Gabapentin Use Rose as Restrictions Fell, Study Shows

Gabapentin use jumped quickly in Michigan after the drug was removed from the state’s controlled substance schedule in 2024, a cross-sectional study showed.

From 2023 through 2025, gabapentin dispensing in the Michigan Medicaid program ranged from 33 to 43 prescriptions per 1,000 enrollees, while pregabalin dispensing remained consistently lower, reported Juan Hincapie-Castillo, PharmD, MS, PhD, of the University of Pittsburgh, and co-authors.

Descheduling gabapentin in May 2024 was associated with an immediate increase in gabapentin dispensing of 4.00 prescriptions per 1,000 Medicaid enrollees (95% CI 2.33-5.67 prescriptions) relative to pregabalin dispensing, the researchers wrote in a JAMA Network Open research letter.

The descheduling policy also was associated with a small uptake in pregabalin use but gabapentin use remained more than threefold higher at the end of the study period, they noted.

“Previous studies have shown that scheduling gabapentin was associated with reduced prescribing. Our study adds to that evidence by suggesting that this relationship may actually operate in both directions,” said co-author Katherine Gora Combs, PhD, MPH, of the University of North Carolina at Chapel Hill.

“Our findings suggest that the regulatory status of gabapentin may play a role in prescribing decisions,” Gora Combs told MedPage Today. “Prescribers may be more hesitant to prescribe gabapentin when it’s subject to stricter regulations, but that hesitancy may ease when those restrictions are lifted.”

Gabapentin is one of the top prescribed medications in the U.S. Often used off-label for chronic pain, gabapentin is approved to treat postherpetic neuralgia and partial-onset seizures. Another gabapentinoid, pregabalin, is approved for the same indications, plus neuropathic pain and fibromyalgia.

In 2019, the FDA warned that respiratory depression or death may occur in patients taking gabapentinoids with opioid pain medicines or other drugs that depress the central nervous system. Gabapentin has been detected in 9.7% of drug overdose deaths, according to the CDC.

Gabapentin is not scheduled as a controlled substance at the federal level, but pregabalin has been scheduled under the Controlled Substance Act since its approval. Between 2016 and 2024, eight states enacted legislation to classify gabapentin as a schedule V controlled substance.

Michigan became the fourth state to schedule gabapentin in January 2019, but removed the drug from its state-level controlled substance schedule in May 2024. The decision was driven partly by a desire to align Michigan’s classification with those of neighboring states and the federal government, Hincapie-Castillo and co-authors noted.

“The upside to descheduling is that it makes it much easier for physicians to prescribe the medication,” said neurologist Brian Callaghan, MD, MS, of the University of Michigan in Ann Arbor, who wasn’t involved with the study.

“Many patients need gabapentin or similar medications to treat neuropathic pain,” Callaghan told MedPage Today. “In contrast to opioids, the downsides to gabapentin are quite small and are not enough to warrant being a scheduled medication. The same goes for pregabalin.”

Hincapie-Castillo and colleagues examined changes in gabapentin dispensing among Michigan Medicaid enrollees from the first quarter of 2023 through the last quarter of 2025, using pregabalin dispensing as an internal negative control. Dispensing records were from Medicaid State Drug Utilization Data files, which provide quarterly dispensing information for covered outpatient drugs.

The study could not account for gabapentin obtained outside formal dispensing channels, and other interventions may have influenced the findings, the researchers noted. The analysis was limited to a relatively short period and the model may lack enough statistical power to detect a meaningful change in trend, they acknowledged.

“Given the potential harms associated with gabapentin misuse, including its involvement in drug overdoses, the increase in dispensing we observed after descheduling warrants attention,” Gora Combs said.

“However, increased prescribing is not inherently harmful, and our findings do not tell us whether the additional gabapentin use resulted in adverse outcomes,” she pointed out. “Our findings do, however, underscore the importance of understanding how regulatory changes affect both access to medications and patient safety.”