Gabapentin (Neurontin): Misuse, Withdrawal, and Recovery Support

Gabapentin (Neurontin) is one of the most prescribed drugs in the country. In 2019, 69 million gabapentin prescriptions were dispensed in the United States, making it "the seventh most commonly prescribed medication nationally" (CDC MMWR, 2022). It is not a federally controlled substance, yet it turns up in almost one in ten overdose deaths where toxicology is run, nearly always next to an opioid. The problem is rarely gabapentin alone; it is what gabapentin does to an opioid, a drink, or a benzodiazepine, and how quietly a "harmless" nerve-pain pill becomes something a person cannot get through the day without. This page covers what gabapentin is, why people misuse it, what withdrawal looks like, how a taper works, and how support at home fits.

What gabapentin is and how it works

Gabapentin is approved for two things: "Management of postherpetic neuralgia in adults" (nerve pain after shingles) and "Adjunctive therapy in the treatment of partial onset seizures" (Neurontin prescribing information, section 1). It is sold as Neurontin, Gralise, and Horizant, and as generic capsules, tablets, and oral solution. On the street it goes by "gabbies" or "johnnies." Its close cousin pregabalin (Lyrica) works the same way, is stronger per milligram, and is a Schedule V controlled substance (Lyrica prescribing information, section 9.1); most of this page applies to both.

The name is misleading. Gabapentin is "structurally related to the neurotransmitter gamma-aminobutyric acid (GABA) but has no effect on GABA binding," and it has no affinity for benzodiazepine, opioid, or cannabinoid receptors either (sections 12.1 and 9.2). It quiets excitatory signaling between nerve cells, which is why it calms nerve pain and why it leaves people sedated, loose, and, at high doses, detached.

Three pharmacology facts explain a lot. It is short-acting: the "elimination half-life is 5 to 7 hours" (section 12.3), so a dependent person feels it wear off the same day. Absorption saturates: bioavailability falls from "approximately 60%" at 900 mg a day to 27% at 4,800 mg, so the more you swallow, the smaller the share that gets in, which is one reason people chasing a high take staggering amounts. And it leaves the body through the kidneys "as unchanged drug," so people with reduced kidney function, including many older adults, hold onto it longer.

Federally, "Gabapentin is not a scheduled drug" (section 9.1). States have moved on their own: the DEA's forensic laboratory system reported in 2022 that "At least 26 States and the District of Columbia have enacted legislation or introduced a bill to schedule gabapentin as a controlled substance or to submit distribution information through a reporting system" (NFLIS-Drug, 2022). Kentucky, for one, lists it in Schedule V under state regulation (902 KAR 55:015, section 5).

Dependence, misuse, and addiction are not the same thing

The Neurontin label draws the lines. "Abuse is the intentional, non-therapeutic use of a drug, even once, for its desirable psychological or physiological effects." "Misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by a health care provider or for whom it was not prescribed" (section 9.2). Dependence is the third thing, and it happens to people who did nothing wrong. Take gabapentin every day for months and your body adapts; stop suddenly and it protests. That is pharmacology.

The gap between the general population and people in recovery is striking. A systematic review in Addiction put gabapentin misuse at about 1% of the general population, "40-65% among individuals with prescriptions," and "between 15 and 22% within populations of people who abuse opioids" (Smith, Havens, and Walsh, 2016). The 2021 update of the largest review puts it in one line: "opioid use disorder is the greatest risk factor for gabapentinoid abuse" (Evoy et al., Drugs, 2021). If you are in recovery from opioids and a gabapentin prescription has started to feel like more than a nerve-pain pill, you are not unusual. You are in the group the literature warned about.

Why is it misused? Three reasons. It makes opioids feel stronger: the CDC notes that "gabapentin can be used to potentiate illicit opioids" (CDC MMWR, 2022), and the FDA found that gabapentinoids are "abused in combination with opioids" (FDA Drug Safety Communication, 2019). At large doses it produces its own high: among 503 adults in Appalachian Kentucky who used prescription drugs non-medically, "15% of respondents reported using gabapentin specifically to 'get high'" (DEA Diversion Control Division, 2026). And it is easy to get: generic, prescribed off-label for dozens of reasons, uncontrolled in most states. Between 2012 and 2016, "the number of patients who filled a gabapentin prescription increased from 8.3 million to 13.1 million annually" (FDA, 2019).

