Gabapentin Nation: A Pain Pill’s Unexpected Takeover

I find it quite remarkable that a non-narcotic pain reliever called gabapentin has become the fifth most commonly prescribed drug in America. Gabapentin is only moderately effective, and only for a certain type of pain called neuropathic pain. This is the kind of nerve pain common in diabetes and shingles. The reason it is so commonly prescribed is probably due to one of its side effects.

Gabapentin was developed in the 1990s as a synthetic version of a naturally occurring neurotransmitter in the brain called GABA. But it turns out that the drug doesn't actually work the way we thought. In fact, we're still not sure exactly how it works in the brain.

Dr. Scott Fishman is a professor of pain medicine and anesthesiology at UC Davis. He says the drug was only approved as an anti-convulsant to stop seizures.

“It didn't do a great job at stopping seizures, but we realized that its properties to decrease the firing of abnormal nerves that cause seizures were also relevant to the firing of abnormal nerves that cause pain. However, most of the anti-convulsants available at that time had pretty significant side effects, and gabapentin did not.”

But it does have a couple of major side effects, including significant drowsiness and nausea. It turns out the drowsiness helped people in pain to sleep. One reason the drug is so popular now is that it's prescribed for insomnia. As a result, many people have taken gabapentin for years just to sleep.

Prescriptions for gabapentin more than doubled between 2010 and 2024.

Currently, gabapentin is only approved for seizures and for pain after a herpes infection. But doctors prescribe it "off label" — meaning without FDA approval — for neuropathic pain, anxiety, insomnia, and even fibromyalgia. It is more commonly prescribed to older people and more often to women than to men. This increase in use might be a result of the dangers associated with drugs like Valium and Ambien. But now we are learning more about the long-term use of gabapentin. Data suggests that gabapentin has abuse potential and can lead to dependency. More recent studies suggest that long-term use might be a risk factor for dementia and depression.

So why has this drug become so widely prescribed? In part, it might be doctors' fear of prescribing addictive pain-relievers like narcotics, but Dr. Fishman says gabapentin has become popular because we're always looking for a pill that provides an easy answer.

“We are a ‘chemically coping society,’ and gabapentin offers a lot of things that might help some people cope. You had this combination of a drug that was effective for pain, without the education that prescribers need, the sense that it was safe — maybe safer than it actually is — and the fact that it's generic and not terribly expensive.”

Interestingly, nurse practitioners and physician assistants tend to prescribe gabapentin far more than physicians. A prescription takes seconds to write, while non-medication approaches take time to explain — time that's increasingly scarce in today's healthcare system.

– Dr. Michael Wilkes with a Second Opinion