Is Gabapentin an Opioid or Narcotic? No, and Here Are the Differences
Key takeaways:
Gabapentin (Neurontin) is FDA approved to treat certain types of seizures and nerve pain. Opioids are approved to treat moderate to severe pain.
Gabapentin is sometimes used “off-label” as an alternative to opioid medications to help manage pain. Opioids have a higher potential for dependence and addiction than gabapentin.
If you’re taking gabapentin or an opioid, take the medication exactly as prescribed. Both medications can cause dangerous side effects, especially when taken at high dosages.
Table of contents
Opioids, commonly known as narcotics, are FDA approved to treat moderate to severe pain. But these controlled substances carry a high risk of dependence and misuse.
As a result, some healthcare providers may prescribe gabapentin (Neurontin) as an alternative to opioids for various types of pain. But this is an off-label use. Gabapentin is only FDA approved to treat specific types of seizures and nerve pain caused by shingles.
Learn about the differences and similarities between gabapentin and opioids.
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Is gabapentin an opioid or narcotic?
No, gabapentin isn’t an opioid. Gabapentin belongs to a group of medications called gabapentinoids. These medications have a similar structure to a chemical in the brain called gamma-aminobutyric acid (GABA). But researchers aren’t exactly sure how gabapentin works. It doesn’t have any effect on GABA receptors (binding sites) or increase levels of GABA in the body.
Gabapentin may work by decreasing the levels of a chemical in the body called glutamate. Glutamate is a chemical that activates nerve cells. By decreasing this activation, gabapentin may help treat seizures and reduce pain.
Opioid medications work differently. They treat pain by attaching to opioid receptors. These receptors are present in the brain and other areas of the body. By binding to these receptors, opioids block your body’s pain signals. And this may lower the amount of pain you feel.
What are the differences between gabapentin and opioids?
There are many differences between gabapentin and opioids. This includes what they’re FDA approved for, how they’re classified, and their potential risks.
FDA-approved uses
Gabapentin is FDA approved to treat certain types of seizures in adults and children who are at least 3 years old. It’s also approved to treat nerve pain caused by shingles (postherpetic neuralgia). Opioids are FDA approved to treat moderate to severe pain.
There are also extended-release (ER) formulations of gabapentin: Gralise and Horizant. Both medications are approved to treat postherpetic neuralgia. But Horizant is also approved for restless legs syndrome.
Off-label uses
Gabapentin is often prescribed for off-label use. That means it’s prescribed for reasons other than what it’s FDA approved for. In fact, up to 95% of prescriptions for gabapentin are for off-label uses.
Some healthcare providers prescribe gabapentin as an alternative to opioids. For example, taking gabapentin may help reduce the need for opioids after surgery. This may help prevent chronic opioid use. But it may not be as helpful for certain types of pain that opioids can treat, such as back pain and pelvic pain.
Other common off-label uses for gabapentin include treating conditions like alcohol withdrawal, anxiety, and diabetic neuropathy. Research shows that some off-label uses of gabapentin are effective, but not all. For example, there’s evidence that gabapentin is effective at treating diabetic nephropathy. It’s even considered a first-choice medication for the condition. But gabapentin may not be helpful for other types of nerve pain, like nerve pain from cancer and HIV.
Controlled substance status
Gabapentin isn’t classified as a controlled substance by the federal government, but opioids are. Medications in this category are more likely to cause physical and mental dependence than other medications. This is dangerous because these medications can lead to substance use disorder.
Although gabapentin isn’t a federally controlled substance, some states have classified it as one. These states consider gabapentin risky enough to warrant controlled substance status.
Controlled substances are divided into five schedules, or groups, in total. Substances are grouped by their potential risk for misuse and dependence. The higher the schedule, the greater the potential risks.
Schedule 1 substances have the highest potential for misuse. This group includes illegal opioids like heroin. Schedule 5 substances are the least likely to cause dependence or misuse. In the states where gabapentin is classified as a controlled substance, it’s a Schedule 5 substance.
