Limited evidence behind one of the most prescribed drugs.

Roughly 25 years ago, the drug gabapentin was approved to treat seizures and nerve pain. However, a whopping 83% of gabapentin use is off-label — meaning a medical provider can legally prescribe the medicine for any condition.

Today, gabapentin is prescribed for a range of pain disorders, depression, anxiety, ADHD, migraines, and many other health issues.

It’s become one of the most commonly prescribed drugs, yet little evidence surrounds it’s efficacy for off-label usage. In fact, the little data backing up gabapentin’s off-label uses comes from uncontrolled studies and limited case reports.

So why is the drug so commonly prescribed?

The unethical marketing of the drug.

Parke-Davis, the company that made gabapentin before being bought by Pfizer, spent millions of dollars on marketing the drug’s off-label potential.

“Parke-Davis rated doctors by the dollar value of the prescriptions they could potentially write,” wrote Shayla Love, a reporter in the realm of medicine and health. “They zeroed in on doctors who were influential and affiliated with major medical centers, who they thought could encourage their colleagues to use gabapentin too.”

The company also hired medical professionals to write flattering reviews of the drug and funded bias studies in favor of gabapentin. These questionable marketing techniques resulted in costly lawsuits for the drug manufacturers.

However, it is the doctors, and not the company, that writes these prescriptions in the end.

Gabapentoids are replacing opioid prescriptions.

Both gabapentin (typically sold as Neurotin) and a similar drug called pregablin (typically sold as Lyrica) have been referred to as “gabapentoids” — drugs that mimic the brain’s GABA receptors and reduce central nervous system activity.

Compared to commonly abused drugs like opioids and benzodiazepines, Gabapentin runs a low risk of abuse. It’s effects on the brain are mild and broad, which has lead it to be prescribed very casually. Although it has a potential to be misused, it’s dangers are often in conjunction with other drugs.

That being said, its alleged safety may speak to it’s rise in popularity. In response to the crisis, opioid prescriptions are being given out less and less. As doctors search for an alternative to opioids, gabapentinoids are being prescribed more often, especially for neuropathic pain.

This does not mean, however, that the drug is comparably effective in treating neuropathic pain.

Dispensed Prescriptions for Gabapentin and Nondiscounted Spending for Pregabalin, 2012–2016. Source: The New England Journal of Medicine.

Gabapentin’s potential role in mental health treatment.

While definitely safer than opioids, reports have found this drug to be used recreationally by former opioid addicts. Perhaps gabapentin can be used as a “step-down” drug for addicts quitting opioids, but studies are yet to explore this relationship in a significant way.

The clinical trials examining gabapentin’s role in treating mental health disorders are scarce. Two randomized placebo-controlled trials found that it did not work better than the placebo in treating bipolar disorder.

Some personal testimonies, however, have claimed the drug made their anxiety symptoms more manageable. Gabapentin’s role in mental health treatment will hopefully be studied more in years to come.