Street value of neurontin?

[billypilgrim37]

Fellow resident has a patient who is asking for refills on her neurontin (a pretty whomping dose, to boot) after just one week in to her 4 week supply. We didn't know of any street value, anything we should know about?

[TheWowEffect]

Originally Posted by billypilgrim37

Fellow resident has a patient who is asking for refills on her neurontin (a pretty whomping dose, to boot) after just one week in to her 4 week supply. We didn't know of any street value, anything we should know about?

I had a patient in the clinic who was on Neurontin 300 mg TID. I took a detailed history but could not find any indication for her to be on it. It was started by someone in another city and she could not remember their name for me to obtain any collateral information. We tried very hard to wean her off it but she was very adamant about being on it. For us, it was just a matter of prescribing rationally. Street value factor did not cross my mind. I should have thought about it considering she stopped coming back after I made it clear to her that we will gradually taper and stop the medication. She was on a good dose of Valium and Zoloft as well.

I have heard of some physicians prescribing it for "mood-stabilization" on an anecdotal basis but nothing beyond that.

[masterofmonkeys]

I was on neurontin for three days and hated every minute of it (causalgia). I felt snowed to death. And I was on a tiny dose.

Honestly though, the effect was pretty tiny. It was noticeable to me at the time because of some of the stuff I was engaged in that required quick thinking.

I didn't know it had a street value.

Some are using it off-label for 'mood stabilization' even though there are a couple of small trials showing it's pretty ineffective.

Many people are on it for chronic fatigue/fibromyalgia, of course.

And we (fellow students and a couple of attendings) speculated about using it for possible anxiolytic properties without the downsides but I can't think of any example of it being used as such.

[billypilgrim37]

This one's on gabapentin 1200mg TID, plus 1mg clonazepam BID, and 100mg quetiapine QHS.

I know, right? It's like, THAT'S the one she's asking for early refills on?

Somebody needs to tell her she isn't doing it right, apparently.

The Google didn't turn up any street value either, which is why I turned to my trusty SDN colleagues.

[TheWowEffect]

Originally Posted by billypilgrim37

This one's on gabapentin 1200mg TID, plus 1mg clonazepam BID, and 100mg quetiapine QHS.

I know, right? It's like, THAT'S the one she's asking for early refills on?

Somebody needs to tell her she isn't doing it right, apparently.

The Google didn't turn up any street value either, which is why I turned to my trusty SDN colleagues.

[OldPsychDoc]

Originally Posted by billypilgrim37

This one's on gabapentin 1200mg TID, plus 1mg clonazepam BID, and 100mg quetiapine QHS.

I know, right? It's like, THAT'S the one she's asking for early refills on?

Somebody needs to tell her she isn't doing it right, apparently.

The Google didn't turn up any street value either, which is why I turned to my trusty SDN colleagues.

My thought is that she's either REALLY anxious and popping them like candy, or she's potentially trying to get a bit of cheap buzz herself (or she's sharing, or she's completely misread the instructions, or her script got filled with a different strength than she had previously and she's used to a certain # of pills instead of paying attention to the # of mg, or...).

You're right, there's no real street value, but people who are psychologically dependent on a pill will do some nutty things.

Benedryl would have a "street value" for its "buzz potential" if it weren't already ridiculously cheap and universally available.

(Extra kudos for referring to "The Google". That's a first for me...)

[whopper]

I have not noticed anyone trying to abuse neurontin among the patients I have. I have though noticed that abuse tends to follow certain geographic patterns. E.g. in some places--certain forms of abuse are more than others. It could be that I just haven't hit the right areas where it is being abused.

http://en.wikipedia.org/wiki/Gabapentin

Though gabapentin is not a controlled substance, it does produce psychoactive effects that could lead to abuse of the drug. However, it is widely regarded as having little or no abuse potential. Pregabalin, a gabapentinoid with higher potency marketed for neuropathic pain, is a controlled substance, under Schedule V of the United States' Controlled Substances Act.

I know its wikipedia & some people do not like it as a source. However its been one of the few sources that have mentioned the abuse potential of prescription drugs that the manuals aren't mentioning.

e.g. with regards to Seroquel....

