Amid opioid crisis, cities face gabapentin, too
Doctors are prescribing gabapentin more often because of its non-addictive properties, but officials are finding signs of abuse that exacerbate opioid abuse
By Rachel Engel, EMS1 Contributor
As the battle against opioid addiction continues across the country, many U.S. cities may overlook both a catalyst and its own budding crisis: the prescription nerve medication gabapentin, also known as "Johnnys."
Doctors Tout Gabapentin as a Good Alternative to Opioids
Often sold under the brand name Neurontin, gabapentin is prescribed to treat nerve pain, seizures and discomfort caused by Shingles, and other illnesses associated with chronic pain. It’s also touted by the Centers for Disease Control as the top non-addictive alternative to opioids in combating neuropathic pain.
Due to the drug being able to treat a variety of issues, doctors have been increasingly prescribing gabapentin over other medications. As of September 2017, GoodRx categorized it as the seventh most-prescribed drug in the country.
"Community prescribers are generally unaware that gabapentin can be misused and, in my experience, are often incredulous and even disbelieving when told about ‘the dark side’ of gabapentin,” said Jeffrey Keller, MD, the chief medical officer of Centurian, a private company that provides prison healthcare services.
Since gabapentin has not been labeled as a controlled substance, there is generally no hesitation among providers to prescribe it, making it readily available and easy to obtain.
How Gabapentin Transitioned to a Drug Used to Get High
As the medical community, in conjunction with law enforcement, continues to fight the opioid epidemic and challenge ways to obtain opioid drugs, users seek alternatives. Since doctors have long considered gabapentin as a safe alternative to opioid pain mediation, use of the drug has sky rocketed.
Taken alone, studies have shown very few addictive properties or high-like reactions. However, when taken with recreational drugs and other prescriptions, such as benzodiazepines, as a cocktail or in very high doses, users report euphoria and a sense of calm.
During a study done in a Florida correctional facility, prescriptions of gabapentin were being passed around to inmates without a need, with many reporting to have crushed and snorted the drug, similar to cocaine.
In addition, gabapentin has been shown to prevent the blocking effect of drugs used to treat addiction, which allows the patient to achieve a high while in treatment. Without acknowledgement from the medical community, however, there is little rehabilitation centers or law enforcement can do to prevent abuse.
One Boston nurse told EMS1 that "Johnnys" are used to both elevate highs and stretch out a user’s illicit drug stash.
Ohio Cracks Down As a Schedule Change is Pondered
Concern about the nerve drug isn’t escaping everywhere, though. In Ohio, where the opioid epidemic has flourished, state officials want to prevent a second wave before it starts with a new drug. In December 2016, the State of Ohio Board of Pharmacy started tracking sales of gabapentin, along with opioid prescriptions, around the state, and issued an alert in February 2017 about possible abuse potential.
Gabapentin is likely a long way from a schedule change, though. According to Vox, any drug schedule request requires large-scale, clinical studies that prove abuse potential to the Drug Enforcement Agency, and from there, the medical value of the drug is evaluated to determine where on the schedule it should fall.
About the author
Rachel Engel is an Associate Editor of Military1.com. She is based in Kansas.