Is gabapentin an opioid?

In this article:

• Is gabapentin an opioid?
• How is gabapentin different from opioids?
• Can gabapentin be used in combination with opioids?
• Is gabapentin a safer alternative to opioids?

In this article

• Is gabapentin an opioid?
• How is gabapentin different from opioids?
• Can gabapentin be used in combination with opioids?
• Is gabapentin a safer alternative to opioids?

Gabapentin, sold under the brand names Neurontin and Gralise, is an anticonvulsant medication that’s FDA approved to treat seizures and postherpetic neuralgia, which is nerve pain after a bout of shingles. Gabapentin is also frequently used off-label to treat conditions like migraines, fibromyalgia, substance dependence, and mood disorders.

If you are taking gabapentin for pain-related symptoms, you might be wondering: Is gabapentin an opioid? The answer is that although both gabapentin and opioids are often used to treat pain symptoms, they are not the same type of drug. Gabapentin is classified as an anticonvulsant and treats pain symptoms by changing how your brain and nerves sense pain.

What are opioids?

Opioids are controlled substances prescribed by healthcare professionals to treat instances of severe, acute pain. They work by attaching to opioid receptors in your brain and nerves and blocking pain signals. They also produce strong feelings of calm and relaxation. Opioids include various medications, both legal and illegal. These include hydrocodone, oxycodone, heroin, morphine, fentanyl, and codeine. Although these drugs can work well for severe pain, opioids can be highly addictive and are frequently misused.

Is gabapentin an opioid?

No, gabapentin is not an opioid, says Sean Ormond, MD, a physician dual-boarded in anesthesiology and is an interventional pain management physician at Atlas Pain Specialists. It’s in a different medication class and is classified as an anticonvulsant, not an opioid. Gabapentin is “primarily used for nerve pain and conditions like seizures, acting on the nerves to calm them down,” Dr. Ormond explains. “It doesn’t target the same pain pathways in the brain as opioids.”

Additionally, opioids are classified as controlled substances in the U.S. by the federal government, which means that they have the potential to be abused. But gabapentin is not classified this way. Still, some individual U.S. states have begun classifying gabapentin as a controlled substance. These states include Kentucky, Michigan, Alabama, North Dakota, Virginia, Tennessee, and West Virginia.

Why is state-specific classification happening? “This is mainly because there have been concerns about people misusing gabapentin, especially in combination with opioids, to increase effects like sedation or euphoria,” Dr. Ormond describes. “When a drug is labeled as a controlled substance, it means there are stricter rules on how it can be prescribed and dispensed, mainly to help prevent misuse and keep people safe.”

Finally, if you are concerned that gabapentin will show up as an opioid on a drug screen test, be assured that it won’t. “When it comes to drug testing, gabapentin won’t show up as an opioid,” Dr. Ormond assures. “It’s typically not on standard drug panels unless you’re being specifically tested for it.”

How is gabapentin different from opioids?

Gabapentin and opioids are not the same. “While gabapentin and opioids can both be used to treat pain, the two medications are very different,” explains Morgan Jacobs, PharmD, a clinical pharmacist at Realo Drugs in New Bern, North Carolina. “Gabapentin is an antiseizure medication that is only FDA-indicated to treat seizures and postherpetic neuralgia, a type of nerve pain that occurs after a shingles outbreak,” she explains.

On the other hand, opioids are controlled substances prescribed particularly for pain management, Jacobs says. “Opioids are powerful painkillers because they block pain signals directly in the brain and spinal cord,” Dr. Ormond says. “They can be incredibly effective for acute or severe pain, like after surgery or a major injury.” Of course, while powerful, they come with serious risks, including addiction, overdose, and concerning side effects like drowsiness and constipation, he says.

These two medications also differ in how they work in the body. While opioids block pain signals directly in your brain and spinal cord, gabapentin “doesn’t work by directly blocking pain,” says Dr. Ormond. Instead, gabapentin “modifies how nerves react to pain signals,” he explains.

Can gabapentin be used in combination with opioids?

Yes, in some cases, gabapentin can be used with opioids, but this must be done under the careful supervision of your healthcare provider, Dr. Ormond emphasizes. “There are situations where combining the two might be beneficial, especially if someone is dealing with both nerve pain and more general pain,” he says. “For example, if someone has nerve damage and also a recent injury or surgery, a doctor might prescribe both to manage different types of pain.”

However, as Jacobs stresses, there are serious risks in taking these two medications together. That’s because, when taken at the same time, gabapentin and opioids can increase the negative side effects of each medication. “Concomitant use of the two has been shown to cause significant central nervous system (CNS) depressant effects, such as slowed breathing and heart rate, which can be fatal,” Jacobs warns. The use of these two medications together is also linked with an increased risk of hospitalization and opioid-related deaths, Jacob adds.

As Jacobs notes, this is why in 2019, the FDA issued a warning about opioids with medications like gabapentin, warning that such combinations could lead to serious breathing difficulties. 

 Is gabapentin a safer alternative to opioids?

In general, gabapentin is a safer option than opioids. This is mostly because, while gabapentin does have the potential to be addictive, it’s not considered as addictive as opioids are, and is not classified as a federally controlled substance. That said, gabapentin does have potentially serious side effects, including drowsiness, loss of coordination, and impaired mental capacity.

Whether or not to use gabapentin in place of opioids depends on what condition you are treating. “The reason I might choose gabapentin over an opioid would depend on the nature of the pain,” Dr. Ormond says. “If someone is experiencing chronic nerve pain, like in the case of diabetic neuropathy, post-surgical nerve pain, or pain after shingles, gabapentin could be a much safer and effective choice.”

If someone is experiencing generalized, severe, acute pain, gabapentin might not be the best option, and opioids may be recommended. At the same time, “for anyone who doesn’t need opioid-level pain relief, or if they’re trying to avoid opioids due to concerns about addiction, gabapentin is a great alternative,” says Dr. Ormond.

It’s also important to note that although the addictive qualities of gabapentin are milder than opioids, they do exist. “Even with appropriate use, both opioids and gabapentin have the potential for psychological and physical dependence to occur and should always be used with caution,” Jacobs describes. People with a history of substance misuse of any kind should be extremely cautious with both gabapentin and opioids, she says.