Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016-2023

Matthew S. Ellis, Ph.D., Penn Whitley, B.A., Steven D. Passik, Ph.D. Drug and Alcohol Dependence 279 (2026) 113020; https://doi.org/10.1016/j.drugalcdep.2026.113020

SAN DIEGO, Calif. – February 2, 2026 – A first of its kind study sought to identify trends in gabapentin use with and without a prescription in substance use disorder (SUD) treatment settings, by specific use disorders, over time. Led by Matthew Ellis, PhD, Washington University in St. Louis, School of Medicine, Department of Psychiatry and co-authored by Millennium Health researchers, the study analyzed 206,161 patients with urine drug tests ordered from 2,053 substance use disorder (SUD) treatment settings in all 50 U.S. states, from 2016 to 2023.

Key Findings

Gabapentin was prescribed to 7.6% of patients in SUD treatment settings in 2023 compared to 3.9% in 2016. Gabapentin prescribing was more common in those who were female, older, prescribed buprenorphine, diagnosed with alcohol, stimulant, or sedative use disorder, and/or diagnosed with anxiety, insomnia, pain, or a mood disorder.

Non-prescribed use of gabapentin decreased from 15.2% in 2016 to 9.9% in 2023. Non-prescribed use occurred more commonly in those with anxiety or mood disorders, and sedative or opioid SUDs.

Co-positivity was higher across all illicit substances, i.e. fentanyl, methamphetamine, etc., for those engaged in non-prescribed gabapentin use.

Key Takeaways

Prescribing of gabapentin climbed in SUD treatment settings between 2016-2023, but non-prescribed use remained higher (9.9%) than gabapentin prescribing (7.6%) in 2023 suggesting that more formal investigation of gabapentin’s effectiveness in those with SUD with or without other psychiatric diagnoses, i.e. anxiety disorder, be undertaken to better understand if potential gaps in care may be contributing to the non-prescribed use of gabapentin.

The Drug and Alcohol Dependence article can be accessed here.