In the midst of the opioid epidemic and decline of Oxycontin, doctors are left scrambling to try and solve the issue that Oxycontin promised: relieve for chronic pain. As an alternative, Doctors started to embrace a drug called Gabapentin—traditionally a preventive drug for seizures—as a way to treat chronic pain. Gabapentin was supposed to be a less addictive option, but recent research suggests that it isn’t the “miracle” replacement for Oxycontin that doctors were hoping. Prescriptions for Gabapentin increased by 64 percent from 2012-2016. Another popular replacement for opioids is Baclofen, a muscle relaxant, that is sometimes prescribed in conjunction with Gabapentin. Both drugs are known to cause a “high” similar to the effects of alcohol but have been thought to be less addictive and less fatal than opioids.
While Gabapentin and Baclofen are safer alternatives to opioids, they still have dangers—especially when combined with other sedatives— that have created discomfort for doctors and creating second thoughts on providing prescriptions. Olga Khazan writes in her article “Chronic Pain is an Impossible Problem” for the Atlantic, that “the findings are a frustrating turn that suggests there’s still no silver bullet for chronic pain.”
Kimberly Reynolds, a researcher at University of Pittsburg, and her co-authors have found that people are using both Gabapentin and Baclofen to get high or attempt suicide. In her study Reynolds points out that “While gabapentin and baclofen are less likely than opioids to result in fatal overdose, they are associated with dependence, misuse and adverse effects.” In her conclusion, Reynolds urges “careful consideration” for prescribing both medications. Some of the findings from Reynolds’ study include: From 2013-2017 there are 42,000 cases of people attempting to commit suicide with gabapentin, with thousands of more cases including misuse and abuse. 70 percent of individuals who had poisoning from gabapentin took it in combination with another drug. Gabapentin is not necessarily dangerous alone, but when combined with other opioids or drugs, or given in high dosages, it can become fatal. According to Khazan, “just as opioids were used to get recreationally high and potentially cause overdose, it appears that their replacements are as well.” Reynolds and her co-authors point out that people have taken gabapentin or baclofen with benzodiazepines or opioids to increase their “high.”
It has been suggested by various researchers and doctors, including Reynolds, that patients should be screened for substance-abuse disorders, mood disorders, or suicidal thoughts before being prescribed gabapentin and baclofen. Current patients taking gabapentin are urged to not mix it with any other drugs, especially alcohol and opioids. Kentucky, Tennessee, and Michigan have reclassified gabapentin as a Schedule 5 controlled substance. Several other states have also began referring to it as a serious drug, rather than a typical pain reliever. Baclofen has not received this same kind of treatment and has not been scheduled by any states. A recent study by Oliver Enke and co-authors has proven that gabapentin is ineffective as a pain reliever for lower back-pain, raising more questions to doctors as to whether or not the drug should be prescribed in the first place.
The problem of how to deal with chronic pain is still at large. One thing is sure though, finding a safer alternative to Oxycontin is not going to be easy, and should not be taken lightly. As Reynolds points out in the conclusion of her study, “while the risks of opioids have been publicized, medication alternatives to opioids also carry risks that need to be better understood.” There is still a lot that is unknown about alternatives to opioids, so patients and doctors alike should use caution when it comes to the drugs they’re interacting with, whether they’re taking them or prescribing them.