Quetiapine is not currently classified as a controlled substance. Reports of quetiapine abuse have emerged in the medical literature, however. While the drug is usually abused through the crushing and snorting of tablets (insufflation), there have also been reports of intravenous abuse and intravenous co-administration with cocaine.[27] A 2004 report recorded a 30% rate of inmate use in the Los Angeles County Jail, where the drug was obtained by inmates faking schizophrenic symptoms and resold under the street name "quell".[28] Also known as "Susie-Q", the drug may be more commonly abused in prisons due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances. A letter to the editor which appeared in the January 2007 American Journal of Psychiatry has proposed a “need for additional studies to explore the addiction-potential of quetiapine”. The letter reports that its authors are physicians who work in the Ohio correctional system. They report that “prisoners ... have threatened legal action and even suicide when presented with discontinuation of quetiapine” and that they have “not seen similar drug-seeking behavior with other second-generation antipsychotics of comparable efficacy”.[29]

Along with benzodiazepines, atypical antipsychotics have sometimes been used to "come down" off cocaine or amphetamines. When used in this manner the slang term "downer" is often applied.

Yeah well that's what Wikipedia says, but that's what I've seen going on in the South Jersey-Philadelphia area for years and I yet have seen this data published in the the "major" sources for psychiatry such as Kaplan & Sadock.

Getting back to Neurontin, I don't see a reason to give it for psychiatric reasons except for some data showing that it may help prevention of relapse in alcoholics. That was from a study from the AJP about 1 year ago, and it really does need more data to back it up before it gains more momentum. If a psychiatrist was giving it as a mood stabilizer, I'd like to hear why, given the lack of data supporting its use as a mood stabilizer.

I took a detailed history but could not find any indication for her to be on it. It was started by someone in another city and she could not remember their name for me to obtain any collateral information. We tried very hard to wean her off it but she was very adamant about being on it.

I would not continue to prescribe a medication if there was no justification that could be documented. If the patient were to pull a "another doctor put me on it, I don't know why" story--well cough cough, I have seen doctors put patients on meds & not really explain why. I find that believable (though reprehensible practice--though of course sometimes doctors do educate patients, and the patients aren't listening or caring).

But if the above situation happened, I would tell the patient that I could not continue a prescription unless the exact reason for it is known and it can't be based on a "someone else started me on it" story that could not be verified. I would also consider calling up the pharmacist because perhaps this person's doctor could be tracked through the pharmacist & the pharmacist could tell you of the patient's prescription history. If for example there were a lot of other drugs of abuse, its a red flag that this person is a prescription abuser.

I would try to see if she had any disorder that it was FDA approved for, and if I found no evidence for such, I'd wean them off of it.

[Encephalopathy]

From: http://www.erowid.org/experiences/exp.php?ID=60659

"It took about an hour for the first dose of 1500mg to kick in, and it felt more like a subtle, but definitely noticeable, mood shift. I was expecting a rush, but that did not happen. At about 1 1/2 hour we did another 1500mg by 2 hours we were feeling the full effect. Did a couple 'boosters' over the next 2 hours and I felt the effects until about 10:30 in the evening about 10-11 hours total.

...

Neurontin put me in a very easy, open mood a very good mood. Like Ecstacy, kind of a warm neutrality, where all judgments seemed 'appropriate' and issue-free.

...

In conclusion, it’s a lot like a single dose of E without the rush, the edge, or the crash. I have never experienced such an easy on and easy off on any drug before. The occasional, recreational use of the drug is probably a lot different than the prescribed therapeutic experience, and I wonder if it is probably wise to not do it too often as the recreational benefits might decrease. Apparently the recreational dose is fairly high. Still it lasts longer than E and is much cheaper at about $14 a dose. Probably not a good drug for dancing all night, but a very nice daytime high. "

From this guy's point of view, maybe she is doing it right. To answer your question, about a buck per 100 mg, $35 a day for your patient.

[billypilgrim37]

Thanks, folks. Awesome replies.

It's actually a medicine resident whose patient this is (well, she's a new patient), and the initial indication was appropriate (and non-psychiatric), and of course, started by some other physician. My friend has every intention of weaning the patient, but I think it's going to be a long process.

Pretty sweet find there, encephalopathy.

[OldPsychDoc]

Originally Posted by billypilgrim37

Thanks, folks. Awesome replies.

It's actually a medicine resident whose patient this is (well, she's a new patient), and the initial indication was appropriate (and non-psychiatric), and of course, started by some other physician. My friend has every intention of weaning the patient, but I think it's going to be a long process.

