The recreational use of anticonvulsans like gabapentin is increasing dramatically. What gives? What's so appealing about an anticonvulsant used to treat epilepsy and chronic neuropathic pain?
The rise in gabapentin recreational use may seem inexplicable. Indeed, Gabapentin is not grouped with other stereotypical substances of abuse.
But this phenomenon reflects a larger growing trend. The abuse of accessible prescription drugs like gabapentin is increasing in popularity as drugs like Oxycontin and Xanax become increasingly restricted. Phenibut is another drug that does not seem like it would have recreational potential, yet is abused.
According to the NIH2:
Unfortunately, our clinical experience suggests that gabapentin is now prevalent as a drug of abuse. The drug's effects vary with the user, dosage, past experience, psychiatric history, and expectations. Individuals describe varying experiences with gabapentin abuse, including: euphoria, improved sociability, a marijuana-like ‘high’, relaxation, and sense of calm, although not all reports are positive (for example, ‘zombie-like’ effects). In primary care, an increasing number and urgency of prescription requests cannot necessarily be explained by the increased number of cases of neuropathic pain. In the substance misuse service, the numbers admitting to using gabapentin (local street name: ‘gabbies’, approx £1 per 300 mg) are also growing.
"Prescribing data from the Tayside region of Scotland show a rise in the number of patients receiving gabapentin, and an exponential rise in the total number of prescriptions issued, particularly since it was licenced for postherpetic neuralgia in 2002."2
Numerous articles have been published in medical journals about the recreational potential of gabapentin in the last decade. The consensus is that gabapentin has low abuse potential.
How Common Is Gabapentin Misuse?
The prevalence of gabapentin misuse in the general population is reportedly 1% 3. Does that seem small? It's actually 40-65% among individuals with prescriptions and between 15-22% of individuals who abuse opioids.
But gabapentin can elicit euphoria, altered mental states, and disassociation in some users. Recreational gabapentin users have also reported that this anticonvulsant helps alleviate benzodiazepine and/or opiate withdrawal.
The first case report of gabapenten recreational use was published in 2007. The authors describe a 67 year-old woman with co-morbid depression and alcoholism who escalated her dose to 7.2 grams per day. She obtained extra gabapentin by lying to pharmacists and purchasing gabapentin over the internet.
When she could no longer obtain gabapentin, she developed a withdrawal syndrome characteristic of this class of medication:
- exopthalmia (protrusion of the eyeballs)
Gabapentin’s Recreational Value
The addictive liability of gabapentin was originally assumed to be low because there was no indication of significant dose escalation in open-label trials. Moreover, Zacny et. al. conducted a study characterizing the subjective effects of Pregabalin (another GABA analogue) in healthy volunteers.
They reported that certain subjective effects such as drug liking/desire to take the drug were not increased. The authors however acknowledged the inherent limitations of the study, in particular the population of non-drug-abusing volunteers they selected.
The Gabapentin High
Gabapentin users have reported a range of subjective experiences:
- Euphoria (Golden Bliss of the World)
- Enhanced sociability
- A state of relaxation, but also “zombie-like” effects
- A sedative/opiate-like buzz with no discernible comedown
- Psychedelic / MDMA-like effects
Gabapentin's chemical structure. Note GABA backbone and cyclohexane ring that increases blood brain barrier penetration of Gabapentin. An excellent example of rational drug design.
One Erowid user emphasizes increased sociability he experienced on gabapentin:
I’m amazed about the social enhancements most of all. I’ve found myself singing joyfully (in front of people!!!) and could envision this drug as treatment for stage fright. Unlike GHB, the sedation effect isn’t as profound, but the social effects are even greater. Anyhow, recreational value definitely exists. Especially in that the drug’s duration can be so extensive. Pop it in the morning on an empty stomach and one could expect to be altered through much of the day. Although it is not a perfect intoxication, there is a zombie feel to it, you feel free to express yourself. The zombie feel is a crapshoot. You may or may not get it.
- “A mild high with no edge” / “A nice and mellow buzz”
- “Euphoric high, sleepy low”
- Seizures following overdose (ref)
- Impaired immune function and ensuing infection from gabapentin use (ref)
In contrast to other anticonvulsants, gabapentin is subjectively more sedating. By comparison, anticonvulsants like Lamictal (lamotrigine) are more sedating.
