What is Gabapentin?
Gabapentin is a prescription medication, sold under brand names like Neurontin, Gralise, and Horizant, and is colloquially known by the street name "gabbies". It is an anticonvulsant primarily approved to treat partial seizures and nerve pain following shingles (postherpetic neuralgia). It is also commonly prescribed "off-label" for other conditions, including anxiety disorders, restless legs syndrome, and alcohol withdrawal. Gabapentin works by binding to a specific subunit of voltage-gated calcium channels in the central nervous system, which helps to calm overactive nerves and decrease the release of excitatory neurotransmitters.
Therapeutic Effects: What to Expect When Prescribed Gabapentin
For individuals taking gabapentin as prescribed, the effects are typically therapeutic and focused on symptom management rather than inducing a "high." The experience is generally perceived as a reduction in pain or anxiety, leading to a calmer, more comfortable state.
- Relief from Nerve Pain: In cases of postherpetic neuralgia or diabetic neuropathy, patients report a significant reduction in shooting, burning, or tingling sensations. This can lead to improved sleep and overall quality of life.
- Anxiety Reduction: As an off-label treatment, gabapentin can produce a calming, anxiolytic effect. Some studies show it may be helpful for social anxiety or anxiety in certain populations, though more research is needed. It is thought to increase levels of the neurotransmitter GABA, which has a calming effect on the nervous system.
- Reduced Seizure Activity: For epilepsy, gabapentin helps stabilize electrical activity in the brain to prevent seizures.
Common Side Effects of Prescribed Gabapentin
Most people experience mild side effects that often diminish over time as the body adjusts. These include:
- Drowsiness, fatigue, and lethargy
- Dizziness and unsteadiness (ataxia)
- Headaches and dry mouth
- Peripheral edema (swelling of the extremities)
- Nausea and vomiting
The Dangers and Effects of Recreational Use
Misusing gabapentin, particularly at high doses or combined with other substances, produces a very different and far more dangerous set of effects than when taken therapeutically. The desired outcome is often a sense of euphoria or a high similar to that experienced with opioids or benzodiazepines.
Misuse is particularly prevalent among those with a history of opioid abuse, who may use gabapentin to intensify the opioid high. The unpredictable nature of these effects is compounded by the fact that gabapentin's absorption decreases at higher doses, making the effects erratic and increasing the risk of overdose.
Key effects of recreational misuse include:
- Euphoria and Enhanced High: Users report an elevated mood, feelings of relaxation, and improved sociability. This effect is often described as similar to a marijuana or opioid high.
- Intensified Depressant Effects: When combined with other central nervous system (CNS) depressants, such as opioids or alcohol, the effects of sedation and respiratory depression are significantly amplified, which can be fatal.
- Cognitive and Behavioral Changes: High doses can lead to impaired thinking, confusion, aggression, memory problems, and, in some cases, psychotic episodes.
Therapeutic vs. Recreational Effects of Gabapentin
| Feature | Therapeutic Use | Recreational Misuse |
|---|---|---|
| Symptom Profile | Decreased nerve pain and anxiety, seizure prevention. | Euphoria, elevated mood, profound relaxation. |
| Common Side Effects | Drowsiness, dizziness, fatigue, nausea. | Extreme sedation, impaired coordination, slurred speech, confusion. |
| Psychoactive Risk | Generally low when taken as prescribed; potential for mood changes. | Significant, with reports of hostility, altered thinking, and suicidal ideation. |
| Overdose Risk | Very low when taken as prescribed. | High, especially when combined with other CNS depressants, increasing risk of respiratory depression and death. |
| Dependence Risk | Gradual dependence is possible over time and should be managed with a tapering schedule. | Much higher, particularly for those with a history of substance abuse. |
What are the Withdrawal Symptoms of Gabapentin?
Because gabapentin can lead to physical dependence with prolonged use, abruptly stopping the medication can trigger withdrawal symptoms. These can manifest within 12 hours to 7 days after the last dose and may last for a week or longer.
Common withdrawal symptoms include:
- Insomnia and anxiety
- Restlessness and agitation
- Sweating and increased heart rate
- Nausea and stomach pain
- Headaches and tremors
- In severe cases, sudden cessation can cause seizures, even in individuals without a history of epilepsy.
Conclusion
Whether an individual experiences therapeutic benefits or dangerous side effects from gabapentin depends heavily on how the drug is used. When taken as prescribed under medical supervision, "gabbies" can effectively manage severe nerve pain and, in some cases, anxiety, providing a much-needed calming effect. However, the growing trend of misusing gabapentin for its euphoric potential introduces serious and unpredictable health risks, including overdose, especially when combined with substances like opioids. The development of physical dependence and potential for severe withdrawal symptoms, including seizures, further highlights the importance of using gabapentin responsibly and only as directed by a healthcare provider. For more information on the dangers of combining gabapentin with opioids, refer to the CDC's recommendations.
Visit the CDC for more information on the risks of combining gabapentin and illicit opioids.
