A qualitative study of gabapentin use and misuse: perspectives of substance abuse treatment professionals

Background: Recent reports have shown that gabapentin is misused for the purpose of getting high. At the same time, literature indicates that gabapentin is frequently prescribed to substance abuse treatment clients to ease withdrawal symptoms or treat mental health problems (e.g., anxiety, depression). This ongoing qualitative study examines the therapeutic benefits and potential risks related to gabapentin prescribed as part of substance abuse treatment.

Methods: In-depth interviews are conducted with a range of substance abuse treatment professionals (e.g., social workers, therapists, clinicians). Eligible key informants report current employment in the substance abuse treatment field and direct contact with clients. To date, 11 interviews have been completed. Interviews are being coded using descriptive and in vivo coding schemes and themed for analysis using Atlas.ti software.

Results: All interviewees were familiar with gabapentin misuse among treatment clients and described it as a recent problem. Approximately one-third of professionals considered gabapentin to have therapeutic value for a limited number of treatment clients. However, nearly all professionals described gabapentin as being overprescribed because prescribers’ lack specific knowledge of patients’ histories, prescription drugs of misuse, and addiction. Structural pressures in treatment settings also contribute to the overprescribing of gabapentin, including the profit motivations of treatment center owners and health insurance reimbursement policies. The professionals nearly universally described gabapentin prescriptions as being risky for individuals with multiple treatment histories because of the potential for misuse leading to a revival of drug-seeking and using behaviors, especially when the client enters lower levels of care (e.g., halfway house). To address this issue, all but one professional endorsed adding gabapentin to the federal list of scheduled drugs as was done in the state of Kentucky. Approximately half also endorsed alternative therapies or medications to assist clients in coping with treatment, withdrawal, and any co-occurring mental health problems.

Conclusions: Although these results are preliminary, they are the first apparent report of substance abuse treatment professionals’ experiences with gabapentin use and misuse among substance abuse treatment clients. Given the continuing prescription drug misuse crisis in the United States, every effort must be made to ensure that substance abuse treatment services are able to best serve clients. Greater communication between prescribers and treatment professionals may make prescribing safer for patients. Policy changes, including adding gabapentin to the federal list of scheduled drugs, may help decrease overprescribing and limit the potential for substance abuse treatment clients to misuse gabapentin.