After months of rest, physical therapy and steroids, he was prescribed a drug called gabapentin by a pain management specialist who told Avery that it could help calm his nerve pain and that it was “nonaddictive,” Avery recalled. He took the medicine for a few days, then had surgery, and took it again for a little more than three weeks.
The 33-year-old former high-school physical education teacher in Newark, Ill., said he experienced a severe protracted withdrawal when he stopped, which led to neurological symptoms now that make his original back problem seem like “a paper cut” by comparison.
His symptoms include shaking and a burning sensation throughout his body, muscle spasms and a racing pulse. He can’t sleep for more than a half-hour at a time, and has lost so much weight that his wife said his calves are the size of her arms.
The change in his life, he said, is “beyond dramatic.”
Approved by the Food and Drug Administration decades ago for seizures and nerve pain from shingles, gabapentin is now the seventh-most widely prescribed drug in the U.S., according to the Iqvia Institute for Human Data Science. About 15.5 million people were prescribed gabapentin in 2024, according to an analysis by Centers for Disease Control and Prevention researchers.
Studies show that most of the prescriptions are written to treat conditions that it wasn’t approved for—a practice that is legal and common, but means the FDA hasn’t vetted its risks and benefits for those purposes.
Some doctors say gabapentin can be helpful for certain types of neuropathic pain, a condition resulting from nerve damage. But doctors also give it to patients with other types of chronic pain, anxiety, migraines, insomnia, distorted sense of smell and hot flashes in menopause. Veterinarians dispense it to calm or treat pain in cats and dogs.
A growing body of research shows it isn’t as safe or effective as doctors have long thought. Gabapentin has been associated in studies with greater risk of dementia, suicidal behavior, severe breathing problems for people who have lung disease, and edema, in addition to well-known side effects like dizziness.
A study published this year found giving gabapentin to surgery patients didn’t reduce complications or get them out of the hospital any faster, and more of them reported pain four months after surgery. Doctors for years had touted gabapentin as a way to use fewer opioids.
While the medical establishment has mostly maintained that gabapentin isn’t habit-forming, some patients have reported debilitating adverse effects when they try to taper off it. They say the withdrawal symptoms make it clear to them they have developed a dependence to the drug taking it as prescribed.
Still, prescriptions have more than doubled over the past 15 years, as doctors turned away from opioids for pain and benzodiazepines like Xanax for anxiety—drugs with more well-known risks.
People sometimes take opioids and gabapentin at the same time—either prescribed by a doctor, or on their own. The CDC warns the combination is potentially deadly. At least 5,000 people have died from gabapentin-involved overdoses in each of the past five years, according to federal and state data.
Gabapentin helps many patients, and most tolerate it well, said Kirk Evoy, a clinical associate professor of pharmacotherapy and translational sciences at the University of Texas at Austin who studies gabapentin misuse. Still, he said, “we shouldn’t be thinking of gabapentin as this safe drug we can just try for anything and see if it helps.”
For Avery, neither the pain management specialist who prescribed him the medication nor a specialist he saw after surgery told him about adverse effects gabapentin might have or that he might need to taper off it, Avery and his wife, Lauren Avery, said. The pain management specialist told him that gabapentin couldn’t possibly be the cause of his symptoms, Avery said. His primary care doctor thought he had anxiety.
Several other doctors have since told him that gabapentin is likely the cause of his condition, including a neuropsychiatrist who diagnosed him with severe dysautonomia, or impairment of the autonomic nervous system.
Treatments he has tried, including other medications, have only made him worse, Lauren said. John now lies every day in a dark room on the first floor at his mother’s house. Light, screens, noise and the boisterousness of his toddler and preschool-aged children at his own home set off more symptoms.
“I thought it was harmless,” he said of the drug. Had he known the risks and that he should reduce his dose gradually when stopping it, Avery said, “I never would have taken it.”
