Americans who thought the opioid panic would free them from dangerous prescriptions are finding a new problem quietly taking its place: gabapentin. Once a niche seizure and shingles drug, it has exploded into mass use as doctors reach for anything that isn’t an opioid, and now millions of patients are on it — a surge that a recent Wall Street Journal investigation says made gabapentin one of the nation’s top-prescribed medicines in 2024.
That boom didn’t happen by accident; it happened because of aggressive marketing and a medical-industrial complex more interested in sales than in sober science. The Justice Department’s 2004 action against Warner-Lambert — the precursor to Pfizer’s ownership — showed how Neurontin was pushed off-label for conditions it hadn’t been proven to treat, costing taxpayers and misleading doctors for profit.
Regulators have not been asleep the whole time, but their warnings came late and in a way that didn’t stop the tide. The FDA went public in December 2019 with clear evidence that gabapentin and its cousin pregabalin can cause life-threatening breathing problems, especially when mixed with opioids or other sedatives — an obvious risk that many patients were never warned about.
Independent researchers have now tied that off-label explosion to real harm: gabapentin shows up in thousands of overdose deaths and dramatically raises overdose risk when used with opioids. Recent clinical studies and CDC-linked analyses document an alarming trend where gabapentinoids were detected in a growing share of overdoses, undermining the narrative that this was a harmless “safe” alternative.
States have quietly started to respond because the federal system moves too slowly. Several states have reclassified gabapentin as a controlled substance or stepped up monitoring, and new state bills — like legislation in Utah in 2024 — signal that local lawmakers are stepping in where federal policy lagged. This patchwork approach proves what conservatives have long warned: when federal oversight fails, states must protect their citizens.
The underlying problem is cultural and institutional: sacrifice real medical judgment at the altar of lawsuit avoidance and bland regulatory pronouncements, and you get blanket prescribing for off-label uses that were never vetted. Doctors must stop treating gabapentin as a default, risk-free bandaid for chronic pain, anxiety, or insomnia and start practicing real medicine again; pharmacists and state regulators must reclaim oversight that was ceded to convenience.
We owe it to hardworking Americans to demand accountability from Big Pharma and complacent health authorities, and to insist on practical safeguards — mandatory prescriber education, tighter monitoring, and criminal penalties for deliberate off-label marketing that endangers lives. Patients deserve honest information, clear warnings, and safe alternatives, not another quietly proliferating drug that was hyped into mass use and left the public holding the bill.