Pretty sweet find there, encephalopathy.

Gotta love that erowid.org... You'll learn stuff there that Kaplan and Saddock can only dream about.

[whopper]

2 attendings I had as a resident who used to work in a prison told me that prisoners tend to be able to figure out what to use to get high. They'd try anything & everything. Once they got a hold of something, they'd also play around with that stuff, seeing if burning it, snorting it, liquifying it, insufflating it etc could somehow get you high off of it.

In prison, they'd do anything & everything to be able to make it into something. Plastic wrap can be converted into shanks, grape juice can be made into prison wine, magazines can be used to make paint for paintings.

Anyways, it was from these 2 guys that I first learned of the abuse potential of Seroquel, and its street value. I also learned that cogentin is sometimes used to catch a buzz, among other substances. Funny thing was some of the other attendings in the same program wouldn't listen to them & gave out seroquel like it was candy for years. It was only till my 4th year that those attendings starting seeing what those 2 were talking about.

For that reason, I wouldn't be surprised if neurontin did do something that might make someone want to abuse it. I just haven't seen it--yet.

& some patients are just med seeking & will take anything, abusing drug that gives them a buzz or not--for whatever reason-obsession, placebo, attention, etc. It could be that this particular person might've not been experiencing a buzz at all, but was abusing it for other reasons.

[Still Kickin]

http://psychiatrist-blog.blogspot.co...street%20value

This blogger seems to be collecting/compiling info about the street value of psych drugs.
(But looks like they haven't shared any of their data yet...)

[Anasazi23]

3g+ish isn't that outrageous for neurontin. It's fairly common for moderate to severe neuropathic pain.

It has relatively little street value, but the patient is likely taking at least half that dose herself, giving some to her mother who ran out, etc. This happens all the time. Simply ask her where the pills went and tell her you need the truth. Then set limits and maybe go for another round.

Of all the things to restrict, I generally don't do it with neurontin. There are bigger fish to fry. Assuming she absolutely doesn't need it, then it's a slightly different story of couse.

[rabblevox]

Hey all,
I am a 50 yo/ male, who is employed but lacks health care (god bless America). I have been dealing with either a pinched nerve in my back, or sciatica. (chronic sharp pain near L5, constant tingling and numbness in R leg and foot).

My neighbor recently sold me 20 300 mg Neurontin capsules for 40 dollars. It works brilliantly for pain management (2x300mg/day), but doesn't get me "high" or seem to have any serious abuse potential.

So in my case "street value" would be $2/300mg. I hope he can hook me up with the same next week.

I realize this is an old thread, but I was curious about exactly this subject, and thought I'd add my 2c worth.

[TheWowEffect]

Based on my recent experience, Neurontin can be quite useful for a certain subset of patients, especially for the vague anxiety or mood swings that many of the substance abusing patients report. Can also be a useful drug for the vague aches and pains in many patients.

[kugel]

Originally Posted by TheWowEffect

Based on my recent experience, Neurontin can be quite useful for a certain subset of patients, especially for the vague anxiety or mood swings that many of the substance abusing patients report. Can also be a useful drug for the vague aches and pains in many patients.

While I won't say that any medication is perfectly safe, this one comes about as close as I can imagine. Of all the meds used off-label, this one worries me so little that I don't mind continuing it if someone seems to be getting benefit. I don't tend to start it because of so little data that it's particularly useful, but I really don't mind continuing it. In cases of vague uncontrollable anxiety, that are not responding to meds + therapy + proven sobriety and I really feel quite certain that we're not in the wrong diagnostic category, then I'm willing to give it a try. Very little downside.

[OldPsychDoc]

Originally Posted by rabblevox

Hey all,
I am a 50 yo/ male, who is employed but lacks health care (god bless America). I have been dealing with either a pinched nerve in my back, or sciatica. (chronic sharp pain near L5, constant tingling and numbness in R leg and foot).

My neighbor recently sold me 20 300 mg Neurontin capsules for 40 dollars. It works brilliantly for pain management (2x300mg/day), but doesn't get me "high" or seem to have any serious abuse potential.

So in my case "street value" would be $2/300mg. I hope he can hook me up with the same next week.

I realize this is an old thread, but I was curious about exactly this subject, and thought I'd add my 2c worth.

He's overcharging you.

