01/13/2026
Wall Street Journal article: The Hidden Risks of America’s Most Popular Prescription Painkiller. Gabapentin has become a widely used alternative to opioids, but as the WSJ highlights, its safety and efficacy are far from what many clinicians assume.
Research now links gabapentin to increased risks of dementia, suicidal behavior, severe respiratory issues in patients with lung disease, edema, and well-known side effects like dizziness. Alarmingly, withdrawal symptoms suggest dependence even when taken as prescribed.
This resonates deeply with what I’ve learned and have seen in those living with chronic pain. Gabapentin is the go-to prescription for chronic pain (CRPS, AMPS, CSS, etc.) and other pain syndromes. Yet, we observed significant cognitive impairment in patients on gabapentin and for some suicidal thoughts.
The WSJ article underscores a critical point: prescribing for supportive care must be grounded in best practices and guidelines, not habit or assumption.
Gabapentin, originally approved for seizures and shingles-related nerve pain, has become the 7th most prescribed drug in the U.S., often used off-label for conditions like chronic pain, anxiety, and insomnia.
While some patients benefit, studies reveal gabapentin is less safe and effective than previously thought, with risks including dementia, suicidal behavior, breathing issues, and severe withdrawal symptoms.
Prescriptions surged as doctors sought alternatives to opioids and benzodiazepines, but gabapentin is now linked to over 5,000 overdose deaths annually, often when combined with opioids.
Many doctors and patients are unaware of the drug's potential for dependence and severe withdrawal effects, leading to prolonged suffering for some users.
Gabapentin's off-label promotion by its original manufacturer, Pfizer, led to a $430 million settlement in 2004 for illegal marketing practices.
Despite its widespread use, evidence supporting gabapentin's effectiveness for off-label conditions is limited, with only 1 in 7 patients experiencing significant pain relief for shingles-related nerve pain.
Adverse event reports involving gabapentin have risen, with over 5,300 cases in 2025, including life-threatening complications and hospitalizations.
Experts caution against viewing gabapentin as a universally safe option, emphasizing the need for careful prescribing and awareness of its risks.