CDC Warns About Overdose Deaths Linked to Gabapentin Abuse

Federal health officials are warning that abuse of the epilepsy drug Gabapentin has been increasingly linked to overdose deaths in the United States in recent years, leading to calls for increased education about the risks associated with combining the medication with illicit opioids.

In a report published this week by the U.S. Centers for Disease Control and Prevention (CDC) in the Journal of the American Medical Association (JAMA), government researchers say Gabapentin has been detected in about to one out of every 10 overdose deaths in the U.S. between 2019 and 2020, and was determined to be the cause of death in about half of those cases.

Gabapentin is approved by the U.S, Food and Drug Administration (FDA) to treat epilepsy and neuropathic pain. It is also widely prescribed off label for treatment of alcohol use disorder, chronic cough, hiccups, post-surgical pain, and post-menopausal hot flashes. The closely related drug gabapentin enacarbil is approved to treat restless leg syndrome and post-therapeutic neuralgia. The drugs are also sold under brand names Neurontin, Gralise and Horizant, or for pregabalin-based drugs Lyrica and Lyrica CR, as well as multiple generic versions.

Among illicit opioid users, Gabapentin is often used to increase the effects of the illegal narcotics. The CDC indicates that between 2013 and 2017, misuse, intentional abuse and unknown exposures to the anticonvulsant increased by 103%, which poses a serious risk of respiratory depression and death.

The CDC assessed the drug’s role in fatal overdoses using data from the State Unintentional Drug Overdose Reporting System (SUDORS) in 23 states and the District of Columbia from 2019 through 2020. The findings indicate that, out of 58,362 overdose deaths with documented toxicology reports, Gabapentin was detected in 5,687 of them, or 9.7%. Most of the overdose deaths, 83.2%, occurred among non-Hispanic Whites. The deaths were split virtually evenly between men and women. However, the rate of deaths seems to be increasing, according to the findings.

“During the second quarter of 2020, the number of deaths reported with gabapentin detected approximately doubled compared with the first quarter of 2019,” CDC researchers wrote. “Among deaths where gabapentin was detected, 49.4% were gabapentin-involved during the first quarter of 2019; this percentage increased to 55.1% during the fourth quarter of 2020.

Earlier this year, the consumer advocacy group, Public Citizen, filed a petition with the FDA calling for gabapentin to be classified as a schedule V controlled substance, warning of the risk of abuse, addiction, overdoses and deaths.

In 2019, federal health officials warned using opioids with gabapentin drugs, like Neurontin, or other drugs used to treat nerve conditions, can lead to dangerous breathing problems that can result in hospitalization and death.

Gabapentin is structurally similar to the naturally occurring neurotransmitter gamma-aminobutyric acid (GABA) and the drug pregabalin, which has been classified as a schedule V controlled substance since 2005.

As of November 2020, seven states have classified gabapentin as a schedule V drug and 12 states require prescription monitoring. The United Kingdom classified both gabapentin and pregabalin as controlled substances since 2019.