Dr. Tom Reach on Neuropathy and the Dangers of Gabapentin

Gabapentin is often described as a “safer” alternative to opioids for managing neuropathic pain. However, a growing body of evidence suggests that its long-term use may carry risks that are not always fully understood by patients—or even by some prescribers.

From a clinical standpoint, the issue is not simply whether gabapentin is “addictive” in the traditional sense. Rather, the more precise concern is dependence—a condition in which the body adapts to a medication and begins to rely on it for normal function. According to Drugs.com, “gabapentin has been shown to lead to dependence, addiction and withdrawal in some people.” This means that discontinuing the medication abruptly can result in symptoms such as anxiety, insomnia, and a rebound of nerve pain.

At the same time, it is important to approach the issue with balance. As Medical News Today notes, “scientists do not believe gabapentin is generally addictive.” However, that same source makes a critical distinction: individuals with a current or past substance use disorder may be at significantly higher risk for misuse. This is something I see regularly in my own practice. In Asheville and the surrounding region, many patients who come to us for opioid use disorder or other substance-related challenges have also been prescribed gabapentin—creating overlapping vulnerabilities that can increase the likelihood of dependence.

Beyond the question of dependence, there is also the issue of how gabapentin is being used in real-world settings. In many cases, it is prescribed long-term without a clear plan for tapering or reassessment. As prescriptions accumulate, so does the potential for unintended consequences—not only in terms of physical reliance, but also in how patients feel day to day. In my experience, patients often describe increasing fatigue, mental fog, and a general sense that something isn’t quite right, even when their pain is being managed. These changes are not always recognized early, which is why ongoing evaluation is essential—particularly in aging individuals and those already managing complex health conditions. Regular reassessment and dose adjustments are a routine part of my work with patients who are taking gabapentin or transitioning away from it. Careful treatment planning helps ensure that these changes are both safe and effective. In some cases, a structured taper or medically assisted detox may be indicated to help patients safely reduce or discontinue the medication.

The risks become even more pronounced when gabapentin is used in combination with other substances. Clinical sources warn that co-use with opioids or alcohol may significantly increase the risk of sedation, respiratory depression, and overdose. This is one reason why my team and I, providing addiction treatment in Asheville, are paying closer attention to gabapentin use in patients with opioid use disorder or polysubstance exposure.

Taken together, these findings highlight an important reality: while gabapentin may provide short-term symptom relief, it is not without potential consequences. For patients already navigating complex health challenges—including neuropathy, chronic pain, or substance use disorders—the decision to use or continue gabapentin should always be made with a full understanding of both its benefits and its risks.

This naturally leads to the next question: if symptom management alone is not enough, what does a more effective approach actually look like?