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. 2026 Feb 1:279:113020.
doi: 10.1016/j.drugalcdep.2026.113020. Epub 2026 Jan 3.

Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016-2023

Matthew S Ellis  1 , Penn Whitley  2 , Steven D Passik  2
Affiliations
Free article

Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016-2023

Matthew S Ellis et al. Drug Alcohol Depend. .
Free article

Abstract

Background: Gabapentin prescriptions have increased due to off-label use, including managing withdrawal/comorbidities in substance use disorder (SUD) treatment, despite gaps in evidence bases and corresponding increases in nonmedical use. This study sought to identify trends in gabapentin use with and without a prescription in SUD treatment settings.

Methods: This retrospective, serial cross-sectional study analyzed urine drug tests (UDT) (n = 206,161) ordered from 2053 SUD settings in all 50 U.S. states, from 2016 to 2023. Specimens were analyzed by liquid chromatography-tandem mass spectrometry to assess positivity for gabapentin and other prescription and illicit drugs, with prescribed medications documented in requisitions. Multivariable regression assessed characteristics/diagnoses associated with gabapentin use with and without a prescription.

Results: Gabapentin was prescribed to 5.9 % of the sample, increasing from 3.9 % in 2016-7.6 % in 2023. Use of gabapentin without a prescription was identified in 11.3 % of the sample, decreasing from 15.2 % to 9.9 %. Gabapentin prescribing was associated with anxiety/mood disorders, insomnia, pain, and sedative, alcohol, or stimulant SUDs. Use without a prescription was associated with anxiety/mood disorders, and sedative or opioid SUDs. Detection was higher across all illicit substances among those engaged in gabapentin use without a prescription.

Conclusions: Gabapentin prescribing significantly increased in SUD treatment settings despite a lack of strong evidence bases for its utility. While rates of gabapentin use outside a prescription were nearly double than for prescribed use, this appears to be decreasing over time. Polysubstance use and potential gaps in multimorbidity care may contribute to the use of gabapentin without a prescription.

Keywords: Gabapentin; Substance use disorder; Substance use treatment.

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Conflict of interest statement

Declaration of Competing Interest Dr. Ellis reported conducting this research in collaboration with Millennium Health through an unpaid consulting agreement. Dr. Ellis is a member of the Scientific Advisory Group for the National Drug Early Warning System and receives support from Denver Health and Hospital Authority and the National Institute on Drug Abuse (5 R21 DA056835–02). Given their role as a member of the Editorial Board of Drug and Alcohol Dependence, Dr. Ellis had no involvement in the peer-review of this article and has no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to another journal editor. Dr. Passik and Mr. Whitley reported being employees of Millennium Health, LLC. No other disclosures were reported.