over time.

• Hydration and activity: Staying hydrated and active can slightly speed up excretion.

Gabapentin Withdrawal: What to Expect

While gabapentin is often prescribed to help ease withdrawal symptoms from other substances, like alcohol or opioids, it can also cause its own set of withdrawal symptoms if stopped suddenly. If you’ve been taking gabapentin regularly, especially at high doses or over an extended period, you may experience withdrawal when the medication is discontinued.

This is especially true if:

• You’ve taken gabapentin for more than a few weeks.

• You’ve increased your dose without medical guidance.

• You’ve combined gabapentin with other drugs that affect the nervous system.

Common Withdrawal Symptoms

Gabapentin withdrawal symptoms can vary in intensity, but they’re generally less severe than those associated with opioids or benzodiazepines. However, they can still be uncomfortable and disruptive, particularly if you stop taking the medication abruptly.

Typical withdrawal symptoms include:

• Anxiety or nervousness

• Insomnia or sleep disturbances

• Irritability or mood swings

• Disorientation or confusion

• Sweating and restlessness

• Nausea or gastrointestinal upset

• Headaches

• In rare cases, seizures (especially for individuals taking gabapentin to manage epilepsy or other seizure disorders)

The timeline for these symptoms often begins within 12 to 48 hours after the last dose and can last up to a week or more, depending on individual factors.

Who’s at Higher Risk for Withdrawal?

You may be more likely to experience gabapentin withdrawal if you:

• Have been taking the drug daily for several weeks or months

• Use high doses (typically over 1800 mg/day)

• Have a history of substance dependence

• Are using gabapentin off-label for conditions like anxiety or sleep

• Stop the medication abruptly, rather than tapering down slowly

The Importance of Medical Supervision

If you’re considering stopping gabapentin for any reason, do not do it suddenly. Always consult with your prescribing physician. A doctor can help you safely taper your dose, reducing the likelihood and severity of withdrawal symptoms.

Tapering means gradually reducing your dosage over time. This process allows your brain and nervous system to adjust to lower levels of the drug and helps minimize discomfort.

If you're already experiencing withdrawal symptoms, reach out for medical support. Withdrawal can be a sign that your body has developed a dependence on the medication, and it’s nothing to be ashamed of. Many people find themselves in this position unintentionally and get back on track with proper guidance.

How Serious Is Gabapentin Abuse?

Gabapentin abuse might not be as widely discussed as opioid or stimulant addiction, but that doesn’t make it any less concerning, especially if you’re someone managing chronic pain, anxiety, or a substance use disorder. The seriousness of gabapentin abuse often lies in how quietly it can develop and how easily it can be overlooked.

The Quiet Risk of Dependency

Gabapentin is sometimes seen as a “safe” alternative to stronger painkillers or anxiety medications. But that false sense of security can actually make it more dangerous in the long term. You may start taking a little more than prescribed to manage pain, sleep better, or feel calmer — and before you know it, you're dependent.

Even though gabapentin doesn’t cause the euphoric “high” associated with many addictive drugs, the emotional and physical reliance it can create is real. This kind of dependency can be especially hard to spot if you’re still taking the medication under a doctor’s prescription.

When Gabapentin Abuse Becomes Dangerous

Gabapentin abuse becomes especially serious when it’s:

• Paired with opioids or alcohol – which drastically increases the risk of overdose

• Used to self-medicate – often masking underlying mental health or substance use issues

• Taken in escalating doses – which increases the chance of developing withdrawal symptoms and physical dependency

• Used without medical supervision – a red flag for potential misuse

Because gabapentin is still not federally classified as a controlled substance (except in certain states), it may not trigger the same safeguards that exist for drugs like opioids. This means the responsibility to recognize problematic use often falls on you, your loved ones, or your healthcare provider.

Getting Help for Gabapentin Abuse

If you’re worried that your gabapentin use is no longer fully in your control, you’re not alone — and there are clear next steps you can take. Recovery is absolutely possible, especially when you get the right support.

Consider reaching out to a professional if:

• You feel anxious or sick when you miss a dose.

• You’ve started increasing your dosage without medical approval.

• You’re using gabapentin with other substances.

• You’re relying on the drug to function emotionally or physically.

• You’ve tried to quit or cut back and weren’t able to.

Treatment Options

Treatment for gabapentin abuse can vary depending on your specific situation. It often includes:

• Medical detox to help you taper off safely

• Behavioral therapy to address emotional triggers and mental health

• Group or individual counseling for support

• Medication-assisted treatment (MAT) if other substances are also involved

• Relapse prevention strategies tailored to your lifestyle

You don’t have to wait until things get worse. If you’re starting to question your relationship with gabapentin, that’s a good enough reason to seek guidance now.

Use Therapy Radar to find treatment options that match your needs.