Today we begin with a medicine that has quietly become one of the most widely-prescribed drugs in America, gabapentin. It’s most often given for illnesses it wasn’t FDA-approved to treat. That practice is legal, but some watchdogs say gabapentin’s allegedly addictive qualities, side effects, and how it dovetails with record opioid deaths — are reason for caution.
Leo Ashline is in an alternative band called Street Sects in Austin, Texas. Here in Russia in 2019, he was nine years sober after a cocaine and alcohol addiction. That was just before his battle with gabapentin began. He was given the medicine for anxiety.
The FDA originally approved gabapentin in 1993 for seizure disorder. Then later, for nerve pain after shingles rash. Doctors now prescribe it for all kinds of unapproved or "off-label” uses.
As a former addict, Ashline was relieved by his prescriber’s assurances.
Sharyl: Don't they say this is a non-addictive drug?
Leo Ashline: That was the thing, yeah. I had told her about my history with addiction, and she said, "This is a drug for anxiety that's safe for people with addiction issues.”
Sharyl: How much would you say you were taking, and for how long, before you started saying to yourself, or something happened that made you think there was a problem?
Ashline: I noticed it wasn't really doing a lot for me when I took it, so I kind of just didn't take it. Then one day, I got into an argument with my girlfriend that was really stressful, and afterwards I took like three or four of them. And then I noticed an immediate change, and I was like, "Oh, that's, that's how that works. You've got to take enough of it." It ramped up pretty quickly. I mean, it got to the point where I would take 15 to 20, sometimes, in a night.
Sharyl: Is that because you needed more to give you the same feeling or relaxation, or you just wanted more and more for more feeling?
Ashline: I think eventually, I was just taking more because I was, you know, back to that addiction mentality, where like, this stuff makes me feel good. When I wouldn't take them, it was bad withdrawals, like it was like... and the withdrawal symptoms felt exactly like the withdrawal symptoms from alcohol, where it was like sweating and shaky. You can't function without it. The anxiety just went through the roof.
Sharyl: And how did it get to the point where you thought it was a problem?
Ashline: I remember realizing it was a problem when I was taking them and I tried to crush them up and snort them at one point, and that didn't really work the way I wanted it to. But once I was doing that, and I had tried that, I remember like, "I know what I'm doing now. I'm abusing this drug, and it's gotten out of hand.” But then by that point, it was too late.
He had black-outs, started using crack cocaine again, pawned his belongings, and lost everything. Ashline says he lived that way for about three months until he checked himself into rehab on New Year’s Eve 2021.
Critics say one factor behind the popularity of gabapentin prescriptions was allegedly illegal marketing by its maker.
In 2014, Pfizer admitted no wrongdoing but settled two giant lawsuits, paying $325 million to resolve claims it boosted profits by marketing gabapentin for unapproved uses — which drug companies aren't allowed to do. And paying $190 million to settle accusations it took steps to keep cheaper, generic versions off the market.
Michael Abrams: Virtually all of gabapentin that's being prescribed are for indications that were not approved by the FDA.
Michael Abrams is a senior health researcher with Public Citizen. He says today, gabapentin is often given with opioids — and it’s proving to be addictive and deadly.
Abrams: It turns out that gabapentin is also a respiratory depressant. And it’s used to treat pain, so it would be perfectly imaginable for a clinician to say, "Oh, let's try a little bit of opioid and let's try a little bit of gabapentin." Combine them together, you're posing an added risk on people that they might not even be aware of.
Gabapentin has also become a driver behind the surge of opioid deaths.
This study, “Gabapentin Increasingly Implicated in Overdose Deaths,” says the drug was found in the bodies of one in 10 overdose deaths in 2019 and 2020. A study in Scotland found gabapentin and a related drug were responsible for one third of accidental drug-related deaths.
Abrams: So it’s become a way to sort of enhance their high if you will. So, really the key thing is, that we're trying to mitigate this risk of respiratory depression and death.
Public Citizen has filed a petition to have gabapentin prescriptions controlled under the Drug Enforcement Administration or DEA, making it what’s called a Schedule Five drug.
Sharyl: What would that do in practice if gabapentin is placed on Schedule Five?
Abrams: It would require that anybody who prescribes gabapentin has to be licensed with the Drug Enforcement Administration to handle a controlled substance. Then the other thing that it would require is it would require manufacturers, pharmacists, the doctors themselves to record the number of pills that they were dispensing and clearly label things for the patient to see on the bottle that they were getting a controlled substance.
Dr. Brian Callaghan of the University of Michigan is against new controls on gabapentin.
Brian Callaghan: Nerve pain is super common, and gabapentin is one of the super, well, it's effective, and we don't have that many things that are effective. And so I think it's important to have it be available to patients.
He helped develop American Academy of Neurology Guidelines for treating painful diabetic nerve pain and says gabapentin is an important alternative to more problematic opioids.
Callaghan: We should be pointing people towards gabapentin and other medicines like it, and away from opioids, whereas this regulation kinda would do the opposite.
It’s been a rough road, but Ashline is clean again, back with his girlfriend, and making music with his bandmate after a year and a half lost.
Sharyl: What have you learned that you think is important about gabapentin?
Ashline: If you have any kind of addictive personality or addiction is a problem for you, you shouldn't take it. And it just kind of seems like maybe there should be more information, there should be more of a warning associated with it, you know?
Sharyl (on-camera): On the one hand, while gabapentin is being prescribed for an ever-widening variety of ailments, on the other hand, the government is giving out millions of dollars in taxpayer-funded grants to study its impact on and role in the opioid epidemic.