March 28, 2023

I was recently asked, Can you overdose on Gabapentin? There’s a lot of variables but here are my thoughts on Gabapentin withdrawal.

Hi everybody welcome back to the channel uh addiction recovery with dr b as you know this channel is about all things substance abuse and in general we have a very informal discussion uh using uh scientific evidence clinical evidence with clinical experience we married it to we package it up so you can digest it in a very easy to comprehend manner the goal being

So that you have some formal understanding of some of these complex topics you are the substance abuse client a loved one the public at large or those policy makers so we can make informed wise decisions that kind of assist in everyone’s recovery and maintain the dignity of the patient uh with that said let’s jump right into today’s topic we will continue

With some concepts in gabapentin and the question asked of me today is can you overdose on gabapentin um this is a very uh it’s difficult to answer this question in one sense and it’s easy in another sense why it’s difficult is that although the data and the information is gathering and piling up in terms of scientific evidence we still don’t have enough data

And we don’t have what’s called real directives in terms of what the answer is we don’t have strong levels of evidence to make strong claims nevertheless when i take that into consideration with what i noticed some years back with the abuse and misuse potential of this uh medication within the substance abuse community that’s important to understand that this

Discussion is actually very directed towards the substance abuse community in particular opiates when we take the current piling up of data mainly case series case reports descriptive analysis of events that are going on we can come up with a very reasonable conclusion at this point to be continued so please keep that in mind the second thing i want to emphasize

Is that most of the discussion and i’ll say it as we go very much applies to those also using opiates have some sort of a history and dependence on opiates in particular heroin or even pills and it really applies to those that deal with benzodiazepines you know the usual run the mill xanax conopene ativan valium and alcohol to a great extent and the question

Is can you overdose on this medication the data on this area is scant at best but it’s real and it’s there it’s scant in the sense that in the pyramid of what we consider uh strength and data to make clinical decisions and claims it’s on the lower order meaning it’s a lot of case reports case series and descriptive analysis okay and that makes it weak in some

Ways but what is important to take from all of that is that it is very meaningful and developing in its strength robustness and ability to predict outcomes two uh my own personal perspective on this is that this was something i noted some years back when i got into this industry that gabapentin was a substance of abuse three this information for the most part

Applies to the substance abuse community in particular to opiates secondly to those with benzodiazepine and thirdly to alcohol within that community there is an increased chance of an overdose whether it’s intentional or whether it’s accidental there is an increased chance of that overdose uh being being able to find gabapentin in the toxicology report that may

Have been prescribed by a doctor or not when you look at across the planet especially in western countries i think some of them are scotland and otherwise there’s more and more and more data piling up about the toxic exposure of gabapentin meaning the person ends up coming into contact with the medical establishment or this stuff is found in their toxicology

Reports after the patient is deceased over and over and over and over again what we’re seeing is the misuse or abuse of this medication whether it’s trying to find relief from opiate addiction and or whether it is to supplement the euphoria through with opiates and benzodiazepines it appears to affect things like respiratory depression and that’s about as far

As i am willing to go but i do think everything is pointing strongly in the direction that yes this stuff by itself is potentially toxic and can cause a death if you take enough of it but more importantly where we’re finding it is in toxicology reports or reports to pace poison centers whether it’s intentional or accidental oftentimes there’s a finding of uh

More more than likely an opioid uh second after that you’ll find the benzodiazepine and uh thirdly alcohol but a little bit less common uh and uh and it’s useless for various reasons whether someone’s trying to come off of the opiates or enhancing the high of the opiates the benzodiazepines or the alcohol that they’re on a little something about the pharmacology

Of this medication keep in mind this is uh basically what’s called a gaba receptor analog that means there’s this thing called the gaba receptor things that hit that receptor are benzodiazepines usually and alcohol also hits that receptor this is something that does hit the gaba receptor but the mechanics of where it hits how it hits and the chain of events that

Happen at that very microscopic architecture of the ligand and the receptor meaning the gaba and the receptor we don’t know much about we just know it’s those set of receptors number two as interesting and complex as the opioid receptors are with their different classes and subclasses the gaba receptors are much more complex uh both in the multiple mechanisms

Where they work uh where they are in the body how they work okay they’re very complex and very spread out throughout the body sometimes with paradoxical uh responses to the ligand that thing that’s hitting the receptor so we have this very complex receptor system in the nervous system we do know there are serious substance abuse issues and overdoses with

With molecules that hit that receptor whether it’s alcohol or benzodiazepines now we’ve added the gaba receptor by the way we don’t know everything about how benzodiazepines and alcohol affects those receptors but now we’ve added a new molecule a gaba class of drugs we know it hits that receptor and we don’t know the mechanism okay so it makes it a little bit

More frightening and to sum it up and this is kind of a short video yes it can cause overdoses and death two the data is starting to be really compiled right now and over the last several years it’s been coming in more and more but in the chain of evidence that we call evidence-based medicine to dictate our clinical decision making it’s still not there where

Someone can get on here and tell you something definitively but everything points in addition to clinical experience that this is a drug of abuse and there is a potential for overdoses prescriptions have been climbing for years and a lot of the agencies internationally different countries for example here are starting to put this stuff under a radar list and

Monitoring what is being prescribed because it has a potential for extensive misuse abuse diversion and to answer today’s question specifically overdoses and it is often connected with another substance that this is being added on to for additional euphoria or trying to mitigate withdrawal symptoms thank you very much i know that video didn’t go into too much

Detail but i don’t want to lead you down the wrong path with this i think the real nugget to take out of this is that look gabapentin is potentially a dangerous drug in particular and especially for the cohort of population of patients that i deal with and that’s the substance abuse prevent patients and be aware of it if you are starting to take it if you think

It’s mitigating something like anxiety or opiate withdrawals or if you are starting to use it in addition to your opiate or your benzo or your alcohol it can be very dangerous and that’s what you need to kind of take out of this in addition if you’re a loved one uh you should be aware you know if somebody that you are with whether it’s your son your daughter or

Family member sister brother if they start you know if there’s some things developing that substance abuse is becoming a topic of discussion or an issue in the family with that person now if you see this medication and they just chalk it up as to nerve pain and they’re 27 years old it’s very possible something else is going on thank you very much if you like

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Transcribed from video
Can You Overdose on Gabapentin? IMPORTANT INFORMATION By Dr. B Addiction Recovery