Examples of prescription opioids and their schedules include:
Schedule 2: morphine (MS Contin), fentanyl (Duragesic), hydrocodone / acetaminophen (Norco)
Schedule 3: buprenorphine / naloxone (Suboxone, Zubsolv) and acetaminophen / codeine
Schedule 4: tramadol (Ultram)
Schedule 5: products with less than 200 mg of codeine per 100 mL, like promethazine / codeine
Misuse and dependence
It’s a well-known fact that opioids can lead to misuse and opioid use disorder. However, when gabapentin was first approved by the FDA, it was considered to have minimal risk of causing dependence.
But gabapentin may be riskier than originally thought, especially when combined with opioids. Even though gabapentin may increase the amount of pain relief you get from an opioid, it also increases your risk of an opioid overdose. Both opioids and gabapentin can cause respiratory depression (trouble breathing), which can be life-threatening. In a 2022 report, the CDC found that gabapentin may have contributed to almost 10% of overdose deaths in the U.S. from 2019 to 2020. In most of these instances, opioids were involved, too.
If you take an opioid, it's a good idea to carry naloxone (Narcan, Zimhi). Naloxone is a lifesaving medication that can reverse an opioid overdose, and it’s available over the counter. And if you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
What are the similarities between gabapentin and opioids?
There are a few similarities between gabapentin and opioids to keep in mind:
It’s best to avoid drinking alcohol if you're taking gabapentin or an opioid. Like gabapentin and opioids, alcohol can slow down your brain. And combining alcohol with gabapentin or an opioid can slow your breathing and decrease alertness. This increases your risk of an overdose.
Abruptly stopping treatment with gabapentin or an opioid can lead to withdrawal. Stopping gabapentin or an opioid suddenly can cause withdrawal symptoms, including nausea, agitation, and sweating. While withdrawal isn’t usually life-threatening, abruptly stopping gabapentin could cause preexisting seizures to return. And abruptly stopping an opioid could worsen pain.
Gabapentin and opioids have some common side effects. The most common side effects of gabapentin are dizziness and tiredness. These side effects can also occur with opioids. Though, as mentioned above, opioids have a greater risk for dependence, misuse, and overdose than gabapentin.
The bottom line
Gabapentin (Neurontin) and opioids don’t work the same way. And they aren’t FDA approved to treat the same medical conditions. But gabapentin is sometimes prescribed as an alternative to opioids.
Both gabapentin and opioids may cause physical and mental dependence. But opioids carry a higher risk for dependence and misuse than gabapentin. When taken together, gabapentin and opioids can be especially dangerous. Gabapentin can amplify the effects of opioids, making breathing problems more likely.
Before starting treatment with gabapentin or an opioid, talk to your healthcare provider about the risks and potential benefits.
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References
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ElSayed, N. A., et al. (2022). Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes—2023. Diabetes Care.
Goodman, C. W., et al. (2019). Gabapentinoids for pain: Potential unintended consequences. American Family Physician.
Gomes, T., et al. (2017). Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. Public Library of Science One Medicine.
Hah, J., et al. (2017). Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort. JAMA Surgery.
Mattson, C. L., et al. (2022). Trends in gabapentin detection and involvement in drug overdose deaths — 23 states and the District of Columbia, 2019-2020. Centers for Disease Control and Prevention.
Peckham, A. M., et al. (2018). Gabapentin for off-label use: Evidence-based or cause for concern? Substance Abuse: Research and Treatment.
Remedy Repack Inc. (2023). Gabapentin - gabapentin tablet, film coated [package insert].
U.S. Food and Drug Administration. (2020). FDA warns about serious breathing problems with seizure and nerve pain medicines gabapentin (Neurontin, Gralise, Horizant) and pregabalin (Lyrica, Lyrica CR).
Wiffen, P. J., et al. (2017). Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews.
Yasaei, R., et al. (2022). Gabapentin. StatPearls.
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