A new study by researchers at University College London (UCL) has found that people taking gabapentinoids, which are increasingly prescribed around the world, especially for chronic pain, are at a much higher risk of drug addiction if they are also taking other drugs.
Authors of new works PLOS medicine The study found that among people taking gabapentinoids, adding benzodiazepines doubled the risk of hospitalization for drug poisoning, and adding opioids increased the risk by 30%.
This study revealed that gabapentinoids are often initiated as drug therapy at a time when people are already at increased vulnerability to drug addiction, when they are experiencing worsening of symptoms and seeking additional drug therapy.
Researchers found that although the risk of addiction may be reduced once you start taking gabapentinoids, the increased risk can last for several months, suggesting that gabapentinoids may not be an effective solution to reducing the risk of drug addiction.
Gabapentinoids (drugs such as gabapentin and pregabalin) are widely prescribed for conditions such as epilepsy, neuralgia, and anxiety disorders, and are increasingly being prescribed as painkillers as an alternative to opioids. They are currently the seventh most commonly prescribed drug in the United States, and a previous UCL study reported that their use increased more than fourfold from 2008 to 2018 in 65 countries.
The authors say the findings suggest that clinicians should be more cautious when prescribing gabapentinoids, and should be especially vigilant about the risks of prescribing gabapentinoids with other drugs.
Prescription rates for gabapentinoids have increased rapidly in recent years as they are considered safe alternatives to opioids. Although they are effective for pain relief and have a better safety profile than opioids, there are still significant risks that clinicians and patients should be aware of. ”
Dr Kenneth Mann, University College London
Researchers looked at data on people who were prescribed gabapentinoids between 2010 and 2020 in the UK, searching for cases of hospitalization for drug poisoning before, during and after gabapentinoids were prescribed, as well as other drugs people were prescribed.
They focused their analysis on 16,827 people who had experienced at least one drug poisoning hospitalization, representing just under 2% of the total group prescribed gabapentinoids during the study period. The analysis incorporated up to 10 years of data for each individual, allowing researchers to compare the risk of drug addiction when the same person was not prescribed gabapentinoids.
The researchers included cases of various types of poisoning, both intentional and accidental, without excluding patients who took more than the prescribed dose or misused the medicine. Symptoms of drug addiction may include loss of consciousness, difficulty breathing, and seizures.
Researchers found that people taking both gabapentinoids and benzodiazepines were four times more likely to be hospitalized for drug poisoning in the first four weeks of gabapentinoid treatment than those taking neither drug. Taking gabapentinoids and opioids doubled the risk of addiction in the first 4 weeks compared with taking neither drug.
Study participants frequently took gabapentinoids alongside other prescription medications, with 89% taking them concurrently with opioids at some point during the study and 55% taking them concurrently with benzodiazepines at least some of the time.
The risk of drug addiction was highest during the 90 days before study participants started taking gabapentinoids, suggesting that prescribing gabapentinoids may be associated with concerns about the effects of other drugs.
Dr Andrew Yuen (UCL School of Pharmacy), lead author of the study, explained: “Clinicians’ decisions to prescribe gabapentinoids may be an attempt to minimize the risk of drug addiction associated with opioids and other drugs.”
“Although the risk of addiction decreased slightly after patients started gabapentinoid treatment, they still faced an increased risk of drug addiction, suggesting that clinicians must remain vigilant against risk.”
Dr. Kenneth Man added, “While our study results do not suggest that gabapentinoids are unsafe or should not be prescribed, clinicians should be cautious when prescribing gabapentinoids, especially if patients are also taking other medications, and clinicians should closely monitor patients taking gabapentinoids.”
The researchers said their findings were in line with an announcement earlier this year by the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), reinforcing warnings against gabapentinoids regarding addiction, dependence, withdrawal and tolerance**.
Researchers say it is still unclear whether and how gabapentinoids directly cause drug addiction, but there is evidence to suggest that gabapentinoids may enhance the sedative effects of drugs such as opioids and benzodiazepines. There is also evidence that there is a potential for abuse, especially for people with a history of drug abuse.
The study was supported by the NIHR UCLH Biomedical Research Center and involved researchers from UCL School of Pharmacy, UCLH Department of Psychiatry, the University of Hong Kong and Aston University.
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Reference magazines:
Yuen, ASC; others. (2026). Association of gabapentinoid treatment, concurrent use with opioids or benzodiazepines, and risk of drug addiction: A self-administered case series study. PLOS medicine. DOI: 10.1371/journal.pmed.1005035. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005035.
