Gabapentin Use Spiked After Michigan Descheduled Drug

Gabapentin dispensing rose immediately after Michigan removed the drug from its state-level controlled substance schedule in May 2024. A new cross-sectional study shows the policy change was linked to an increase of 4.00 prescriptions per 1,000 Medicaid enrollees relative to the similar drug pregabalin.

Juan Hincapie-Castillo, PharmD, MS, PhD, of the University of Pittsburgh, and colleagues published the findings in a research letter in JAMA Network Open. From 2023 through 2025, gabapentin dispensing in the Michigan Medicaid program ranged from 33 to 43 prescriptions per 1,000 enrollees. Pregabalin dispensing remained consistently lower throughout the period.

Regulatory Status Influences Prescribing

Co-author Katherine Gora Combs, PhD, MPH, of the University of North Carolina at Chapel Hill, told MedPage Today the findings suggest a two-way relationship. "Previous studies have shown that scheduling gabapentin was associated with reduced prescribing." she said.

Gora Combs explained that prescriber hesitancy may ease when restrictions are lifted. "Our findings suggest that the regulatory status of gabapentin may play a role in prescribing decisions," she said.

Michigan had originally scheduled gabapentin as a controlled substance in January 2019. The state reversed that policy in May 2024, partly to align its classification with neighboring states and the federal government. Gabapentin is not scheduled federally, while pregabalin has been a controlled substance since its approval.

A Widely Used Medication with Risks

Gabapentin is one of the top prescribed medications in the United States. It is approved to treat postherpetic neuralgia and partial-onset seizures but is often used off-label for chronic pain. Another gabapentinoid, pregabalin, is approved for the same indications plus neuropathic pain and fibromyalgia.

Potential harms exist. In 2019, the FDA warned that respiratory depression or death may occur when gabapentinoids are taken with opioids or other central nervous system depressants. The CDC has reported gabapentin was detected in 9.7% of drug overdose deaths.

Between 2016 and 2024, eight states enacted legislation to classify gabapentin as a schedule V controlled substance. Michigan was the fourth state to do so.

Study Details and Limitations

Hincapie-Castillo's team used Medicaid State Drug Utilization Data files to track quarterly dispensing from the first quarter of 2023 through the last quarter of 2025. They used pregabalin dispensing as an internal negative control. The descheduling policy was also associated with a small uptake in pregabalin use, but gabapentin use remained more than threefold higher by the end of the study period.

The researchers acknowledged several limitations. The study could not account for gabapentin obtained outside formal dispensing channels. Other interventions may have influenced the findings. The analysis covered a relatively short period, and the model may lack enough statistical power to detect a meaningful change in trend.

Perspectives on Access and Safety

Neurologist Brian Callaghan, MD, MS, of the University of Michigan in Ann Arbor, who was not involved in the study, highlighted the access benefit. The upside to descheduling is that it makes it much easier for physicians to prescribe the medication, he told MedPage Today. Callaghan argued the downsides to gabapentin are quite small compared to opioids and do not warrant a scheduled status.

Gora Combs emphasized the need for balance. Given the potential harms associated with gabapentin misuse, including its involvement in drug overdoses, the increase in dispensing we observed after descheduling warrants attention, she said. She cautioned that increased prescribing is not inherently harmful, and the study does not show whether the additional use resulted in adverse outcomes.

The findings show the importance of understanding how regulatory changes affect both medication access and patient safety.