Is it effective to use Gabapentin for Opioid Withdrawal?
Is using gabapentin for opioid withdrawal effective? The multi-use prescription medication has many off-label uses that include treatment for alcohol and opioid withdrawal. Researchers are still seeing mixed results when it comes to its effectiveness in treating withdrawal symptoms. However, that has not stopped medical providers from prescribing the anticonvulsant drug as an adjunctive treatment alongside evidence-proven methods to treat opioid withdrawal symptoms.
Opioid use disorder is a massive epidemic in the US. It has impacted public health over the past two decades. An estimated 16 million people worldwide are impacted by opioid misuse. It has caused more than 1 million deaths. In the US alone, opioid misuse is responsible for an estimated 135 deaths every day.
Opioid withdrawal symptoms can include nausea, vomiting, muscle aches, anxiety and insomnia. The intensity of symptoms can range from mild to severe. Without treatment for opioid withdrawal, users can get dragged back into a cycle of misuse and drug relapse due to the painful and unmanageable withdrawal side effects.
Some research has found that gabapentin can be effective in treating symptoms of opioid withdrawal. Gabapentin is used in off-label purposes to manage the severity of symptoms or manage any comorbid conditions, such as mental health issues and chronic pain. These conditions often occur alongside an opioid use disorder. However, studies have shown mixed results in whether or not gabapentin can be impactful in treating withdrawal symptoms for opioid use disorder.
What is Gabapentin?
Gabapentin is an anticonvulsant medication that mimics the chemical structure of a neurochemical called gamma aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that slows down brain functions by reducing the transmission of excitatory signals between the brain and body. This is helpful for preventing seizures, relieving pain and reducing specific symptoms of withdrawal.
Brand names of gabapentin include Neurontin, Graslise and Horizant. It was first approved by the FDA in 1983 and developed to treat conditions such as epilepsy, pain relief and neuropathic pain. It was being used as an adjunctive treatment for people experiencing partial seizures. Today, it is FDA-approved to treat symptoms of epilepsy in people ages 3 and older, partial seizure disorders, pain caused by post-herpetic neuralgia and moderate to severe restless leg syndrome.
Today some of its off-label uses include treatments for bipolar disorder, migraines, fibromyalgia, anxiety, depression, ADHD, PTSD, social phobia, insomnia, chronic cough and IBS. It is now very commonly prescribed as part of treatment for alcohol and opioid addiction.
Side Effects of Gabapentin
- Fatigue
- Dizziness
- Headaches
- Nausea and vomiting
- Fever
- Difficulty speaking
- Memory loss
- Weight gain
- Recurring infections
- Movement problems
- Eye problems
- Changes in mood or behavior such as worsening depression, anxiety, irritability, restlessness and panic attacks
- Signs of liver damage such as yellowing of skin and eyes
- Signs of kidney damage such as difficulty urinating, changes in how much urine is passed, blood in urine and swelling of hands and feet
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Gabapentin for Opioid Withdrawal
Today gabapentin is a prescription medication often used in the treatment of alcohol withdrawal as well as opioid withdrawal. Some research is now finding that gabapentin can help lessen the severity of opioid withdrawal symptoms. However, the data from research is not sufficient to establish the complete effectiveness and safety of gabapentin in the treatment of opioid withdrawal.
Recommendations for the drug to be used in opioid withdrawal treatment should be based on the individual patient’s condition and their specific symptoms.
In one study, researchers were examining the impact of gabapentin in treating patients who were withdrawing from a substance known as “Iranian crack”, which is essentially condensed heroin. It resulted in a significantly lowered pain severity during the detox phase. This suggests gabapentin could be effective in removing heroin withdrawal-related pain.
A second study of patients going through opioid withdrawal, results found that those who received high doses of gabapentin experienced a decrease in the severity of diarrhea, muscle tension and dysphoria.
Another study published in the Library of Medicine highlighted the effectiveness of gabapentin for alleviating pain associated with heroin withdrawal. Opioid pain related to withdrawal is often the biggest barrier to reducing opioid consumption and preventing drug relapse.