‘I cannot function’
Gabapentin quiets nerve firing in the spinal cord and brain. It works in about 12 separate chemical pathways in the body, making it a complex drug that can act differently in different people, said Dr. Marc Russo, a pain specialist and researcher in Newcastle, Australia, who wrote a 2022 research article titled “Gabapentin—Friend or foe?”
He called the drug a two-headed Janus, useful when prescribed for the right condition but harmful when it’s prescribed for other conditions, produces side effects or has no benefit. “The trouble is that this two-headed nature is appreciated by about 5% of doctors in my opinion,” he said.
The majority of patients prescribed gabapentin are over age 65. More than 90% of Medicare beneficiaries who received gabapentin within a month of a reported visit with the prescribing doctor got it for an off-label use, according to a Wall Street Journal analysis of Medicare claims data from 2020 through 2022 that matched up prescriptions with diagnoses.
One big reason for gabapentin’s popularity is simply that there are a lot of patients in pain, with pressure on medical providers to evaluate and help patients quickly, and few perfect medicines to treat them, said Dr. Christopher Goodman, clinical associate professor of internal medicine at the University of South Carolina School of Medicine Columbia.
“We want to help patients in pain, and there’s not a lot of great options,” he said. He co-wrote a study finding that evidence is limited for off-label use of gabapentinoid drugs—including gabapentin and another drug in the same class, pregabalin—for most pain-related conditions.
Reviews of studies in recent years have shown that only one in seven patients treated with a moderate dose felt a major reduction in shingles-related nerve pain.
Gabapentin is the top prescribed central nervous system drug—and among those, it’s also one of the most often reported to the FDA for adverse events. Healthcare professionals, patients and manufacturers reported more than 5,300 adverse events involving gabapentin in 2025, including a 21% jump in life-threatening complications compared with 2024. Hospitalizations have also risen.
Dr. Betsy Grunch, a neurosurgeon in Gainesville, Ga., said many of her patients benefit from gabapentin. Still, she said, she has become more cautious about prescribing it.
She warns of side effects like sleepiness since experiencing them herself. After taking a dose before a surgery a few years ago, she recalls, she felt “like, wow, I prescribe this all the time, and I cannot function.” A study earlier this year gave her further pause. It suggested a link between gabapentin for chronic low back pain and higher risk of dementia and mild cognitive impairment for adults under 65 with six or more gabapentin prescriptions.
“We’re just in the habit of making sure our patients are happy, and if they think a medicine works, we just refill it,” Grunch said.
A checkered past
Gabapentin was approved by the FDA in 1993 under the brand name Neurontin to help treat partial seizures. The FDA approved it in 2002 for post-herpetic neuralgia, or nerve pain after shingles.
Neurontin’s manufacturer, Warner-Lambert, which was acquired by Pfizer in 2000, sought a bigger market for its niche drug. Rather than seek more FDA approvals, it funded studies purportedly proving its efficacy for more common ailments such as anxiety, migraines and chronic nerve pain.
Warner-Lambert and Pfizer amplified the positive findings to doctors through sales calls and “continuing medical education” seminars that drew thousands of physicians, as well as a publication strategy focused on pushing positive articles about gabapentin in medical journals and suppressing negative data, including about harms, according to a review of legal documents, scientific studies and interviews with doctors and researchers.
Potential adverse events the companies knew about included depression, suicidal ideation, somnolence, edema, dizziness and confusion, documents from lawsuits show.
One Pfizer medical director referred to the drug as the “‘snake oil’ of the twentieth century” in an email later made public. The drug’s sales grew from almost $98 million in 1995 to more than $2 billion in 2003.
The Pfizer unit responsible for gabapentin ultimately pleaded guilty to criminal wrongdoing and was fined $430 million in 2004 for illegally promoting Neurontin’s off-label use to doctors. It was one of the largest Medicaid-fraud settlements at the time, and the case led to calls for new marketing standards for pharmaceuticals.
Pfizer said in a written statement that the company divested itself of the product in 2020, and added the company “is strongly committed to complying with the laws that apply to its business activities and regulations related to the marketing of its products.” Viatris, which now owns the brand name Neurontin, didn’t respond to a request for comment.
