Gabapentin Misuse and Withdrawal: Is It a Narcotic, and Why Opioids Change the Risk

Is gabapentin a narcotic?

No. Gabapentin (Neurontin; Gralise and Horizant are other brands) is not an opioid, and its FDA label says it does not bind to opioid, benzodiazepine, or cannabinoid receptors. It is approved for nerve pain after shingles and, alongside other drugs, for partial-onset seizures.

It is also not a federally controlled drug. The label says it plainly: “Gabapentin is not a scheduled drug.”

Neither of those facts makes it harmless. The risk that shows up in the overdose death data is gabapentin taken with an opioid, and that combination is most of what this page is about.

Is gabapentin a controlled substance in New Jersey?

No, but New Jersey watches it as if it were. Since May 7, 2018, pharmacies have had to report every outpatient gabapentin prescription they fill to the state Prescription Monitoring Program, the same database that tracks Schedule II through V drugs. In June 2019 the Division of Consumer Affairs made that permanent, citing concerns about use outside of what federal law authorizes and the drug’s “abusive potential.”

At least one state has gone further and scheduled gabapentin itself: Kentucky lists it in Schedule V. State rules change, so check the current list for any state other than New Jersey.

Who misuses gabapentin, and why it matters for detox

The label says misuse and abuse have been reported, that most of the people in those reports had a history of using several substances, and that some took more than the recommended dose for unapproved uses. It tells prescribers to watch for dose escalation and drug-seeking.

A 2016 systematic review in Addiction found reported misuse of about 1 percent in the general population and 15 to 22 percent in populations of people who misuse opioids. People misused it alone or with other substances, especially opioids, benzodiazepines, and alcohol.

That overlap matters at detox intake. Someone coming in for opioid or alcohol withdrawal may be taking gabapentin too, prescribed or not. Put it on the medication list, even though it is not a controlled drug.

Gabapentin and opioids

In December 2019 the FDA warned that gabapentin and pregabalin can cause serious breathing problems in people with respiratory risk factors: taking opioids or other drugs that slow the central nervous system, lung disease such as COPD, and older age. It required new label warnings, and required manufacturers to study abuse potential, particularly with opioids, because misuse of the two together is increasing.

Pfizer’s current prescribing information backs that up. It says respiratory depression and sedation, sometimes resulting in death, have been reported when gabapentin is taken with opioids, and names morphine, hydrocodone, oxycodone, and buprenorphine. In one study it cites, taking morphine two hours before gabapentin raised gabapentin levels (AUC) by 44 percent.

What the death data show

• Ontario, 1997 to 2013. Among people on prescription opioids through Ontario’s public drug plan, those also prescribed gabapentin had about 49 percent higher adjusted odds of dying of an opioid-related cause, and nearly 60 percent higher at moderate and high gabapentin doses, in a PLoS Medicine case-control study. It is observational, so it shows an association, not proof of cause.
• 23 states and DC, 2019 to 2020. CDC data in MMWR found gabapentin on the toxicology report in 9.7 percent of overdose deaths that had toxicology results. Among those deaths, 85 to 90 percent in each quarter involved an opioid, and gabapentin was judged a cause of death in about half.

Gabapentin alone can also be dangerous in overdose. The label reports fatal respiratory depression with gabapentin overdose, alone and with other sedatives.

If someone you know uses gabapentin with opioids, keep naloxone in the house. It reverses the opioid; it does nothing for gabapentin, so call 911 as well. Our naloxone guide for families covers how to get it in New Jersey.

Gabapentin withdrawal

The label reports reactions after gabapentin was stopped abruptly, most often anxiety, insomnia, nausea, pain, and sweating. It also describes rare reports of agitation, disorientation, and confusion in people who suddenly stopped doses higher than recommended, which cleared once gabapentin was restarted.

The onset window comes from a 2016 review in the Annals of Pharmacotherapy, which also found that every addiction case in the reports it reviewed involved someone with a prior history of alcohol, cocaine, or opioid misuse, and that patients averaged more than 3,000 mg a day.

Can gabapentin withdrawal cause seizures?

For anyone taking it for epilepsy, yes; that is the seizure risk the label names. Evidence on people without epilepsy is thin, so do not read it as a guarantee. The label warns that seizure drugs should not be stopped abruptly because seizures can become more frequent. Anyone with a seizure disorder, or who is also withdrawing from alcohol or benzodiazepines, needs a clinician running the plan, whatever the source of the gabapentin.

How to stop gabapentin safely

Slowly, and with the prescriber. The label says that when the dose is reduced, stopped, or switched to another medication, it should be done gradually over at least one week, and longer if the prescriber judges it necessary. Do not stop a prescribed medication on your own.

• Prescribed, no other substances. Work out the taper with the prescriber.
• Higher than prescribed, or from the street. Say so. A clinician can only taper from the dose you are actually taking.
• With opioids, alcohol, or benzodiazepines. This is a polysubstance withdrawal, and the plan has to cover every drug involved. Our polysubstance detox guide covers where to go in New Jersey.

For opioid withdrawal in particular, tell the team about gabapentin before any medication starts. The label tells prescribers to monitor for breathing problems and sedation and to consider a low gabapentin dose when it is combined with an opioid, and that includes buprenorphine.

In New Jersey

Under New Jersey law P.L.2017, c.28, fully insured New Jersey plans and the State Health Benefits and School Employees’ plans cannot require prior authorization for the first 180 days per plan year of in-network treatment your own physician, psychologist or psychiatrist finds medically necessary, or, during those same 180 days, for outpatient prescription drugs that treat substance use disorder, such as buprenorphine and naltrexone, when that clinician finds them medically necessary. Self-funded employer plans, Medicare and Medicaid are not covered by that rule, so verify with the plan.

NJ FamilyCare covers buprenorphine, methadone, and naltrexone. Residential detox is authorized through the IME for most members, and residential care and opioid treatment programs are scheduled to move into the NJ FamilyCare health plans in January 2027.

For help independent of us, the state’s IME Addictions Access Center at 1-844-276-2777 screens NJ FamilyCare and uninsured residents and refers them to treatment, and ReachNJ, the state treatment line, is at 1-844-732-2465. Periscope Behavioral Health, which publishes this site, is opening a medical detox in Hammonton, Atlantic County, expected Summer 2027. Until it opens, Periscope Behavioral Health at (888) 313-3583, our publisher’s admissions line, can talk through options in New Jersey and Florida, including facilities Periscope operates. What a plan covers depends on the plan and the facility’s network status.

What to tell a doctor or detox program

Four answers help decide whether stopping gabapentin is a taper with the prescriber or a supervised detox:

1. The real daily dose, including anything taken beyond the prescription.
2. Every other substance: opioids, buprenorphine or methadone, alcohol, benzodiazepines, sleep aids.
3. Any history of seizures, and any past withdrawal seizure.
4. Any lung disease, and your age if you are older; both raise the breathing risk the FDA flagged.