The substance above is commonly used to treat “nerve pain” but is also prescribed and used for just about every kind of pain — muscle, joint, headaches, you name it — is the new “companion” drug for opiate users to gain a better “high”.  Gabapentin, aka, Neurontin, is the de rigueur new designer drug to go into your opiate sandwich.  In fact adding some gabapentin — or it’s much advertised cousin, Lyrica — to the treatment mix is frequently the quickest way to end a visit with a chronic pain sufferer whose diagnosis continues to be frustratingly ambiguous.  Hmm.

 

Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is neither an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state.  (Internal Medicine News 7.6.17)

 

Just like the laws of thermodynamics, for every action there is an equal an opposite re-action.  Here, my detective nose is once again going down that road that begins with asking the question, “What is REALLY happening here?”  So often I see patients who have been bounced around from clinic to clinic, specialist to specialist, Mayo to Mayo.  Dust to dust, ashes to ashes.  We live in a medical world increasingly dominated and frustrated by ill-defined, chronic, painful, and dysfunctional conditions for which we have seemingly continued to add one Band-Aid drug after another. Very little gets resolved. Did I mention Lyme disease? Now, we have created a new Pharnkenstein, and there will be more. Until the medical system begins to honestly address underlying causes and reasons for these chronic conditions, the drug industry will continue to spawn new black market epidemics.

So, what could be the harm in this seemingly innocuous add-on medication?   There is strong evidence that gabapentin and its cousin, pregabalin (Lyrica), actually inhibit dendritic plasticity and may also adversely affect reproductive functions. In other words long-term use of these two drugs will create infertility and inhibit one’s ability to learn. One might even say that it would accelerate brain aging and limit cognitive function.  The apparent benefit of these drugs in their use for chronic pain seems to largely come from limiting new “pain synapses”. That is certainly not a bad thing. However, unless the underlying reason for the pain is more aggressively sought, the patient is left to a future of simply covering it all up. Eventually, the brain is affected adversely. But also, eventually, novel and abusive uses of these drugs are discovered. This seems to be just the beginning.

 

 

 

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