WASHINGTON – The story sounds familiar: a popular pain drug is becoming a new way to get high as the doctors rise.
But the latest drug raising red flags is not part of the opioid family at the center of the nation drug epidemic. It is a 25 year old generic pill that has long been regarded as a low-risk method of treating seizures, nerve pain and other ailments.
The drug gabapentin is among the most widely prescribed medications in the US and ranks ninth last year, according to GoodRx Tracker prescription. Researchers attribute the recent increase to stricter restrictions on opioid analgesics, which has led physicians to seek alternatives for their patients.
The same forces are changing the drugs Americans abuse, experts say.
"We basically squeeze people into other drugs because the prescription opioids are much harder to get," Dr. Richard Dart, who tracks drug abuse through a national data network of the state of Colorado.
While Prescriptions for Opioids Like Vicodin and Oxycontin Since 201
The Food and Drug Administration is currently investigating the prescribing patterns and the illegal use of gabapentin and will soon be sharing its findings, said Commissioner Scott Gottlieb.
"One of the lessons from this whole opioid crisis is that we were probably too slow to trade. We saw problems emerge and we awaited more definitive conclusions," said Gottlieb. "I do not want to sit here in five or ten years and cling that we did not act more aggressively."
Many doctors are unaware of the potential of gabapentin for abuse, especially those with a history of drug abuse, said Rachel Vickers Smith of the University of Louisville.
The people who tracked their research described gabapentin as a "cheap high," almost always "always available." They report having mixed the drug with opioids, marijuana and cocaine to boost the high, with effects ranging from "increased energy" to "soft" deafness.
Journal journal articles estimate that between 15 and 25 percent of opioid addicts also use gabapentin. And recent research suggests combining gabapentin and opioids, which increases the risk of overdose.
Gabapentin, which has been on the market since 1993, has long been considered to be non-additive and is not as closely monitored as riskier drugs like opioids. But calls to US poison control centers show a sharp increase in abuse and overdoses.
The abuse rate increased by almost 400 percent between 2006 and 2015. This is clear from the poison center data analyzed by the Denver Health and Hospital Authority RADARS research group. a state health system. The work of the group is funded by drug manufacturers and government agencies, although they are not involved in the analysis or publication of the data.
In some parts of the US, the rise in abuse of gabapentin has led to new restrictions and surveillance.  Last year, Kentucky became the first state to classify the drug as a "planned substance" and put it among other high-risk medications that had additional restrictions and tracking. Gabapentin was detected in one-third of fatal overdose cases analyzed by forensic physicians in Kentucky in 2016. Now, only health professionals registered with the federal government can prescribe the drug and patients are limited to five refills.
Ohio, Minnesota, West Virginia, and Several other states have begun to track gabapentin through their prescription databases. Ohio took this step after gabapentin became the drug most used in the state. Government surveys on drug users also said it was "extremely easy to get" with a street price of about $ 1.50 per capsule.
Alyssa Peckham, a researcher at Midwestern University in Arizona, believes a more comprehensive federal response is needed, including a potential reclassification nationwide. Like others, Peckham says gabapentin alone is not dangerous, but when combined with opioids and other medicines that suppress breathing.
However, there is little agreement on the next steps or even the scope of the problem.  Michael Polydefkis, a neurologist at Johns Hopkins University, who primarily treats seniors with nerve pain, says he has never seen patients deliberately abusing gabapentin.
Given the recent restrictions on opioids by hospitals, insurers and authorities, many physicians are wary of limiting other medications that can help treat pain. The prescriptive guidelines of the Center for Disease Control and Prevention confirm gabapentin as a good choice for nerve pain.
But there are questions about how much is prescribed for proven applications – and to what extent patients benefit from it. A recent study by the Cochrane Group confirmed the benefits of gabapentin for various forms of nerve pain, but found little evidence of its effectiveness in more frequent muscle and joint pain.
In the past, the vast majority of prescriptions were used for applications that were not okay. "This drug was unusual in that it was prescribed as a kind of miracle pill that can be used for anything," Dr. Joseph Ross, Researcher at Yale University
In a recent Journal of the American Medical Association, he called for new studies on Gabapentin's actual use.
The free-running prescription comes from years of aggressive marketing by the original manufacturer of the drug, Warner-Lambert. The company pleaded guilty and agreed to pay more than $ 430 million in 2004 to promote gabapentin for a range of unapproved uses such as migraine, attention deficit disorder, bipolar disorder, and Lou Gehrig's disease. While physicians are free to prescribe medicines for any use, drug manufacturers can only market their products for uses approved by the FDA.
Warner-Lambert was purchased in 2000 by Pfizer, which continues to sell gabapentin under its original brand name Neurontin. Pfizer also sells a similar drug called Lyrica, a blockbuster drug approved for fibromyalgia, diabetic nerve pain and various other uses. Unlike gabapentin, Lyrica is a planned substance under federal law, in part because of reports of euphoria and other side effects that indicate "potential for abuse".
With stricter restrictions and a single manufacturer, Lyrica has not seen the same problems as gabapentin.
"Pfizer understands the importance of preventing the abuse and misuse of our medicines, and will continue to work with regulators and health authorities to monitor the safety of these medicines," the company said in a statement.