After the drug started going generic in 2004, its price dropped so significantly that it became the default pain reliever, said Ambrose Carrejo, a former national pharmaceutical contracting leader at Kaiser Foundation Hospitals, which alongside its namesake health plan successfully sued Pfizer over its Neurontin marketing practices and was awarded $142 million in 2010.
At the same time, a sharp rise in opioid overdoses led to new state and federal regulations that made it harder for doctors to prescribe the drugs. The amount of opioids prescribed began dropping in 2011—and gabapentin took off.
“It became the moral and regulatory safe harbor for clinicians under pressure to treat pain and cut back on opioids,” said Dr. Sean Mackey, chief of the division of Stanford Pain Medicine and professor of anesthesiology.
In 2016, the CDC warned the medical community not to prescribe opioids routinely for chronic pain and listed gabapentin among alternatives for certain types of neuropathic pain.
Dr. Thomas Gilson, medical examiner and crime laboratory director for Cuyahoga County, Ohio, grew worried when gabapentin turned up in an increasing number of drug-overdose deaths. Although it isn’t addictive in the same way as opioids, he was concerned that, as with opioids, it was being prescribed widely for uses without much evidence.
“It was just such a bad idea to ever reach into using opioids for chronic pain,” he said. “What concerned me about seeing gabapentin was, is this just another chapter of this idea?”
Amid growing concerns, Gilson co-wrote a CDC report in 2022 warning about overdoses. The agency updated its opioid-prescribing guideline for pain later that year, warning of risks of gabapentin, including “blurred vision, cognitive effects, sedation and weight gain.” But it said gabapentin could be considered for some conditions.
A toxic combination
Just before Christmas last year, 77-year-old Nancy Hammer visited her family doctor seeking help for her worsening back pain. She left the office with prescriptions for gabapentin and an opioid. The next morning, Hammer’s husband of 49 years found her dead.
A toxicology review by a pharmacist found that gabapentin played a central role. Hammer’s doctor, William Scott Dacus, already had her on 14 other drugs for pain, anxiety and other conditions. The gabapentin and opioid combined with two others to create a toxic cocktail that slowed her breathing to the point of death.
Neither the doctor, his office nor the pharmacy had made clear to Hammer the danger of mixing gabapentin with other sedatives, her daughter Beatrice Stugart said. The doctor did prescribe naloxone, as needed to reverse a potential opioid overdose.
Hammer, who lived in Pelion, S.C., had been on gabapentin earlier in 2024 at a lower dose to treat shingles nerve pain. Hammer’s doctor, Dacus, was ranked among the top 10% of gabapentin prescribers to Medicare beneficiaries nationwide from 2018 to 2023, according to a Journal analysis of Medicare data.
Stugart and her father, John Hammer, filed a lawsuit in October against Dacus, another provider in his office, and their employer, Lexington Health, alleging negligence and wrongful death. “Doctors should be held responsible for making sure that people are aware, particularly older people,” Stugart said.
Lexington Health, based in West Columbia, S.C., declined to comment, citing the pending litigation. Dacus didn’t respond to requests for comment.
Many patients say doctors are often unaware how difficult it can be to quit.
Jessica Carman has been taking gabapentin for about a decade for anxiety and felt it helped. But the 38-year-old in San Antonio is trying to get off it. She became worried about dementia when she noticed her short-term memory fading and that she was dropping things and tripping over her own feet. She has also experienced tooth decay, and her dentist suggested the gabapentin might be a contributing factor, she said.
When Carman has tried to reduce her dose, she said, her body aches, she feels desperately tired and she becomes disoriented. She has stayed on the same dose for several months. She never would have taken gabapentin if she knew back then what she knows now, she said.
“I just don’t think it’s something that is meant to be used long-term like this,” she said.
Write to Betsy McKay at betsy.mckay@wsj.com and Shalini Ramachandran at Shalini.Ramachandran@wsj.com
