The regulatory status of gabapentin, commonly sold under the brand name Neurontin, has been a source of confusion for many. Originally approved by the FDA for nerve pain and seizures, its increased use has raised concerns about potential misuse and abuse, leading some states to enact stricter regulations despite its non-controlled federal status.
Federal vs. State Classification
Federal Standpoint: Not a Controlled Substance
Federally, the DEA does not classify gabapentin as a controlled substance under the Controlled Substances Act. This means there are no federal restrictions on its prescription or dispensing, contributing to its high prescribing rate as a perceived less dangerous alternative to opioids.
State-Level Response: Schedule V Classification and Monitoring
Many states have reclassified gabapentin due to growing concerns about misuse, diversion, and harm. These states have designated it as a Schedule V controlled substance, the lowest classification, which still imposes stricter regulations than non-scheduled drugs. Some states with this classification include Alabama, Kentucky, and Michigan.
Other states utilize Prescription Drug Monitoring Programs (PDMPs) to track gabapentin prescriptions. This helps identify potential misuse by allowing healthcare providers to review a patient's refill history. States requiring PDMP reporting for gabapentin include Connecticut, Indiana, and Ohio.
Why Gabapentin's Status is Under Review
Gabapentin's re-evaluation stems from factors that have emerged since its approval.
Growing Misuse and Diversion
Misuse is increasing, especially among those with substance use disorders. High doses may produce a psychedelic or marijuana-like effect.
Dangerous Combination with Opioids
Combining gabapentin with opioids is particularly concerning as it significantly increases the risk of dangerous respiratory depression and can be fatal. The FDA issued a warning about this in 2019.
Dependence and Withdrawal Potential
Abruptly stopping gabapentin can cause withdrawal symptoms within 12-48 hours that can be severe and last for weeks. Symptoms may include anxiety, insomnia, headaches, nausea, tremors, sweating, and potentially seizures.
Gabapentin vs. Other Common Drugs
Comparing gabapentin to other substances helps illustrate its regulatory context. While not a narcotic, its depressant properties are similar to other abused drugs.
| Feature | Gabapentin (In regulated states) | Pregabalin (Lyrica) | Oxycodone (OxyContin) |
|---|---|---|---|
| Federal Schedule | Non-controlled | Schedule V | Schedule II |
| State Schedule | Schedule V in many states | Schedule V universally | Schedule II universally |
| Abuse Potential | Lower than higher schedules, but present, especially in high doses or with other drugs | Lower potential, but evidence of misuse exists | High potential for abuse and dependence |
| Withdrawal Risk | Can cause withdrawal syndrome upon abrupt cessation | Can cause withdrawal syndrome | Significant risk of severe withdrawal symptoms |
| Common Misuse Pattern | Combining with opioids or taking high doses for euphoria | Combining with other CNS depressants | High-dose abuse for euphoria |
What the Regulatory Landscape Means for Patients
The varying regulations mean patients must be aware of their state's rules regarding gabapentin prescriptions and monitoring. Stricter regulations may apply in states where it is a controlled substance.
Patients should always take gabapentin as prescribed and avoid combining it with opioids, alcohol, or other depressants without medical advice. It's crucial to inform your doctor about any history of substance abuse and never stop gabapentin suddenly due to the risk of severe withdrawal symptoms.
Conclusion
In conclusion, the answer to is gabapentin a controlled substance? depends on whether you are considering federal or state law. Federally it is not controlled, but many states have classified it as a Schedule V substance or require PDMP monitoring due to concerns about misuse, dependence, and dangerous interactions, particularly with opioids. Patients need to be aware of their local regulations and adhere strictly to medical guidance for safe and effective use. This highlights the ongoing need for vigilance regarding prescription drug misuse.
For more information on drug regulation, consult resources like the DEA's website DEA Diversion Control on Gabapentin.
