Epidemic ensnares older pill for nerve pain
WASHINGTON—The story line sounds familiar: a popular pain drug becomes a new way to get high as prescribing by doctors soars.
But the latest drug raising red flags is not part of the opioid family at the center of the nation’s drug epidemic. It’s a 25-year-old generic pill long seen as a low risk way to treat seizures, nerve pain and other ailments.
The drug, called gabapentin, is one of the most prescribed medications in the U.S., ranking ninth over the last year, according to prescription tracker GoodRx. Researchers attribute the recent surge to tighter restrictions on opioid painkillers, which have left doctors searching for alternatives for their patients. Those same forces are changing the drugs that Americans abuse, according to experts.
“We’re basically squeezing people into other drugs because the prescription opioids are becoming a lot harder to get,” said Dr. Richard Dart, who tracks drug abuse through a national data network owned by the state of Colorado.
While prescriptions for opioids like Vicodin and Oxycontin have been falling since 2012, health regulators have seen increased overdoses with unexpected medications, including the overthe-counter diarrhea drug Imodium.
The Food and Drug Administration is now studying patterns of prescribing and illicit use of gabapentin and will soon share its findings, said Commissioner Scott Gottlieb. “One of the lessons from this whole opioid crisis is that we probably were too slow to act where we saw problems emerging and we waited for more definitive conclusions,” Gottlieb said. “I don’t want to be sitting here five or 10 years from now lamenting that we didn’t take more aggressive action.”
Many doctors aren’t aware of gabapentin’s potential for abuse, particularly among those with a history of misusing drugs, said Rachel Vickers Smith of the University of Louisville.
People tracked in her research describe gabapentin as a “cheap high” that is almost “always available.” They report mixing the drug with opioids, marijuana and cocaine to enhance the high, with effects ranging from “increased energy” to a “mellow” numbness.
Medical journal articles estimate that between 15 and 25 percent of opi- oid abusers also use gabapentin. And emerging research suggests combining gabapentin and opioids heightens the overdose risks. Gabapentin, on the market since 1993, has long been considered nonaddictive and is not tracked as closely as riskier drugs like opioids. But calls to U.S. poison control centers show a stark rise in abuse and overdoses.
The abuse rate increased nearly 400 percent between 2006 and 2015, according to poison center data analyzed by the RADARS research group within the Denver Health and Hospital Authority, a state-owned health system. The group’s work is funded by drugmakers and government agencies, though they don’t participate in the analysis or publication of the data.
In some parts of the U.S., the rise in gabapentin abuse has led to new restrictions and surveillance.
Last year, Kentucky became the first state to classify the drug as a “scheduled substance,” placing it among other high-risk medicines subject to extra restrictions and tracking. Gabapentin was detected in a third of fatal overdose cases analyzed by Kentucky medical examiners in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.
Ohio, Minnesota, West Virginia and several other states have begun tracking gabapentin through their prescription databases. Ohio took that step after gabapentin became the most dispensed drug in the state. State surveys of drug users also indicated it was “extremely easy to get” with a street price around $1.50 per capsule.