Signs gabapentin has become a problem

Here is what families and members describe to us most often. The prescription runs out early, or there is a second prescriber, or pills arrive from a friend. The dose has crept well past any nerve-pain regimen, shrugged off because "it's just gabapentin." They seem drunk without drinking, and the label lists those same signs for overdose: "double vision, tremor, slurred speech, drowsiness, altered mental status, dizziness, lethargy, and diarrhea" (Neurontin prescribing information, section 10). The person in recovery from opioids asks every doctor for it, or times it against the buprenorphine dose. There is sweating and agitation on days the pills run short. Any one of these deserves a conversation. Several together, in someone who also uses opioids or drinks, deserve a call.

Is stopping gabapentin dangerous?

For most people, stopping gabapentin is uncomfortable rather than dangerous, but two exceptions matter, and a taper avoids both. The first is seizures. Gabapentin is an antiepileptic drug, and the label warns that "Antiepileptic drugs should not be abruptly discontinued because of the possibility of increasing seizure frequency" (section 5.5). Its dosing instruction applies to everyone: "If the NEURONTIN dose is reduced, discontinued, or substituted with an alternative medication, this should be done gradually over a minimum of 1 week" (section 2.5). The higher the dose and the longer the use, the further past a week the taper should run.

The second is confusion. The label reports withdrawal "shortly after discontinuing higher than recommended doses," with "agitation, disorientation and confusion after suddenly discontinuing gabapentin that resolved after restarting gabapentin" (section 9.3). A disoriented person falls, drives, or takes something else to make it stop. So: if you have taken gabapentin daily for more than a few weeks, especially above the label's range, do not stop on your own. Call the prescriber and ask for a taper.

The bigger danger is combining gabapentin with other sedatives, covered below, and, for anyone in recovery from opioids, lost tolerance. SAMHSA lists "Using drugs after a recent period of abstinence, which may decrease previous tolerance levels" among the leading overdose risk factors (SAMHSA, 2023).

Gabapentin withdrawal timeline

The published case series describe withdrawal beginning "within 12 hours to 7 days of discontinuation of the medication" (Mersfelder and Nichols, 2016). The width reflects dose, kidney function, and whether the person stopped cold or cut down. Everyone differs; 600 mg at night for sciatica is a different week from 4,000 mg a day on top of methadone. This is the general shape.

First 12 to 24 hours

With a half-life of five to seven hours, blood levels fall fast. The first signs are a return of whatever the drug was quieting: nerve pain, restlessness, anxiety, trouble falling asleep. High-dose users may be sweaty, jittery, and irritable by nightfall.

Days 1 to 3

The peak for most people. Insomnia, sweating, a racing heart, agitation, nausea, and, at high doses, the disorientation the label describes. Seizure risk after an abrupt stop is highest here, and so is "I'll just take a couple to sleep." A taper exists to flatten this stretch.

Days 3 to 7

Physical symptoms ease. Anxiety and poor sleep linger, and the original pain, if there was one, is back and needs its own plan. For people who used gabapentin to boost opioids, this is when the craving shifts to the opioid.

Week 2 and beyond

Most people feel physically normal. Mood and sleep can take longer, and some notice that anxiety they had been treating, knowingly or not, is still there. That is information for your prescriber, not failure.

How treatment works

There is no FDA-approved medication for gabapentin dependence, and most people do not need one. The treatment is a taper written by the prescriber, over at least a week per the label (section 2.5) and usually longer for high doses, plus attention to whatever the gabapentin was actually doing. If the gabapentin was potentiating opioids, the opioid use disorder is the main event, and buprenorphine, methadone, or naltrexone is the standard of care.

Gabapentin is also a legitimate tool in addiction medicine. The American Society of Addiction Medicine's 2020 alcohol withdrawal guideline names gabapentin as an appropriate option for mild withdrawal and an alternative to benzodiazepines for moderate withdrawal, and says that "Gabapentin is a favorable choice for treating alcohol withdrawal when a clinician also plans to use it for a patient's ongoing treatment of alcohol use disorder" (ASAM, 2020, recommendations IV.16, IV.17, IV.32). Many of our members with alcohol use disorder take it as prescribed and do well. The line is between a steady prescribed dose and an escalating, unmonitored one.

