Gabapentin Misuse in Seniors - An Issue That Requires More Awareness
By Don Drake, Connelly Law Offices, Ltd.
Gabapentin has been increasingly associated with drug abuse, particularly in those who mix it with opioids and alcohol. According to multiple medication websites, it is now among the top ten prescribed drugs 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 the treatment of pain in place of opioids. On the street, this drug is called “Johnny Rotten,” “Johnnies,” “Morontin,” or “Gabbies,” and addicts have abused it for years. Even more concerning, there is a good chance that this medication is in a senior’s medicine cabinet. As a result, gabapentin misuse in seniors is becoming an issue that must be discussed.
"Gabapentin is an anticonvulsant medication that was initially approved by the FDA in 1993 to treat epilepsy and pain caused by shingles," said professional fiduciary and certified elder law Attorney RJ Connelly III. "It controls nerve impulses, which helps prevent seizures and treat nerve pain. Since then, gabapentin has become a commonly used drug for various medical conditions such as migraines, restless leg syndrome, hot flashes, fibromyalgia, and neuropathic pain. This drug's most popular brand names are Neurontin, Horizant, and Gralise."
In a report cited in the newsletter PharmacyToday, authors of a November 2022 study published in the JAMA Internal Medicine found consistent growth in the concurrent prescription of opioids and gabapentin throughout the 13-year study period. The newsletter also stated that "Gabapentin’s mechanism of action is similar to that of other controlled substances, such as benzodiazepines and barbiturates, leading to an opportunity for misuse and abuse. Taken in combination with opioids, gabapentin increases the risk of respiratory depression and death in patients."
And more on the dangers of gabapentin, a Centers for Disease Control (CDC) report found that during 2019–2020, "gabapentin detection and involvement in fatal drug overdoses increased, appearing to follow the rising trend in overall overdose deaths during the COVID-19 pandemic. Overall increases were largely driven by increases in synthetic opioids such as illicitly manufactured fentanyls and likely exacerbated by the social and economic consequences of the pandemic. Nearly 90% of drug overdose deaths in which gabapentin was detected also involved an opioid, particularly (and increasingly) illicitly manufactured fentanyls."
"With doctors focusing on reducing the number of opioid prescriptions, they are turning to narcotic-free medications like gabapentin instead," stated Attorney Connelly. "According to the website Statista, in 2004, gabapentin was prescribed over 18 million times compared to forty-seven million prescriptions in 2021. A Reuters report states that this growth in prescriptions has been particularly concentrated among older adults, diabetics, individuals with chronic health issues, or those who are already using benzodiazepines."
Russell was in his late sixties, on SSI, and had developed a gabapentin habit. He not only had scripts for the drug but bought them from other seniors at a senior center just outside of Boston. He 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 or knowledge of how to obtain them.
Russell would wait until the end of the month when other seniors at the center ran low on money while waiting for their checks to come in. He used this to his advantage by buying gabapentin – and other drugs -- from them at a bargain basement price or by trading cigarettes, food, or other medications.
After being confronted at the center by the staff following his making threats to others over obtaining this medication illegally, the police were notified, and he was arrested and told he could not return to the center. At that time, was mixing gabapentin with quetiapine (also known as Seroquel and Seroquel XR, used for the treatment of psychiatric disorders) to get a high that he described as sedating and euphoric.
When he was sent to medication-assisted treatment by the court, he began mixing 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. Unfortunately, Russel suffered a stroke and is currently in a long-term care facility.
"But the question that is asked repeatedly is, who would think that our seniors would be involved in such activities," asked Attorney Connelly rhetorically. "Sadly, today’s baby boomer seniors are obviously not our grandparents. They are children of the sixties and seventies, the Woodstock era, and bring a much different view on drug use and other behaviors into their later years and eventually 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.
Gabapentin Misuse and Abuse
Those who abuse gabapentin report the following effects:
A high like marijuana.
A sense of calmness.
As with all drugs of abuse, the negatives far outweigh the perceived positive effects that users seek. One of the most reported adverse effects is a “zombie-like” feeling 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.
Detecting Neurontin Abuse
Signs of gabapentin abuse in seniors can include:
Going through a prescription of gabapentin too fast due to taking higher doses than prescribed.
Requesting refills from a provider or requesting that the dose be increased even when it may no longer be medically necessary.
Exaggerating symptoms to the provider to get additional refills or increase the dose.
Doctor shopping (this is increasingly more difficult given the prescription reporting network. However, it can be purchased online without a prescription, which is a danger as the drug may be counterfeit and it is usually quite expensive.)
Pill bottles without labels that contain medication (which may have been obtained from friends or acquaintances or from the street, which could be counterfeit drugs mixed with fentanyl or other drugs).
Crushing, chewing, or using gabapentin in a way that is not intended (quicker action).
Mood swings and/or suicidal ideation.
Social withdrawal and isolation and change in physical appearance and grooming habits.
A change in their circle of "friends".
Financial problems, legal difficulties, or a sudden change in health.
The abuse of gabapentin can lead to physical dependence, and stopping the medication abruptly can cause withdrawal symptoms. These symptoms may start within 12 hours to 7 days after the last dose and may last up to 10 days. When an individual stops taking gabapentin, they may experience a range of withdrawal symptoms that can be similar to the symptoms associated with alcohol and benzodiazepine withdrawal.
This is likely since gabapentin, alcohol, and benzodiazepines all interact with gamma-aminobutyric acid (GABA), a neurotransmitter that plays a crucial role in slowing down the activity of nerve cells in the brain. The withdrawal symptoms associated with gabapentin cessation can manifest in a variety of ways, including anxiety, insomnia, nausea, sweating, and tremors, among others.
Gabapentin As a Controlled Substance
As of July 2022, the federal government does not classify it as a controlled substance. However, in certain states, gabapentin has been categorized as a Schedule V controlled substance. This means that in those states, stricter laws regulate the prescription and dispensing of gabapentin from pharmacies.
To help prevent abuse and addiction, some states have included gabapentin in their prescription drug monitoring programs (PDMPs). These programs are online databases that track the dispensing of controlled substance medications. By monitoring and identifying patients who may be refilling a controlled substance at multiple pharmacies, prescribers, and pharmacists can identify those who may be at risk of overdose or taking too much medication. This helps healthcare providers better manage and regulate the use of gabapentin, ensuring its safe and effective use for those who need it.
A Final Word
"It's important to understand that stopping gabapentin use abruptly can cause a lot of discomfort and adverse effects," stated Attorney Connelly. "If you're experiencing Neurontin withdrawal symptoms, it's crucial to seek medical advice to help you safely stop taking gabapentin. If you're also using other substances, like opioids, benzodiazepines, or alcohol, a medical detox program can be especially beneficial. Remember, you're not alone, and there's no shame in seeking help."
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