The antiepileptic drug gabapentin has recently been touted as a support for addiction treatment, both as a means of safe, comfortable detox and as a support for avoiding relapse. However, those in treatment may not be aware of the medication’s capabilities and associated risks with detox and withdrawal treatment in cases of substance abuse.
While research is still ongoing, there is a fair bit of information about the use of gabapentin in detox and the medicine’s potential to help people achieve and maintain recovery from substance abuse. However, when the medicine is prescribed, the individual who receives it may not be aware that there are also risks to using this medication for substance abuse treatment, including a risk of continued addiction to gabapentin itself.
Understanding more about gabapentin can dispel this lack of information and enable treatment professionals and individuals in treatment to make well-informed decisions about the best course of action for their substance abuse treatment plan.
Gabapentin in Addiction Treatment
In the last few years, several studies have demonstrated that gabapentin can be a helpful resource for treating substance abuse in various ways. Specifically, it is useful in treating withdrawal and maintaining abstinence in people struggling with alcohol, benzodiazepine, and opioid addiction.
A research review from Pharmacology & Pharmacy indicates that multiple studies show gabapentin as a positive support to alcohol detox and withdrawal. The drug may help to moderate the discomfort of alcohol withdrawal, and it may also help to manage co-occurring disorders, such as anxiety and depression, during treatment. Because these co-occurring disorders can hinder the addiction treatment process, being able to manage them is likely to provide more positive outcomes from addiction treatment, from detox through recovery.
Gabapentin is also used to help with opioid detox, as detailed in the Journal of Clinical Psychopharmacology, as well as benzodiazepine withdrawal in methadone treatment, described by the American Journal of Drug and Alcohol Abuse. All of these studies indicate major improvements in detox and withdrawal using gabapentin in combination with other treatments, as opposed to using the other treatments alone, as well as in comparison to placebo.
How Gabapentin Affects the Brain
The full mechanism of gabapentin is not thoroughly understood. However, it is known to help calm brain activity through increasing certain neurochemicals in the brain, such as GABA. Originally, it was thought that gabapentin worked through this neurotransmitter system, but the medication doesn’t bind with GABA receptors in the brain, so it is not known exactly what the action of the drug is.
Mental Health Daily states some hypotheses about how the medicine works.
- It reduces electrical stimulation in the brain by interacting with calcium channels in neurons.
- It reduces release of monoamines in the brain.
- It decreases brain cell excitability in certain parts of the brain.
Any and all of these may be part of the action of gabapentin. Research to determine exactly how the drug works is still ongoing.
The main result of gabapentin use is a calming effect, which can help the body manage withdrawal from depressants like alcohol, opioid drugs, and benzodiazepines with a drug that is considered to have a much lower addiction potential.
Detox Using Gabapentin
Using gabapentin to support detox is helpful because of the medicine’s ability to reduce withdrawal symptoms. This is beneficial because the symptoms of withdrawal and the detox process present some of the most difficult aspects of substance abuse treatment; these symptoms and the often overpowering cravings for drug use that accompany them can make it extremely tempting for individuals to relapse into substance use.
As indicated in the studies mentioned above, gabapentin’s ability to decrease much of the discomfort of withdrawal can help individuals navigate this relapse risk, getting them through the difficult detox phase without returning to substance use. The individuals can then move into the therapeutic aspects of substance abuse treatment to make it more likely that they will achieve recovery at the end of the treatment period.
Risks of Use in Detox
Use of gabapentin in detox does pose certain potential risks. Some of those risks include the following.
- Seizures: Pharmacology & Pharmacy mentioned the existence of five seizures or suspected seizures during the research studies on gabapentin-supported detox. In fact, even though it is an anti-seizure medication, gabapentin can also cause seizures in some people. Increased incidence of seizures is also a risk when ceasing use of gabapentin. This can be a substantial risk for some individuals. A study from American Family Physician also indicates that, contrary to expectations, gabapentin may not prevent seizures caused by alcohol withdrawal syndrome, one of the most dangerous complications in alcohol detox.
- Severe side effects: People using gabapentin can have other uncomfortable or even severe side effects when using the drug. According to Medline Plus, these include:
- Shakiness, tremors, unsteadiness, weakness, and drowsiness
- Digestive upset, including nausea, vomiting, heartburn, appetite loss, and diarrhea or constipation
- Problems with memory, strange thoughts, anxiety, and dizziness
- Swelling of extremities, joint and back pain, headaches
Allergic reaction is also a risk with this drug, as with any other medication. If side effects are too disruptive, it may make the detox process harder and negate any benefit that might have come with easing withdrawal symptoms.
- Addiction: While it was expected that gabapentin would have a much lower addiction potential due to the fact that it doesn’t bind with neurotransmitter receptors, several incidences of gabapentin addiction have been noted, including multiple case studies reviewed and analyzed through Medscape. In particular, it seems that addiction to gabapentin is more likely among those who have a history of other addictions. For this reason, treatment professionals should carefully assess an individual’s risk for developing a complicating addiction to gabapentin before using it to treat detox and withdrawal from other drugs.
Gabapentin can be greatly beneficial to the detox and withdrawal process. Under the care of an experienced treatment professional, and by carefully following prescription instructions, a person entering detox from alcohol, opioids, or benzodiazepines can experience a milder, more comfortable withdrawal process, making it easier to stick to abstinence all the way through the detox process. This, in turn, increases the likelihood that the person will complete the rest of the substance abuse treatment program and emerge in recovery.
For this to have the best chance of working without leading to relapse or transferring addiction to gabapentin, it is important to attend a research-based treatment program with experienced personnel who can measure the benefits against the risks and determine whether gabapentin is the right treatment for the individual. Through personalized, careful treatment, gabapentin can be part of a program that leads an individual to sustained sobriety and a brighter future.