Because gabapentin is so often mixed with opioids, naloxone belongs in the house of anyone who misuses it. Narcan 4 mg nasal spray has been sold over the counter since March 29, 2023 (FDA). It reverses only the opioid part, which is usually the part stopping the breathing.

Gabapentin with opioids, alcohol, or benzodiazepines

Read this section twice. In December 2019 the FDA warned that "Serious breathing difficulties may occur in patients using gabapentin or pregabalin who have respiratory risk factors," and named them: opioid pain medicines and other central nervous system depressants, lung conditions like COPD, and advanced age (FDA Drug Safety Communication, December 19, 2019). "Among 49 case reports submitted to FDA over the 5-year period from 2012 to 2017, 12 people died from respiratory depression," and "Most cases occurred in association with co-administered central nervous system (CNS) depressants, especially opioids, in the setting of underlying respiratory impairment, or in the elderly." The Neurontin label now carries the same warning, citing "serious, life-threatening, or fatal respiratory depression when coadministered with CNS depressants, including opioids, or in the setting of underlying respiratory impairment" (section 5.7).

The death data say the same thing. Across 23 states and Washington, D.C., CDC examined 58,362 overdose deaths with toxicology results from 2019 and 2020; "a total of 5,687 (9.7%) had gabapentin detected on postmortem toxicology," and in 2,975 of those (52.3%) it was judged to have contributed to the death (CDC MMWR, 2022). Among deaths with gabapentin detected, the share also involving an opioid "remained consistently high, ranging from 85% to 90%." Poison centers counted gabapentin in "135 fatalities in 2020 alone" (DEA, 2026).

Gabapentin plus fentanyl, plus methadone, plus a few drinks, plus a benzodiazepine at bedtime: each stacks a sedative on a sedative, and the breathing is what gives. If someone you love takes gabapentin and uses any opioid or drinks heavily, keep naloxone in the house and know the FDA's warning signs: "Slowed, shallow, or difficult breathing" and "Bluish-colored or tinted skin, especially on the lips, fingers, and toes" (FDA, 2019).

Drug testing for gabapentin

Gabapentin is invisible to a standard drug test. None of the usual immunoassay lines react to it; the clinical reference on NCBI Bookshelf notes that it "does not appear in urine drug tests" unless specifically ordered (StatPearls, 2024). Whoever orders testing must ask for it by name.

Saliva detection windows are not well established, and we would rather say so than invent a number. With a half-life of five to seven hours (Neurontin prescribing information, section 12.3), most of a single therapeutic dose is cleared within a day or two in someone with normal kidneys. Heavy daily use and reduced kidney function extend that. A prescribed dose will test positive, which is expected; what matters is whether the result matches the plan.

Our members use at-home saliva screening that is assigned at random through the week. You do not choose whether you test; you choose who sees the results. Gabapentin is not on the instant 10-panel strip. For a member whose plan involves gabapentin, screening is run as our lab-confirmed oral fluid test, which a CLIA-certified laboratory confirms by LC-MS/MS and which reports gabapentin and pregabalin as individual analytes at a 2 ng/mL cutoff, alongside fentanyl, buprenorphine, methadone, and the other opioids that travel with it. For most members, the prescriber and, if they want, a spouse or parent see the results. We explain the details in our guide to how sobriety monitoring works.

How recovery from gabapentin works with Accountable

We are not a detox and we do not prescribe. The taper, and any medication for opioid or alcohol use disorder, belong to your doctor. We provide the support around it, at home, in three stages.

1. Get the full picture

In the first sessions your coach maps what is actually going on: how much gabapentin, from how many sources, for how long, and what it is doing for you. Nerve pain, anxiety, sleep, or an opioid that stopped working? Is there alcohol, a benzodiazepine, or fentanyl in the week? Any seizures? If no prescriber knows the real dose, we help you find one, and with your permission we coordinate so the taper, the pain plan, and any medication for opioid or alcohol use disorder come from one page instead of three.

2. Build a plan that fits your life

A gabapentin taper does not require time off work, but it does require a plan for the nights. Your coach helps you plan around the real calendar: what you will do at 2 a.m. when nerve pain and insomnia arrive together, who holds the taper bottle, who you will text before you call the old contact. If opioids are part of the story, naloxone goes in the house in week one. Daily peer group meetings and a weekly family Zoom group give the people around you their own support.

