Gabapentin is the tenth most prescribed medication in the United States. The majority of gabapentin prescriptions are written for off label indications, such as fibromyalgia, restless leg syndrome, bipolar disorder, attention deficit disorder, hot sweats, and alcohol use disorder. Although there is literature supporting some of these uses, it is not the case for all. Increased prescriptions may be attributed to providers attempting to avoid prescribing opioids, when possible, although substance use disorder individuals appear to have a disproportionate higher risk for gabapentin misuse.
In this article, the authors describe state policies regarding gabapentin misuse and discuss their benefits and risks. Based on the authors’ findings, 22 states and federal districts had strengthened regulations on gabapentin. Of these, 68.2% enrolled gabapentin into their prescription drug monitoring program and 31.8% reclassified gabapentin as a Schedule V controlled substance (C-V). Two other states were in discussions on increased action on gabapentin misuse. Currently, federal guidance is not available for misuse of gabapentin and the states hold the responsibility to oversee gabapentin, which range from no interventions to rescheduling the drug. The authors summarize that harm reduction needs to be through informed public policies to positively impact patient outcomes and enhance gabapentin safety.