In 2012, at the height of the opioid epidemic in this country, the US had 95% of the hydrocodone prescriptions in the world, despite having only 5% of the world’s population. The shocking fact that was thrown around was that “health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.” (Dowell, Haegerich, and Chou)
Over time we realized that the marketing wasn’t true: a person could become addicted even if the opioids were being used for pain. And then we noticed that people started dying from opioid overdoses. Fast.
Fast forward to now. Opioids are prescribed less frequently, which has, of course, caused additional problems with regard to opioid use disorder. Fewer people are being prescribed opioids, but people are still dying from the overdoses. Fast.
Enter gabapentin. In my little corner of the world, Kenosha, Wisconsin, overall toxicity deaths increased 14% from 2018 to 2021. However, in 2018, Kenosha had its very first toxicity death that included gabapentin, and in 2021 there were eleven. That is, gabapentin involvement in toxicity deaths increased 1,000% in four years.
Gabapentin, also known by the brand name Neurontin, is an anticonvulsant, used to prevent and control seizures. But it’s also approved by the Food and Drug Administration to be prescribed, off label, to treat nerve pain, such as that experienced due to shingles. But now it’s also prescribed for other pain, restless legs, anxiety, panic attacks, impulse control, and hot flashes, and, oh, yeah, it’s prescribed for your pet for all of these issues PLUS chronic pain.
Approved by the FDA as an anticonvulsant in only 1993, there are now 69 million gabapentin prescriptions dispensed annually in the United States, already making it the seventh most commonly prescribed medication nationally. (Mattson, Chowdhury, and Gilson) Hydrocodone, on the other hand, was approved by the FDA in 1943 as a cough suppressant and is the tenth most-prescribed prescription in the US.
Are you scared yet?
You should be. It appears that we have learned NOTHING from the overprescribing of opioids.
We’re not quite to the same level as we were with opioid prescriptions, but we now have enough prescriptions of gabapentin for one of every four adults, not to mention all those written for our pets. And that only took us 30 years instead of the 70 or so we needed to completely overuse opioids.
Gabapentin doesn’t kill quickly the way that opioids do; there aren’t the same physical issues with tolerance, so overdosing accidentally by taking a lethal dose is unlikely. That doesn’t make it safe, though! We have this idea that if people don’t die quickly – or die at all – then the substance must be safe, right? Wrong.
People can overdose on gabapentin, and they do, yet a bigger concern is that they are dying with gabapentin in their systems – 1,000% of the time more often now in Kenosha, which can’t be different from other places. Still, the biggest problem – yes, bigger even than death – is the abuse going hand in hand with gabapentin. First, consider that eight of the ten most prescribed drugs are NOT mood altering. They treat cholesterol, high blood pressure, bronchospasm, thyroid deficiency, reflux, and type 2 diabetes. Only two of the most prescribed medications are mood altering: gabapentin for seizures and hydrocodone for pain.
What could go wrong?
I think we know. When a mood-altering medication is prescribed to one out of every four people, there will be negative consequences, no matter how safe we want to pretend that this drug is. With gabapentin, we’re seeing rampant use; we’re seeing misuse; we’re seeing abuse; we’re seeing death.
We’ve been here before, but we can find a way out. As a community we need to fully grasp what Otto Von Bismarck said: “Only a fool learns from his own mistakes. The wise man learns from the mistakes of others.” We won’t be able to learn from our own mistakes; let’s instead be wise with this new epidemic.
References
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1-49. DOI: http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Mattson CL, Chowdhury F, Gilson TP. Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths – 23 States and the District of Columbia, 2019-2020. MMWR Morb Mortal Wkly Rep 2022:71:664-666. DOI: https://www.cdc.gov/mmwr/volumes/71/wr/mm7119a3.htm?s_cid=mm7119a3
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