Research from the University of Toronto that was published in the National Library of Medicine found that gabapentin showed enhanced pain relief, decreased opioid consumption and reduced the incidence of opioid related symptoms.
Despite limited data and research on the effectiveness of gabapentin for opioid withdrawal many providers continue to prescribe the medication. It is not a complete solution. But it can help alleviate certain symptoms and be used as a supportive treatment to help maintain abstinence when combined with cognitive therapy and other medications.
The rise in popularity of Gabapentin
Gabapentin is a very popular prescription medication. One big reason for this is due to its ability to treat a wide variety of ailments, whether it is FDA-approved or used off-label. From 2006 to 2018, prescriptions for gabapentin increased significantly. A 2018 study found that almost 1 in 4 adults with issues of chronic pain were prescribed some sort of gabapentinoid.
Part of the rise in popularity and prescribing was due to the promotion of the drug’s off-label uses. In fact, Pfizer, the company that manufactures gabapentin, pleaded guilty to multiple counts of illegally promoting the off-label use of the drug in 2004. It results in almost $430 million in fines.
In 2019, the FDA issued a warning about the potential risk of respiratory depression in patients taking gabapentin in combination with other medications that were central nervous system depressants. CNS depressants included opioids, antidepressants and benzos. However, despite the warnings, prescription use of gabapentin continued to rise with almost 70 million prescriptions in 2021.
Can Gabapentin become addictive?
Gabapentin is not generally considered to be an addictive drug. Despite its multipurpose use, gabapentin misuse has been on the rise. Studies found that the drug can cause addiction with more than 50% of users reporting misuse. Its ability to induce feelings of euphoria is what drives the addiction. Some studies show that patients who take as little as 400 mg of gabapentin per day for 3 weeks can experience drug dependence and drug withdrawal symptoms that include anxiety, pain, nausea and fatigue.
In some cases of misuse, gabapentin is used alongside other drugs to enhance the effects of euphoria. Studies found that gabapentin was present in about 85%-90% of opioid related deaths.
Risk factors that contribute to drug misuse include co-occurring addiction, chronic pain, family history of drug abuse, age, mental health symptoms, stress, trauma, sleep difficulties, environment and social standing. Gabapentin withdrawal can occur about 12 hours after drug use has stopped and can last up to 10 days.
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Treatment for Substance Use Disorder
Gabapentin is an anticonvulsant medication used for treating conditions such as seizures, but some studies have found its effectiveness in treating substance withdrawal. It has been used in treating alcohol withdrawal symptoms, benzodiazepine withdrawal symptoms and opioid withdrawal symptoms. For the treatment of withdrawal, it is recommended for short-term use only due to the possibility of developing an addiction to gabapentin.
In some states, gabapentin is considered a controlled substance and it is used just as frequently as opioids are used. The use of gabapentin as a standalone treatment for opioid withdrawal has resulted in very little and insufficient data. And its use in treating opioid withdrawal has mostly been to complement other more established methods of treatment. Professional behavioral health programs such as Hotel California by the Sea provide excellent treatment for opioid use disorder.
We offer treatment at all levels of care including detox, residential, PHP and IOP. We utilize evidence-based treatment methods such as CBT, DBT and EMDR therapy. Hotel California by the Sea is dedicated to helping clients reach their goals of sobriety and overcome their addiction.
References:
https://opiateaddictionsupport.com/gabapentin-for-opiate-withdrawal-symptoms-relief
https://www.confidanthealth.com/medication-for-addiction-treatment/gabapentin-for-opiate-withdrawal
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2809162
https://agapedetoxcenter.com/gabapentin-for-opiate-withdrawal
https://my.clevelandclinic.org/health/drugs/21561-gabapentin
https://psychiatryonline.org/doi/full/10.1176/appi.pn.2023.11.11.29
https://www.choosingtherapy.com/gabapentin-addiction
https://whitesandstreatment.com/addiction-articles/detox/gabapentin-opiate-withdrawal/