Find a local charity clinic where you can get an actual physical exam and hopefully a regular prescription.

Gabapentin is reasonably useful in chronic pain with a neuropathic origin. Also, thank God, its abuse potential is negligible.

[psychotrope]

Originally Posted by OldPsychDoc

He's overcharging you.

Find a local charity clinic where you can get an actual physical exam and hopefully a regular prescription.

Gabapentin is reasonably useful in chronic pain with a neuropathic origin. Also, thank God, its abuse potential is negligible.

these local charity clinics(where they are useful at least) are very rare. In small towns and rural areas they are unheard of, and in the medium sized cities(I've been in several) they are sporadically there but certainly don't provide any sort of "actual physical exam" and bloodwork to go with it.

I've never lived in a big city so I can't comment on the availability there.

But if he went to a pcp and had the routine workup every new patient gets(cbc, lipid panel, cmp, etc) and an office visit....even just that after the labs and everything would be 400 dollars+(probably a lot more).....thats not even counting what it would cost to fill the scripts.

He's coming out *WAY* ahead now by buying for $2/pill. Note that Im not saying this is the best medical care for him(I have no idea), but his options are very limited by his lack of access.

[TheWowEffect]

Originally Posted by kugel

While I won't say that any medication is perfectly safe, this one comes about as close as I can imagine. Of all the meds used off-label, this one worries me so little that I don't mind continuing it if someone seems to be getting benefit. I don't tend to start it because of so little data that it's particularly useful, but I really don't mind continuing it. In cases of vague uncontrollable anxiety, that are not responding to meds + therapy + proven sobriety and I really feel quite certain that we're not in the wrong diagnostic category, then I'm willing to give it a try. Very little downside.

Totally agree...

[whopper]

It's been awhile since I last posted in this thread.

I have done more research on Gabapentin.

Aside from it's FDA-approved indications, there is a great double-blinded, placebo controlled study showing it can help with abstinence from the use of alcohol in those with alcohol dependence. There are also studies that it can reduce anxiety. I have one patient with panic disorder and ironically every single SSRI and SNRI we've tried she claimed made her feel suicidal. We could not get her panic attacks under control until she was tried on Gabapentin by someone else. (I'm actually speculating that she has rapid-cycling bipolar, and that the SSRIs spiked off the rapid cycling...hers is a complicated case with multiple Axis I issues).

If you look up Erowid, Pregablin is the med of abuse people are talking about more so than Gabapentin.

As for Bipolar, there is not one double blinded placebo controlled study showing it works, yet several doctors still give it out to treat bipolar. This has put me in an uncomfortable position a few times this year so far. Once every 2 weeks I need to evaluate about 7 people for the court, and the judge directly asks me the prognosis. I had one patient on topamax and gabapentin (I kid you not) and I had to flat out say that I could not give a prognosis because both medications are not FDA approved, nor have data other than case studies supporting their use as a mood stabilizer. The results of the case study could be argued to be no better than placebo effect.

This then brings up a protest by the lawyer representing the patient, who then says something to the effect of "if my client is going to be held against his will in a hospital, the least they can provide is standard-of-care treatment."

It's an awkward position because as a court evaluator, I'm strictly not allowed to cross into the treatment zone and tell the other doctor what to do, yet the judge and lawyers don't feel they can do it either.

I have tried to contact the doctors on the occasions where this happens, and often times I do not get a call back (and mind you they are still on duty. Most of them seem to show up to work at 8-9am, leave at noon and let the treatment team do all the work. All they do is prescribe, admit, discharge and write notes. They rely on their team to do everything else.)

Bottom line: don't give it for bipolar. Have a suspicion people are abusing it only if you have strong evidence because likely they are not abusing it. Worry more about pregabalin (Lyrica) more so than gabapentin.

[Manicsleep]

Got a great moonlighting job a the prison this weekend. I used to work there and they pay really well plus they don't make me go through a locums company.

Anywho...talking about prison drugs: I had a guy lock up after snorting several 80mg geodons.

A lot of prison drugs are snorted that otherwise wouldn't be on the streets. Combine drug addicts with a lack of easily available drugs, not enough money, ignorance/stupidity, little self respect and willingness to malinger for medications: You have a prison culture

the most common where I am are:

Gabapentin: The prisoners say snorting is mildly like ecstasy but also takes the edge of the opiate abusers.

