#gabapentin

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no oj no straw, when you give it to me, you give it to me raw!

Gabapentin is a drug officially approved for partial seizures and posherpetic neuralgia (pain due to shingles).

It also represents the 10th most commonly prescribed drug in the US by number of prescriptions.

Now, that's not because that many people have epilepsy and shingles. Instead, it's because gabapentin is one of those drugs that you throw at the wall to see if it works. It is used off label for diabetic nerve pain, for anxiety, for restless leg syndrome, for alcohol (and methamphetamine, and cocaine) withdrawal, for a number of different acute and chronic pain syndromes, bipolar disorder, and migraines, and has probably been at least tried for everything else, too.

That is not to say that it actually works for everything. At most, it has about a 40% chance of being effective for things like diabetic neuropathy and anxiety, and it has a number of side effects that don't make it anywhere near a perfect drug. But if you notice, most of the things it's been tried and used for are usually treated with controlled substances. And in (most of) the US, gabapentin is not controlled. This makes it easier to prescribe and in theory that means it has less addiction/abuse risk than alternatives (only about 1% of people with an addiction history have used gabapentin recreationally).

Why gabapentin in particular? You may ask. Why not a first generation antipsychotic or a first generation antihistamine or a muscle relaxer? All of those are used as adjuncts to prevent having to prescribe controlled substances, right?

Well, that's because Pfizer broke the law. Repeatedly.

You may not know this, but if you're marketing a drug, you can only market it for what it has been approved by the FDA to treat. And Pfizer was going around telling anyone who would listen that their drug could be used for anything you didn't want to treat with a controlled substance. Which made it very attractive for prescribers and very lucrative for Pfizer.

But you know who really didn't like this situation? The insurance companies, which were paying a premium for this on-patent drug that at least according to the FDA was doing very little for things that weren't epilepsy or shingles.