Gabapentin and Polysubstance Absue
A couple of drugs are reportedly misused in conjunction with gabapentin. The most common combinations seem to be cannabis, alcohol, SSRIs, LSD, and GHB.
In a similar vein, Pregabalin has been characterized as an ideal psychotropic drug to attain specific mindsets, including benzodiazepine-like effects mixed with euphoria, entactogenic feelings, dissociative states and to cope with opioid withdrawal.
Growing in Popularity
The recent increase in the recreational use of gabapentin is due to a confluence of factors.
- Access to benzodiazepines and opioids is increasingly restricted, so substance users are turning to alternatives like gabapentin
- Gabapentin is a cheap, generic drug that is widely available
- Drugs that affect the GABA receptor in the brain tend to relieve anxiety and can elicit euphoria
- Most physicians won’t think twice about writing a gabapentin prescription for pain or anxiety
Effects of Gabapentin in the Brain
Psychopharmacologists like to invoke the term “mechanism of action.” The truth is, many mechanisms are poorly understood and in some cases, the proposed mechanism is unrelated to the therapeutic action of the drug.
With that caveat, gabapentin is a GABA derivative, like the Russian nootropic phenibut. GABA is the major inhibitory neurotransmitter in the brain – meaning that GABA tends to inhibit neuronal activity, decreasing anxiety, reducing seizures and having a number of other downstream effects.
The most common approved uses of gabapentin are for neuropathic pain and seizures.
Comments on Gabapentin Use:
… The most I have done has been 4,800 mg of the 600 mg pills whilst the lowest amount that I can take to get any effect seems to be around 900 mg or more … To classify this pharm is a near impossible task. It is everything and anything in one pill. The only downside to gabapentin so far as I can tell, is the onset. These little guys take upwards of an hour to really start to kick in, but luckily, they last for 4–8 h it seems … I feel as if I’m on a super amphetamine rush and can tackle anything, yet feel so content it’s like I’m on a fully sedated opiate buzz. I’m chatty and witty, deep and insightful …
… I knew that I need at least 10 300’s to get the right effect. Most everyone else I know that takes gapapentin take only 7 or 8 … so about an hour taking after them I feel a disassociation much like DXM, but only in my head and hands. My worries started to fade away. I am a very quiet, shy person normally, but when I am on gabapentin after about 1.5 h I get very friendly, very talkative, very active, very uninhibited … You really need to walk around on gabapentin dancing would be incredible …’ ‘… The feeling was comparable to cannabis with more of a heavy feeling in the body …
Misuse and abuse of pregabalin and gabapentin: cause for concern? (2004)1
Gabapentinoids (e.g. pregabalin and gabapentin) are widely used in neurology, psychiatry and primary healthcare but are increasingly being reported as possessing a potential for misuse. In fact, increasing levels of both prescriptions and related fatalities, together with an anecdotally growing black market, have been reported from a range of countries. This article reviews the current evidence base of this potential, in an attempt to answer the question of whether there is cause for concern about these drugs. Potent binding of pregabalin/gabapentin at the calcium channel results in a reduction in the release of excitatory molecules. Furthermore, gabapentinoids are thought to possess GABA-mimetic properties whilst possibly presenting with direct/indirect effects on the dopaminergic 'reward' system. Overall, pregabalin is characterized by higher potency, quicker absorption rates and greater bioavailability levels than gabapentin. Although at therapeutic dosages gabapentinoids may present with low addictive liability levels, misusers' perceptions for these molecules to constitute a valid substitute for most common illicit drugs may be a reason of concern. Gabapentinoid experimenters are profiled here as individuals with a history of recreational polydrug misuse, who self-administer with dosages clearly in excess (e.g. up to 3-20 times) of those that are clinically advisable. Physicians considering prescribing gabapentinoids for neurological/psychiatric disorders should carefully evaluate a possible previous history of drug abuse, whilst being able to promptly identify signs of pregabalin/gabapentin misuse and provide possible assistance in tapering off the medication.
Schifano F. Misuse and abuse of pregabalin and gabapentin: cause for concern?. CNS Drugs. 2014;28(6):491-6. ↩
Smith BH, Higgins C, Baldacchino A, Kidd B, Bannister J. Substance misuse of gabapentin. Br J Gen Pract. 2012;62(601):406-7. ↩
Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160-74. ↩