Buspirone: Gives a short buzz when snorted

Buproprion: Speedy high when snorted

Quetiapine: I heard a lot of people want this for various reasons. Its very sedating and they just want to sleep prison away. "It makes you feel tingly" when snorted. The reasons were vast but those were probably the main 2.

Clonidine: Makes the heroin go further. (yes heroin is available in prison but its very expensive).

Artane/Cogentin/Vistaril/Benadryl: Short buzz when shorted

The faking of pain symptoms is common with people running, literally running, around with canes to get in line for methadone for their back or knee pain.

Most of these drugs are crushed and floated in water per the order but often times the LVNs are too overworked or just dont care. Even the actual medications are supposed to be dispensed and they are supposed to see the guy take it. But again the LVNs dont always do the job and the cons are cons, they will cheek the meds for later consumption or sale.

[Faebinder]

Lyrica, which is the cousin derivative of Neurontin, is an official drug of abuse. Well known in the middle east.

[OldPsychDoc]

Originally Posted by Faebinder

Lyrica, which is the cousin derivative of Neurontin, is an official drug of abuse. Well known in the middle east.

Heroin is probably cheaper--and obtainable without a Prior Auth.

[jettavr6]

Having worked in a correctional facility, I can say that many inmates will try to con any doctor into giving them Neurontin. It gives them a high if snorted and therefore does have a street value.

[billypilgrim37]

So what drug did this thread snort to bring it back to life?

[whopper]

Charles Scott, the head of the U. of San Diego forensic psychiatry fellowship program wrote an article on the abuse of Seroquel in the California prison system. He's a big shot in the field, and some speculate he may be the next generation Resnick.

Scott has authored several articles and books specifically on correctional psychiatry.

As far as I know, however, that's the only medication he's mentioned that's been observed to be abused in prisons. I wouldn't be surprised, however, if he wrote about more.

Again, apologizes for not finding the specific article. I'm almost done with fellowship and will have more time in the near future to get back into the habit of putting better links to data I bring out.

[jettavr6]

Charles Scott is correct. In fact, seroquel has been in the literature frequently over the past few years due to it's abuse within the prison system. Seroquel, along with Wellbutrin and benadryl are off formulary in the CA State Correctional facilities. Neurontin is restricted on a case by case basis. Benzodiazepines are only used in extreme cases, and it's pretty much limited to IM ativan. Inmates will try anything to get high.

[sunlioness]

Originally Posted by OldPsychDoc

Heroin is probably cheaper--and obtainable without a Prior Auth.

LOL. Too true. I don't think I've ever managed to get Lyrica approved. But having said that, I don't think I've actually tried more than twice.

[Manicsleep]

C. Scott is at Napa State and UC Davis

He is unlike P. Resnick (aka mr burns) in so many ways its hard to describe but he may well be the next Top Dog in forensics, he is already a big shot.

The list earlier is based on the California correctional system.

BTW, Napa state isn't corrections, although Scott used to go to Folsom I think.

As far as the California forumulary. It is idiotic and not based on abuse.
Trazodone has been off formulary for years while benadryl just went off.

Everyone is on antichoinergics and antipsychotics for the hypnotic effects or for SSI.
That many people dont hear voices.

[zenman]

Originally Posted by Faebinder

Lyrica, which is the cousin derivative of Neurontin, is an official drug of abuse. Well known in the middle east.

I've been on Lycria for 5-6 months for OA pain. Seemed to help for awhile but not as much now. I'm only on 75mg. It does make me sleep a little better but I certainly get no thrill out of it.

[billypilgrim37]

Originally Posted by zenman

I've been on Lycria for 5-6 months for OA pain. Seemed to help for awhile but not as much now. I'm only on 75mg. It does make me sleep a little better but I certainly get no thrill out of it.

Are you saying it's not a drug abuse, or are you pointing out that you're just not doing it right?

[zenman]

Originally Posted by billypilgrim37

Are you saying it's not a drug abuse, or are you pointing out that you're just not doing it right?

Well, since I bought it from a pharmacy I guess it's not a "street drug" so I must not be using it correctly.

[OldPsychDoc]

Originally Posted by zenman

Well, since I bought it from a pharmacy I guess it's not a "street drug" so I must not be using it correctly.

Crush first, THEN snort!

[reedman]

http://www.google.com/cse?cx=0095132...h=bluelight.ru

enjoy