Gabapentin dispensing rose after controls lifted

Clinical takeaway: Continue to assess the indication, misuse potential, and respiratory risk—particularly with concurrent opioids or other sedating drugs—when prescribing gabapentin in states where controlled-substance restrictions have been removed.

Gabapentin prescribing has expanded substantially, including for off-label indications, amid concerns about misuse, overdose involvement, and respiratory depression when combined with other psychotropic medications. Although 8 states classified gabapentin as a schedule V controlled substance between 2016 and 2024, Michigan removed that designation in May 2024.

In a repeated cross-sectional study, researchers used a controlled interrupted time-series analysis to evaluate quarterly Medicaid dispensing from the first quarter of 2023 through the third quarter of 2025. Pregabalin, which has similar indications but remained controlled, served as the comparison.

Gabapentin dispensing ranged from 33 to 43 prescriptions per 1,000 enrollees. Descheduling was associated with an immediate increase of 4.00 prescriptions per 1,000 enrollees relative to pregabalin, with the plausible increase ranging from 2.33 to 5.67 per 1,000.

Investigators found no clear subsequent change in the quarterly dispensing trend. Pregabalin dispensing also showed a small immediate increase, but gabapentin dispensing remained more than 3 times higher by the end of follow-up.

The authors cautioned that dispensing data cannot confirm medication use, follow-up was relatively short, and other contemporaneous changes preclude causal conclusions. Still, the results complement earlier evidence that scheduling is followed by lower gabapentin use.

“Our findings suggest that drug scheduling may serve as a supply-side policy to prevent overprescribing,” the authors concluded.

Source: Gora Combs K, et al. (2026 Sep 21) JAMA Netw Open. Gabapentin Use in Medicaid After Descheduling