America’s most popular nerve-pain drug is under renewed scrutiny

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Gabapentin was approved decades ago to treat seizures and nerve pain from shingles, but it has since become one of the most commonly prescribed drugs in the United States. About 15.5 million people received prescriptions for it in 2024, making it the country’s seventh-most widely prescribed medication. Its appeal has rested on a simple idea: that it could calm pain without the addiction risks associated with opioids.

For many patients, that promise has not held, the Wall Street Journal reported.

When stopping becomes the crisis

John Avery, a former high-school physical education teacher in Illinois, was prescribed gabapentin after a slipped disc caused nerve pain. He was told it was nonaddictive. After taking it for just over three weeks, he stopped and experienced what he describes as severe, prolonged withdrawal. His symptoms now include shaking, burning sensations throughout his body, muscle spasms, insomnia and dramatic weight loss. Several doctors later told him gabapentin was likely the cause. Avery says that had he known he needed to taper slowly, he would never have taken the drug.

A pattern of off-label use

Most gabapentin prescriptions today are written for conditions the US Food and Drug Administration has never approved it to treat. Doctors prescribe it for chronic pain, anxiety, migraines, insomnia, menopausal hot flashes and other conditions. While off-label prescribing is legal and common, it means the FDA has not vetted the drug’s risks and benefits for many of its most common uses. Among Medicare beneficiaries, more than 90 percent of gabapentin prescriptions tied to doctor visits were for off-label purposes.

Evidence of harm grows

A growing body of research suggests gabapentin is neither as safe nor as effective as long believed. Studies have linked it to increased risks of dementia, suicidal behaviour, serious breathing problems in people with lung disease, swelling and cognitive impairment. One recent study found that giving gabapentin to surgery patients did not reduce complications or shorten hospital stays, and more patients reported pain months later.

Although medical guidance has long described gabapentin as non-habit-forming, many patients report debilitating symptoms when trying to taper off, suggesting physical dependence even when the drug is taken as prescribed.

A dangerous combination

Gabapentin is often taken alongside opioids, either intentionally or through overlapping prescriptions. The US Centers for Disease Control and Prevention warns that the combination can be deadly. Federal and state data show at least 5,000 people have died from overdoses involving gabapentin in each of the past five years.

One such case involved Nancy Hammer, a 77-year-old South Carolina woman who was prescribed gabapentin along with an opioid and other sedating drugs. A toxicology review later found that the combination slowed her breathing until it stopped. Her family says the risks were never clearly explained.

Why doctors keep prescribing it

Prescriptions have more than doubled over the past 15 years, rising as doctors moved away from opioids and benzodiazepines under tighter regulations and growing scrutiny. Gabapentin became, in the words of one pain specialist, a moral and regulatory “safe harbour” for clinicians under pressure to treat pain quickly, with few good options.

Many doctors say the drug helps some patients and is often tolerated well. But others now argue it has been treated too casually, tried for too many conditions and refilled too routinely.

A troubled history

Gabapentin’s popularity traces back to aggressive marketing in the 1990s and early 2000s, when its manufacturer promoted it for a wide range of uses without FDA approval. The company later pleaded guilty to criminal wrongdoing over illegal promotion and paid hundreds of millions of dollars in fines. Once the drug went generic and prices collapsed, it became an easy default for pain treatment just as opioid prescribing fell.

Living with the consequences

Patients like Jessica Carman, who has taken gabapentin for nearly a decade, say quitting can be as frightening as staying on it. Attempts to lower her dose leave her disoriented, exhausted and in pain. Others describe memory loss, balance problems and long-term cognitive effects. Many say they were never warned that stopping could be so difficult.

As prescriptions continue to climb, researchers and clinicians are increasingly questioning whether gabapentin has simply become the latest chapter in America’s long struggle with overprescribing—another drug that promised relief, and delivered harm to some of the very people it was meant to help.