According to the website, GoodRx, it is now the seventh most prescribed drug in the United States. With the focus on opioids and the opioid epidemic, it is rapidly moving up that list as it is being prescribed for treatment of pain in place of opioids. On the street, this drug is called “Johnny Rottens”, “Johnnies”, “Morontin” or “Gabbies” and has been abused by addicts for years. And chances are, this medication is in a senior’s medicine cabinet.
This medication is Gabapentin, also known by the brand names Neurontin, Gralise and Horizant.
Gabapentin is used to treat partial seizures, neuropathic pain, and essential tremors. However, it has several “off-label” uses with mixed results. These uses include treating fibromyalgia, hot flashes, restless leg syndrome, anxiety, migraine headaches, helping those with sleep disorders, extreme hiccups and even assisting addicts with withdrawal symptoms (especially cocaine).
With the focus on decreasing prescriptions for opioids, doctors have shown an
interest in narcotic free medications like gabapentin, so much so that since 2012, gabapentin prescriptions have increased by 64 percent. Of this increase, Reuters reports that this prescription growth has been concentrated among older adults, diabetics, those with chronic health issues or those already using benzodiazepines (see our earlier blog on benzodiazepine use among seniors).
Those who abuse gabapentin report the following effects:
A high similar to marijuana
A sense of calmness
Unfortunately, as with all drugs of abuse, the negatives far outweigh the perceived positive effects users seek. Some who use gabapentin report “zombie like” feelings even at the prescribed amounts and when abused, the side effects are certainly much more pronounced. Some of these include:
Blurred or double vision
Shaking of body parts
Memory problems Fatigue
Uncontrollable eye movements
Increased weight gain and appetite
In some instances, users have reported having seizures without a history of them.
Watch this news report from WXYZ - TV in Detroit regarding the abuse of gabapentin. It is quickly emerging as a drug of abuse due to the decrease in opioid prescriptions and the availability of inexpensive opioids on the street.
In Kentucky, gabapentin was found in the toxicology screens of more than one-third of drug overdose victims in that state during 2015-16. So concerned were medical providers and lawmakers about the abuse and diversion of gabapentin that in July, 2017, it was made a Schedule 5 controlled substance there.
Kentucky isn’t the only state with serious concerns about this medication.
Police in Ohio have reported a dramatic rise in the abuse of gabapentin and in a study of pain clinics and urine samples from 323 patients, it was found that 70 patients were taking gabapentin illegally. These samples were taken from clinics in Indiana, Arizona and Massachusetts.
In a recent national bulletin distributed to police and narcotics officers, the High Intensity Drug Trafficking Areas lists gabapentin as an “emerging threat”. But is this an issue for seniors?
We asked Don Drake, one of Connelly Law’s Community Education Program presenters and a retired administrator of substance abuse programs and licensed clinician in Massachusetts about the dangers of gabapentin and if he saw any abuse in the senior population.
“What I find interesting is that many medical professionals have denied that gabapentin is being abused and I even saw a statement by a doctor stating that gabapentin has very little street value and by using that standard, this means it is not being abused. It’s a ridiculous statement. True, it can be bought on the street quite cheaply, perhaps as little as seventy-five cents for a 300 milligram tablet, but the reason it has such little street value is because it is so widely available. Also, getting prescriptions for it is easy since it’s not a controlled medication in most of the country”, Drake said.
“Once opioids become scarcer and more expensive, you will see the diversion of gabapentin increase and the street value rise. If nothing else, addicts and their behaviors are quite predictable.”
Drake also told a story of a senior patient, we’ll call Russell, who developed a gabapentin habit. He not only had scripts for the drug but bought it from other seniors at a senior center just outside of Boston.
“Russell had a history of marijuana use and had spent some time in rehab for abusing narcotics, so he was no stranger to illicit drug use. What Russell would do is wait until the end of the month when other seniors at the center were running low on money while waiting for their checks to come in and he used this to his advantage by buying gabapentin – and other drugs -- from them at a bargain basement price”, Drake said.
“When Russell entered treatment, he was mixing gabapentin with quetiapine (also known as Seroquel and Seroquel XR, used for treatment of psychiatric disorders) to get a high that he described as sedating and euphoric. He also told me that when he was sent to treatment by the court, he mixed gabapentin with methadone which enhanced the opioid effects of the drug, leading him to proudly brag about going through treatment high but never getting caught because the urine screens did not check for gabapentin.”
“Who would think that our seniors would be involved in such activities, but today’s baby boomer seniors are obviously not our grandparents. They are children of the sixties and seventies and bring a much different view on drug use and other behaviors into senior programs.”
Given these attitudes, statistics also show that today seniors have higher rates of addiction and alcoholism. An even more distressing statistic reports that baby boomers are being arrested for possession of substances at higher rates than teens and young adults.
The American Addiction Centers report multiple cases of middle age and elderly patients with histories of alcohol abuse being prescribed gabapentin and ended up abusing it, creating considerable withdrawal symptoms for them, which could be life threatening.
Does this mean that seniors are abusing gabapentin at record numbers?
The answer at this time is no, however a decade ago, no one would have believed that a problem with seniors and opioids would exist -- and we continue to turn a blind eye to the over-prescribing and misuse of benzodiazepines among this age group.
We write many of our blogs hoping to provide insights into issues which we believe allows us to develop better foresight, and given that, here are some additional insights on gabapentin;
Between 2008 and 2011, the Drug Abuse Warning Network (DAWN) reports the number of emergency room visits for misuse or abuse of gabapentin increased nearly 500%.
Gabapentin is now one of several medications being promoted by the Centers for Disease Control and Prevention as a “safer” alternative to opioids (meaning that it will continue to be prescribed at higher rates).
The American Pain Society recently recommended that gabapentin be considered for post-operative pain relief.
In our prison system, medical professionals have called gabapentin “one of the most abused and diverted drugs”.
Our concerns about gabapentin are being expressed as a cautionary tale,
however knowing that this drug may be in a senior’s medicine closet or may be prescribed in the future, it is a tale worth heeding.
And for those who provide services to seniors, what should they take away from this?
“I think those who work in nursing homes have little to be concerned about here”, said Drake. “But in senior centers and senior communities, staff need to be aware of the misuse and abuse of gabapentin and be prepared to intervene if necessary, and that includes referring people for treatment”.
What does gabapentin abuse look like?
According to the Food and Drug Administration (FDA), gabapentin abuse may be associated with suicidal thoughts or behaviors. Other signs of abuse may be:
New or worsening anxiety and/or depression.
Changes in mood or behavior.
Aggressive or violent behavior.
Withdrawal can occur among people who used gabapentin for as little as 3 weeks and symptoms can begin within 12 hours to 2 days after the last use.
The effects of gabapentin withdrawal are similar to the symptoms of benzodiazepine withdrawal can be life threatening to seniors and may include sweating, anxiety, and irregular heartbeat.
Finally, Drake adds this, “I’m a firm believer in regular staff and family trainings around these emerging issues, especially because baby boomers bring a different dynamic into senior programs today and education needs to keep pace with these changing behaviors.”
Next Week's Senior Issues Blog: "Hiring Home Health Aides - Keeping Your Senior Safe".
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.