3. Weekly check-ins through the long stretch

Gabapentin's harmless reputation is what makes a return to use so quiet; nobody hides a gabapentin bottle the way they hide a fifth of vodka. Your coach shows up every week, and because gabapentin is on the lab-confirmed test, the screening turns "I think she's only taking what's prescribed" into a shared record that you control. When a result runs higher than the plan, or an opioid shows up next to it, we treat it as information. The plan changes and the support goes up. Every coach at Accountable has their own recovery behind them.

Accountable is covered by a growing list of commercial health plans, with more added each month, and private-pay plans start at $375 per month. You can check your coverage in a few minutes or call the care team at (646) 450-7641. Families are welcome to make the first call; see our page for families.

Common questions

Is gabapentin a controlled substance?

Not federally. The label states "Gabapentin is not a scheduled drug" (Neurontin prescribing information, section 9.1). Several states, including Kentucky, Alabama, Michigan, Tennessee, Virginia, and West Virginia, have made it Schedule V under state law, and others require prescription monitoring program reporting (NFLIS-Drug, 2022).

How long does gabapentin stay in your system?

The half-life is five to seven hours in people with normal kidney function (section 12.3), so most of a single dose is gone within a day or two. Heavy daily use and reduced kidney function extend that. Saliva windows are not well established, and standard panels do not include gabapentin at all.

How long does gabapentin withdrawal last?

Symptoms begin anywhere from 12 hours to 7 days after stopping (Mersfelder and Nichols, 2016), usually peak in the first three days, and ease over about a week. Anxiety and poor sleep can linger longer. A taper over at least a week, and longer for high doses, keeps most of this mild (Neurontin prescribing information, section 2.5).

Can you get high on gabapentin?

At doses far above the prescribed range, yes, and more reliably when it is combined with an opioid. In one Kentucky cohort of people who used prescription drugs non-medically, 15% reported using gabapentin specifically to get high (DEA). Published cases of gabapentin addiction involved "more than 3000 mg/d (600-8000 mg/d)," all in people with a prior alcohol, cocaine, or opioid history (Mersfelder and Nichols, 2016).

What should I do if someone on gabapentin is breathing slowly or will not wake up?

Call 911. If there is any chance opioids are involved, and with gabapentin there usually is, give naloxone; it "rapidly reverses the effects of opioid overdose" (FDA) and does no harm if opioids turn out not to be involved (SAMHSA). Keep them on their side and stay with them. Naloxone does nothing for the gabapentin itself, so they still need emergency care.

Sources

• U.S. Food and Drug Administration. Neurontin (gabapentin) capsules, tablets, and oral solution, prescribing information, revised July 2024.

• U.S. Food and Drug Administration. Lyrica (pregabalin) capsules and oral solution, prescribing information, revised December 2023.

• U.S. Food and Drug Administration. FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR). Drug Safety Communication, December 19, 2019.

• Mattson CL, Chowdhury F, Gilson TP. Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths, 23 States and the District of Columbia, 2019 to 2020. MMWR Morbidity and Mortality Weekly Report, May 13, 2022;71(19):664-666.

• Drug Enforcement Administration, Diversion Control Division. Gabapentin, drug and chemical information sheet, April 2026.

• Drug Enforcement Administration, Diversion Control Division. NFLIS-Drug Special Report: Gabapentin and Pregabalin Reported in NFLIS, 2011 to 2020. January 2022.

• Kentucky Cabinet for Health and Family Services. 902 KAR 55:015, Schedules of controlled substances. Kentucky Administrative Regulations, effective March 12, 2026.

• Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160-1174.

• Mersfelder TL, Nichols WH. Gabapentin: Abuse, Dependence, and Withdrawal. Annals of Pharmacotherapy. 2016;50(3):229-233.

• Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and Misuse of Pregabalin and Gabapentin: A Systematic Review Update. Drugs. 2021;81:125-156.

• American Society of Addiction Medicine. The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management. 2020.

• Yasaei R, Katta S, Patel P, Saadabadi A. Gabapentin. StatPearls, NCBI Bookshelf, updated February 21, 2024.

• Substance Abuse and Mental Health Services Administration. Overdose Prevention and Response Toolkit. PEP23-03-00-001, 2023.

• U.S. Food and Drug Administration. FDA Approves First Over-the-Counter Naloxone Nasal Spray. Press announcement, March 29, 2023.