Off Label, On Agenda: Gabapentin’s Rise and the Debauchery Behind It
Updated
From 2010 to 2024, data on the drug gabapentin show something deeply telling about our medical‑industrial complex. Specifically, a study published September 30, 2025, in Annals of Internal Medicine reveals that prescriptions of the drug (a GABA-analog drug approved for partial seizures and postherpetic neuralgia) exploded, going from around 24 million prescriptions in 2010 to nearly 59 million in 2024. In other words, as currently the fifth most prescribed medication in 2024, the number of people prescribed gabapentin more than doubled during that timeframe. As we’ve repeatedly shared, this type of drug pushing—as Americans get sicker and sicker—is not about patient care alone. No, indeed, instead it is about greed-driven methods of dispensing drugs for profit and control while creating lifelong patient-customers.
On its face, the expanse of Gabapentin prescriptions might seem like a therapeutic tool gaining use, but beneath that surface is the echo of an ever‑expanding network of writing scripts for Big Pharma’s products. Older adults (65 +) received gabapentin at rates higher than any other group; in 2024, more than 114 per 1,000 persons in that age group were given gabapentin. Female patients outpaced male patients. