Is gabapentin addictive? Understanding the Risks of Dependence and Abuse

October 7, 2025 •

5 min read

Gabapentin misuse has risen significantly over the past decade, especially when combined with other substances. While not a federal controlled substance, many ask: is gabapentin addictive? The answer is nuanced, involving both dependence and abuse potential.

Quick Summary

Gabapentin can lead to physical dependence and has a risk of misuse and abuse, particularly among those with a history of substance use disorder. Stopping use abruptly can cause withdrawal symptoms. The risk is elevated when combined with other central nervous system depressants, like opioids.

Key Points

Addictive Potential: Gabapentin carries a risk for dependence, misuse, and abuse, though generally lower than opioids, especially in those with a history of substance use disorders.
Dependence vs. Addiction: Physical dependence is a biological adaptation to the drug's presence, while addiction is a compulsive, behavioral pattern of drug seeking despite negative consequences.
Withdrawal Risks: Abrupt discontinuation can lead to withdrawal symptoms like anxiety and insomnia; in epilepsy patients, it can trigger seizures.
Dangerous Combinations: Mixing gabapentin with other CNS depressants, particularly opioids and alcohol, significantly increases the risk of severe respiratory depression and fatal overdose.
Regulatory Scrutiny: Although not federally controlled, several states have reclassified gabapentin as a Schedule V controlled substance due to rising misuse.
Medical Supervision is Key: Discontinuing gabapentin requires a doctor-supervised tapering plan to minimize withdrawal symptoms and ensure safety.

What is Gabapentin and Why is its Addictive Potential a Concern?

Gabapentin, most famously known by the brand name Neurontin, is a medication approved by the FDA primarily to treat seizures and nerve pain caused by shingles. It is also frequently used "off-label" for various conditions, including anxiety, insomnia, and other forms of neuropathic pain. When first introduced, gabapentin was believed to have a low risk of abuse, making it seem like a safe alternative to more addictive substances, such as opioids.

However, in recent years, mounting evidence has shown that gabapentin does carry a risk for dependence, misuse, and abuse, especially when taken in high doses or used recreationally. The misconception of its harmlessness, coupled with a rise in prescriptions, has led to a parallel increase in its misuse, particularly amid the opioid epidemic. Drug users may seek gabapentin to get a euphoric or relaxing high, to manage withdrawal from other drugs, or to enhance the effects of other central nervous system depressants.

Dependence vs. Addiction: Clarifying the Difference

It's crucial to distinguish between physical dependence and addiction. These terms are often used interchangeably but refer to different physiological and behavioral processes.

Physical Dependence

Physical dependence occurs when the body adapts to a medication, requiring its presence to function normally. It can happen even when a person takes gabapentin exactly as prescribed for a long period. If the medication is stopped abruptly, the body reacts with withdrawal symptoms. This is a physiological response, not necessarily a sign of compulsive drug-seeking behavior. For gabapentin, withdrawal can include anxiety, insomnia, sweating, and nausea. A key danger for those with epilepsy is the risk of rebound seizures. To avoid this, doctors recommend a gradual tapering schedule when discontinuing the medication.

Addiction

Addiction, or a substance use disorder, is a complex brain disease characterized by a compulsive desire to seek and use a drug despite harmful consequences. This involves behavioral changes beyond simple physical reliance. Signs of gabapentin addiction include:

Taking larger doses or using the medication more often than prescribed
Exaggerating symptoms or forging prescriptions to obtain more of the drug
Experiencing strong cravings for gabapentin
Failing to meet obligations at work, school, or home due to drug use
Continuing to use gabapentin despite negative financial, social, or health impacts

While gabapentin's addictive potential is generally considered lower than that of opioids, misuse can lead to addiction, especially in individuals with a history of substance abuse.

The Mechanism Behind Gabapentin's Effects and Risks

Gabapentin's mechanism of action involves binding to the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system. This binding inhibits the release of excitatory neurotransmitters, effectively calming nerve activity. It is a GABA analogue but does not directly bind to or activate GABA receptors. This contrasts sharply with opioids, which bind to opioid receptors to block pain signals.

The recreational effects, such as a feeling of euphoria, calmness, or a marijuana-like high, are often achieved through high-dose misuse. Combining gabapentin with other depressants, such as alcohol or opioids, significantly increases the risk of side effects, including dangerous respiratory depression. The FDA has issued warnings specifically addressing the risks associated with this combination.

Regulatory Changes and State-Level Control

Because of the growing concerns surrounding gabapentin misuse, many states have taken action to increase oversight, even though it is not federally classified as a controlled substance.

Schedule V Controlled Substance: Several states have reclassified gabapentin as a Schedule V controlled substance. This schedule indicates a lower, but existing, potential for abuse and may lead to dependence.
Prescription Drug Monitoring Programs (PDMPs): Many states now require gabapentin prescriptions to be reported to their PDMP database. This allows healthcare providers and pharmacists to track prescriptions and identify potential misuse.

The Dangers of Combined Use and Overdose

One of the most dangerous aspects of gabapentin misuse is its use in combination with other substances. This practice dramatically elevates the risk of severe complications, including overdose.

List of Dangerous Combinations

Opioids: Combining gabapentin with opioids increases the risk of respiratory depression (slowed or stopped breathing). Studies have found a significantly higher risk of opioid-related overdose deaths among those co-prescribed gabapentin.
Alcohol: Like opioids, alcohol is a central nervous system depressant. The combination with gabapentin intensifies sedative effects, increasing the risk of respiratory issues, extreme drowsiness, and overdose.
Benzodiazepines: These medications are also CNS depressants. Combining them with gabapentin creates a dangerous synergistic effect, substantially increasing the risk of respiratory depression and overdose.

Overdose Symptoms

An overdose on gabapentin, particularly when combined with other depressants, is a medical emergency. Symptoms can include:

Severe drowsiness and lethargy
Slurred speech
Double vision
Diarrhea
Bluish-tinted skin, especially on lips or fingers
Shallow or slow breathing
Unresponsiveness or loss of consciousness

If you suspect an overdose, seek immediate medical attention or call emergency services.

Comparing Gabapentin and Opioids


Feature	Gabapentin	Opioids
Classification	Anticonvulsant (Gabapentinoid)	Narcotic
FDA Approval	Seizures, postherpetic neuralgia	Moderate to severe pain
Mechanism	Modulates voltage-gated calcium channels to reduce neurotransmitter release.	Binds to opioid receptors in the brain and body to block pain signals.
Addiction Potential	Lower risk than opioids, but misuse can lead to dependence and addiction.	High risk of dependence and addiction.
Controlled Status	Not federally controlled, but Schedule V in some states due to misuse concerns.	Federally controlled substances (Schedule II, III, IV, V).
Recreational Effects	Euphoria, relaxation, sedation, especially at high doses or combined.	Euphoria, pain relief, sedation.
Combination Risk	Severely increases risk of respiratory depression and overdose when combined with other CNS depressants.	Dangerous to combine with any other CNS depressants due to respiratory depression risk.

Conclusion: Safe Use and Medical Supervision

While gabapentin is not an opioid and was once considered relatively benign, growing evidence confirms its potential for misuse and addiction. Physical dependence can develop even with proper, long-term use, leading to withdrawal symptoms if discontinued abruptly. For individuals with a history of substance abuse or those who misuse it recreationally, the risk of developing a full-blown addiction is significant. The greatest danger lies in combining gabapentin with other central nervous system depressants, which can lead to life-threatening respiratory depression and overdose. Therefore, it is essential for patients to take gabapentin strictly as prescribed by a healthcare provider, avoid mixing it with other depressants without medical approval, and seek medical supervision for a controlled tapering schedule if they wish to stop the medication. Given the complexities, consulting a qualified medical professional is the safest path to managing the risks associated with this medication.

Medical News Today: Gabapentin addiction: Misuse, dependence, and more

Frequently Asked Questions

Dependence is a physical adaptation where your body relies on gabapentin to function normally, leading to withdrawal symptoms if stopped suddenly. Addiction is a behavioral pattern involving compulsive drug use despite negative consequences, and it's a more complex condition than dependence.

Gabapentin withdrawal can cause symptoms such as anxiety, insomnia, nausea, sweating, pain, and headaches. For individuals with a history of seizures, abruptly stopping gabapentin can trigger rebound seizures.

At the federal level, gabapentin is not a controlled substance. However, due to concerns over misuse and abuse, several U.S. states have reclassified it as a Schedule V controlled substance, leading to stricter regulations.

It is extremely dangerous to combine gabapentin with opioids, alcohol, or other central nervous system depressants. This combination can lead to severe and potentially fatal respiratory depression (slowed breathing).

Signs of gabapentin misuse include taking larger doses than prescribed, doctor shopping, intense cravings, spending excessive time and money to obtain it, and continuing use despite negative consequences.

Stopping gabapentin abruptly is strongly discouraged, especially for those who have been taking it long-term or at high doses. Doing so can cause significant withdrawal symptoms and potentially dangerous complications, such as rebound seizures.

The safest way to stop taking gabapentin is under the supervision of a healthcare provider. They can create a personalized tapering schedule that gradually reduces the dosage over time, minimizing withdrawal symptoms.