Dental Dose: How patients use gabapentin illicitly

By Theresa Pablos, DrBicuspid.com editor in chief

September 24, 2021 -- Dental Dose is a twice-monthly video series featuring pharmacologist Tom Viola, RPh. In each episode, Viola shares bite-sized pieces of dental pharmacology news, facts, and myths.

Now that Dental Dose has wrapped its review of local anesthetics, we're turning our attention to ways patients may use legal drugs used illicitly -- starting with gabapentin.

"This is a realm of pharmacology that's definitely on the darker side," Viola said in the episode.

Gabapentin is a legal drug sold under the brand names Horizant and Neurontin. It started as a drug for epilepsy but had much greater success as a treatment for neuropathy, the kind of pain caused by nerve damage.

"This was born out of years of research into things like phantom limb pain," Viola said.

Gabapentin rose to stardom because it was one of the few medications that could block certain erroneous pain signals from reaching the brain. That led physicians to think it might also work with people with chronic pain. That's right, the same type of pain often treated with opioids.

So physicians begin to prescribe gabapentin and opioids together. But as patients grew tolerant to the effects of the opioids, they needed higher and higher doses to live without pain.

"Because of the nature of opioids -- the fact that they're very addictive if you take them long term -- these nice folks become dependent on the opioid and maybe start taking too much," Viola said.

While the law prohibits these patients from getting a refill of opioids too soon, they still have plenty of gabapentin left from their prescription. And "necessity is the mother of invention," he said.

"What are these nice folks supposed to do? Live in pain?" he asked. "They take higher and higher doses of gabapentin to see if they can alleviate their pain because they have no opioid left."

Well, guess what? It turns out that gabapentin can produce an opioidlike effect if taken in high doses. It doesn't take long for the word to get out, and now, gabapentin has become a drug of abuse, Viola said.

Watch the video below to learn more about legal and illicit gabapentin use, as well as one important side effect of high gabapentin use that dental professionals need to be aware of.

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