Michigan Gabapentin Dispensing Jumps After Drug's Controlled-Substance Status Lifted
A study of Michigan Medicaid data found that gabapentin prescriptions rose immediately after the state removed the drug from its controlled substance schedule in May 2024, while pregabalin dispensing stayed lower. The increase amounted to about four additional prescriptions per 1,000 enrollees relative to pregabalin, and gabapentin use remained more than three times higher by the end of the study period. Researchers suggest that regulatory status influences prescriber decisions, with less hesitation when restrictions are eased.
Gabapentin is among the most widely prescribed medications in the United States, approved for seizure disorders and postherpetic neuralgia, though much of its use is off-label for chronic pain. The FDA has warned that combining gabapentinoids with opioids or other central nervous system depressants may cause respiratory depression, and the CDC has detected gabapentin in nearly 10 percent of overdose deaths.
Michigan initially placed gabapentin on its controlled substance schedule in 2019, becoming the fourth state to do so, but reversed that decision in May 2024 to align with neighboring states and federal policy. The reversal was tied to an immediate rise in dispensing among Medicaid enrollees, while pregabalin, which remains federally scheduled, stayed at consistently lower levels throughout the study period.
The regulatory status of gabapentin could shape prescribing behavior in ways that affect both patient access and safety. If descheduling reduces prescriber hesitation, more patients with neuropathic pain may receive treatment more easily, but the resulting increase in dispensing could also raise concerns about misuse or overdose risk, particularly when combined with opioids. Policymakers may need to weigh these trade-offs carefully when considering similar changes elsewhere.