Key takeaways
Gabapentin is a generic prescription medication used for many medical conditions. It’s FDA-approved to treat certain types of nerve pain and seizures. However, healthcare providers also prescribe the drug off-label to treat conditions such as fibromyalgia, anxiety, and bipolar disorder.
There have been increasing reports of gabapentin misuse, either alone or with opioids to enhance their euphoric (“high”) effects.
At the federal level, gabapentin is not a controlled substance. However, some states have implemented their laws to reclassify gabapentin as a Schedule V controlled substance.
In states that label gabapentin as a controlled substance, there may be regulations mandating specific requirements for prescriptions, as well as limits on the quantity prescribed or refills available.
Gabapentin is an anticonvulsant approved by the U.S. Food and Drug Administration (FDA) for certain types of nerve pain, seizures, and restless leg syndrome. Since its approval in 1993, gabapentin use has grown significantly. In 2021, 70.9 million gabapentin prescriptions were dispensed by U.S. pharmacies. Its popularity is partly due to its versatility in treating various medical conditions. Doctors prescribe gabapentin off-label for several other medical conditions, including general neuropathic pain, bipolar disorder, anxiety, fibromyalgia, and migraines.
After its approval in 1993, there was no known risk of misuse or addiction to gabapentin. However, there are growing concerns that gabapentin may have more risks than people realize. At this time, gabapentin isn’t recognized as a controlled substance on the federal level. However, several states have passed laws to classify it as a Schedule V controlled substance.
RELATED: What is Gabapentin: Uses, Warnings & Interactions
Is gabapentin a controlled substance?
Gabapentin isn’t classified as a controlled substance by the federal government. However, some states recognize it as a Schedule V controlled substance and regulate its use. This is because of the growing concerns about misuse and abuse of the drug.
Controlled substances are classified into five categories, or schedules, by the United States Drug Enforcement Administration (DEA). The schedule depends on the drug’s potential for abuse or dependency. Schedule V drugs have a lower potential for abuse than all other controlled substances. This means gabapentin has a lower risk of abuse compared to Oxycontin (oxycodone), which is a schedule II opioid medication.
At this time, seven states label gabapentin as a controlled substance. These include:
- Alabama
- Kentucky
- Michigan
- North Dakota
- Tennessee
- Virginia
- West Virginia
Certain other states require that gabapentin prescriptions be reported to a prescription drug monitoring program (PDMP). These states include:
- Kansas
- New Jersey
- Nebraska
- Connecticut
- Minnesota
- Ohio
- Washington D.C.
- Massachusetts
- Indiana
- Utah
- Oregon
- Wyoming
- Wisconsin
Gabapentin refill laws and requirements
Because gabapentin isn’t labeled as a controlled substance at the federal level, its prescribing and dispensing laws are the same as those for non-controlled substances unless state law says otherwise. In states that classify it as a controlled substance, there may be specific prescription requirements, as well as limits on the quantity prescribed or refills available.
As an example, Virginia passed a law in 2019 to classify gabapentin as a Schedule V controlled substance. This means Virginia pharmacies must comply with the state’s controlled substance laws when dispensing and refilling gabapentin prescriptions. Some of the Virginia laws for Schedule V controlled substances include:
- The drug shall not be dispensed or refilled more than six months after the original prescription date.
- The prescription may not be refilled more than five times.
Recent changes to gabapentin refill laws
According to the Centers for Disease Control and Prevention (CDC), people may use gabapentin to strengthen the effects of illegal opioids. Reports of intentional abuse, misuse, or unknown exposures to gabapentin have increased by 104% from 2013 to 2017. Gabapentin was detected in almost 10% of overdose deaths between 2019 and 2020.
The DEA also associates gabapentin with sedative and psychedelic effects and recognizes that the drug can intensify the euphoric (“high”) effects of opioids. There are concerns that this is contributing to the opioid epidemic. Although gabapentin is typically safe when taken on its own, when it’s used in combination with other drugs that depress the central nervous system or alcohol, the risk of respiratory depression and potentially death increases significantly.
As a result, several states have taken necessary action to reduce these risks by making gabapentin a controlled substance. In these states, there are stricter regulations on prescribing and dispensing gabapentin. Each state may regulate gabapentin slightly differently, setting its own time, quantity, or dosage limits to minimize the risk of drug misuse and abuse. For example, Rhode Island law only allows up to a 90-day supply for prescriptions for Schedule V controlled substances.
Tips for patients on managing gabapentin refills
Whether you’re taking gabapentin for nerve pain, seizures, fibromyalgia, or anxiety, you must follow the directions of your medical professional. Taking more gabapentin than prescribed can increase your risk of serious side effects, including sleepiness and dizziness. On the other hand, you should not stop taking gabapentin without talking to your healthcare provider first. Abruptly stopping the medication can lead to withdrawal symptoms or more frequent seizures if you’re taking the drug for seizure disorders. With that being said, it’s also important to stay on top of gabapentin refills so you don’t run out of medication. To do so, consider enrolling in automatic refills at your pharmacy. That way, your pharmacy can refill your medication automatically when running low.
Other ways to limit side effects and the potential for drug abuse and misuse include:
- Take gabapentin exactly as prescribed.
- Check with a healthcare provider before starting new medications, supplements, or vitamins.
- Avoid alcohol use during gabapentin treatment.
- Avoid other central nervous system depressants, including drugs that make you sleepy or dizzy.
Future of gabapentin regulation
As of June 2024, gabapentin remains a non-controlled substance under the U.S. federal government. With mounting evidence of misuse and abuse of gabapentin use, certain states have implemented regulations or policies to limit or monitor the use of the drug, especially given its potential to enhance the effects of opioids. Some experts and nonprofit groups have called for national reclassification of gabapentin as a controlled substance.
Despite these efforts to reclassify the drug, gabapentin is only regulated in some states as a controlled substance. Concerns remain about its risk of misuse and abuse, especially when taken with opioids.
Sources
- Detection and involvement in drug overdose deaths – 23 states and the District of Columbia, 2019-2020, Centers for Disease Control and Prevention (2022)
- Drug scheduling, United States Drug Enforcement Administration (n.d.)
- FDA, DEA pushed to make gabapentin a controlled substance to stop “widespread misuse”, Medscape (2022)
- FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR), Food and Drug Administation (2019)
- Gabapentin (Neurontin), Drug Enforcement Administration (2023)
- Gabapentin for off-label use: Evidence-based or cause for concern? Substance Abuse (2018)
- Gabapentin tablets, for oral use prescribing information, Food and Drug Administration (2024)
- Gabapentin use, abuse, and the U.S. opioid epidemic: The case for reclassification as a controlled substance and the need for pharmacovigilance, Risk Management and Healthcare Policy (2018)
- Prescription drug time and dosage limit laws, Centers for Disease Control and Prevention (2015)
- Scheduling of gabapentin, Virginia Department of Health Professions (2019)
- Should gabapentin be a controlled substance? Neurology Today (2022)