Why Gabapentin is Now a Schedule 5 Controlled Substance in Two States
In January 2019, the state of Michigan classified gabapentin as a Schedule 5 controlled substance. Part of a larger plan to better manage the opioid epidemic in the state, gabapentin was identified by the Michigan Board of Pharmacy as potentially harmful when taken with highly addictive Schedule 1 drugs such as heroin and cocaine. But Michigan was not the first state to change gabapentin’s status from a non-addictive drug to a mildly addictive one. Kentucky was the first to classify gabapentin as a scheduled controlled substance.
The fifth most prescribed pain drug in the US
The 2017 Kentucky decision was partly based on interviews of 33 gabapentin users in rural Appalachia who admitted to using it recreationally to get high. The Centers for Disease Control had been recommending using it for pain relief in place of the more highly addictive opioids. The FDA approved Neurontin for the treatment of post-herpetic neuralgia (shingles) and seizures. Pfizer, Inc, the drug company that made Neurontin—the brand name for gabapentin—touted its off-label use as a treatment for chronic pain caused by neuropathy, fibromyalgia, and migraines. By 2016, its liberal off-label applications and perceived safety culminated in a 49% rise in gabapentin prescriptions from just five years earlier. “In May 2018, it was the fifth most prescribed pain drug in the US… [Also in 2016,] gabapentin showed up in as many as one-third of the state’s fatal overdoses.” Its accessibility is due to two factors.
Cost and accessibility
One factor is that gabapentin prescriptions are easy to get and relatively inexpensive. Prescribers considered the drug safe and effective for multiple uses. Another factor is its street accessibility. Ohio police have reported that the street price of a 300 mg pill can be as low as 75 cents.
In January 2019, FDA commissioner Scott Gottlieb, MD, said that federal health officials are just starting to look at this potential problem. He further stated that gabapentin abuse is not widespread right now, and they will be tracking opioid abusers’ social media discussions about using gabapentinoids – a category that includes gabapentin and Lyrica – as enhancers for their opioid experience.
Street drugs cut with gabapentin
A 2017 Pharmacy Times article reported that street drugs such as heroin are being cut with gabapentin, and that a study of 323 pain clinic patients’ urine tests revealed that 70 contained gabapentin that was not obtained by prescription.
Gabapentin has not yet been reclassified as a controlled substance on the federal level by the Drug Enforcement Administration (DEA). Lyrica, a drug similar to gabapentin, is also FDA-approved to treat epileptic seizures and shingles pain. It is currently classified as a Schedule 5 controlled substance, meaning it has a low potential for addiction and abuse.
Impact on MS patients
If or when gabapentin’s federal classification changes, how will that impact MS patients who have been taking it for neuropathic pain?
I am a Michigan resident. My first refill of gabapentin in January 2019 involved a call from the pharmacy alerting me to the status change and their contact with my prescribing doctor. They told me that I might be asked to show a picture ID with each refill in the future, and that will probably be the extent of the impact on the patient until further notice.
The divide between patients and non-users
But it does raise questions for MS patients who have been taking gabapentin for years, patients who are not addicted and are helped by it. Early reaction to this legislation shows a big divide between non-addict patients and non-users (including pharmacists and other health professionals), a number of whom might have jumped on the political bandwagon to wipe out opioid use both good and bad, as well as medications such as gabapentin picked up in toxicology reports of those who have died from opioid overdose. Many people suffering from chronic pain can only find relief with opioids and gabapentinoids. NSAIDs (naproxen, Aleve, ibuprofen, Motrin, Advil) and Tylenol (acetaminophen) are not effective substitutes. If you take gabapentin or are considering it, please contact your prescribing doctor to discuss your concerns.
Until recently, gabapentin was deemed safe and effective in doses as high as 3600 mg a day. But recent studies indicate that the body expels the drug at doses higher than 600 mg a day. Because of this, my own prescribing doctor has me on 100 mg pills with a cap of 600 mg per day.
It should be noted that ongoing studies of opioid and gabapentin use are invaluable in continuing to reassess risk, efficacy, uses, and abuses.
Editor's note: An earlier version of this article incorrectly stated the number of urine tests that contained gabapentin that was not obtained by prescription. This has been corrected.
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