Authored by: Michael Roach, DO, CCHP – President of Medical Operations Division
In the jail setting, practitioners learn to differentiate ‘want versus need’ for patients before prescribing medication. Gabapentin, an anti-epileptic drug, should be monitored in your jail.
The only FDA approved uses of Gabapentin are for partial seizure disorder and herpetic neuralgia; however, it is used for a variety of “off-label” uses, such as neuropathic pain, fibromyalgia, alcohol dependence, bipolar disorder, depression, complex regional pain syndrome, migraines, ADHD, and restless leg syndrome. Gabapentin doesn’t solve the root cause of the problem in these cases. Instead, the side-effects of the medication are used to alleviate symptoms.
Gabapentin is well-known among drug abusers. The medication decreases cognition and, at elevated doses, causes a euphoria similar to marijuana. Incarcerated patients often see this as a substitute for their street drug of choice.
Gabapentin should be weaned down and a TRUE diagnosis should be made.
Safer alternatives include: Venlafaxine (Effexor), Duloxetine (Cymbalta), Amitriptyline (Elavil), or Nortriptyline. These medications should begin at the same time Gabapentin is being weaned down.
If Gabapentin is prescribed, there should be:
- A clear guideline on who is eligible for Gabapentin, consistent among facilities
- Trials of other available medication for the diagnosis – Gabapentin should not be the first choice
- A maximum dosage set that is consistent with other facilities – The Prescriber’s Letter states: “Gabapentin doses above 900 mg/day will not provide more pain relief–but will increase side-effects. Keep in mind there’s a diminishing return with higher doses . . . doubling the dose does not double drug concentration.”
- Ways to monitor compliance with the prescription
- A plan in place for anyone caught ‘diverting’ Gabapentin
There is no literature to support Gabapentin as a psychotropic medication, and there are other FDA approved options to treat these patients. Often patients are on several illegal substances at intake. These drugs can also alter the mind, mimicking an array of psychotic episodes and mental illnesses. Remember, jail is a controlled environment and patients may be monitored to find the true underlying condition. It may take the brain weeks or even months to recover from the effects of illicit drugs, if it recovers at all. Once a patient is clear of mind-altering drugs, medications may not even be required.
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Published: 14 December 2018. All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis.
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