Gabapentin prescriptions are rising in addiction treatment despite weak evidence

In recent years, gabapentin prescriptions for addiction treatment have surged, despite scarce evidence supporting its effectiveness. Simultaneously, non-prescribed use of the drug has also risen, though at a slower pace. Gabapentin, originally FDA-approved to treat seizures and nerve pain, is commonly used "off-label" to manage withdrawal symptoms in substance use disorder patients.

Clinicians often prescribe it for co-occurring issues such as anxiety, insomnia, and chronic pain. The medication's safety compared to addictive opioids and benzodiazepines has contributed to its popularity among medical professionals. However, research on its efficacy in treating substance use disorders is limited. Medical trials have shown no benefits for cocaine or methamphetamine use disorders.

Despite this, gabapentin prescriptions have steadily increased over the past two decades, while non-prescribed use has also grown but is slowly declining. A study in Drug and Alcohol Dependence investigated these contrasting trends. Researchers analyzed urine drug test results from over 200,000 patients at 2,053 treatment facilities across the U.S. between 2016 and 2023.

Gabapentin was found in 5.9% of cases with a prescription, and 11.3% without one. The proportion of unprescribed use has decreased over time, while prescribed use has nearly doubled. Older adults, women, and patients with opioid or sedative use disorders were more likely to receive a gabapentin prescription. Non-prescribed users were often diagnosed with opioid or sedative use disorders and had psychiatric conditions like anxiety and mood disorders.

Gabapentin use without a prescription often coincided with the presence of other drugs, particularly cannabis.