Some MyOpioidRecoveryTeam members have wondered whether they should take the medication gabapentin for opioid withdrawal. The short answer? Researchers aren’t sure.

Gabapentin is not approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder (OUD). Many doctors prescribe it off-label because it may help ease withdrawal symptoms, but research is mixed as to how well it works.

Keep reading to learn about gabapentin and its possible role in treating OUD. You’ll also learn the safety risks associated with the medication and when it’s appropriate to take it.

🗳️ What has been your experience with gabapentin during opioid withdrawal?

It helped ease withdrawal symptoms

It didn’t make much of a difference

I experienced side effects

I haven’t taken gabapentin for withdrawal

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What Does the Research Show?

Early research suggested benefits of taking gabapentin for opioid withdrawal, but some more recent research disagrees. Here’s a breakdown explaining both sides.

Findings That Suggest Possible Benefits

In 2004, a small study added gabapentin to OUD treatment for seven people with heroin dependence. Each participant took 600 milligrams three times per day, for a total of 1,800 milligrams per day (the usual maximum daily dose). All seven participants completed treatment with fewer withdrawal symptoms and without complications.

Another small study from 2011 compared different gabapentin doses for OUD treatment: 900 and 1,600 milligrams per day. The 1,600-milligram dose decreased symptoms the most, with participants reporting significantly less coldness, diarrhea, yawning, and muscle tension than the 900-milligram group.

Findings That Show Limited or No Clear Benefit

Fewer studies suggest limited to no benefit.

In 2018, a high-quality, but small, research study compared participants’ withdrawal symptoms during OUD treatment with 1,600 milligrams of gabapentin, 450 milligrams of pregabalin (a similar anti-seizure medication), or no added medication. Gabapentin and pregabalin controlled some withdrawal symptoms, but the difference from no medication wasn’t significant enough to say there was an added benefit.

Limitations of Evidence

At first glance, more studies support the effectiveness of gabapentin for opioid withdrawal. But these studies have two big limitations:

• Size — Most studies are too small to draw results you can count on.
• Quality — High-quality studies have controls in place to show that one treatment clearly had an effect, but most of the early studies weren’t well controlled.

Also, the studies used gabapentin as an add-on to OUD treatment. Most OUD treatments use medications such as methadone and buprenorphine to reduce cravings and help taper off opioids. There’s no evidence that gabapentin could be a standalone treatment.

Safety Concerns and Potential Risks

Taking gabapentin also comes with some safety risks, especially for people taking opioids. If you’re considering gabapentin, be sure to review these risks with your doctor.

The possible misuse and wide availability of gabapentin can make the drug extremely dangerous. People with substance use disorders are more likely to misuse gabapentin. Some studies have also found that multiple doctors may unknowingly prescribe gabapentin, and that people can source it from family members, friends, dealers, or the internet.

The FDA issued a warning that serious breathing difficulties can happen with gabapentin or pregabalin. Opioid medications and other CNS-depressing medications (medicines that slow down your central nervous system) also affect your breathing, so combining them with gabapentin can be harmful and even dangerous.

Breathing problems from gabapentin and OUD are life-threatening. If you or someone you care for develops the following symptoms, call 911 or seek emergency treatment right away:

• Short, shallow breathing
• Confusion
• Lightheadedness or dizziness
• Feeling extremely sleepy
• Blue-colored fingers, toes, or lips
• Being unresponsive or difficult to wake up

Talk to Your Doctor

If you’re ready for OUD treatment but you’re nervous about withdrawal symptoms, talk to an addiction specialist. Fear of withdrawal symptoms is common, but it’s not a reason to delay or avoid an opioid treatment program.

When people are anxious about withdrawal during recovery, they’re usually worried about precipitated withdrawal. This type of withdrawal is an intense version of expected opioid withdrawal symptoms and can feel unbearable. But the right care and medications can help prevent it.

When precipitated withdrawal happens, it’s often at the beginning of recovery with your first dose of OUD treatment. If that dose is timed incorrectly, the treatment may affect the brain too much and trigger those intense symptoms.

You and your doctor will work together to find the right schedule and dosing to help prevent intense withdrawal. You’ll also discuss your long-term plan and how to successfully maintain progress alongside personal obstacles like chronic pain or a mental health condition.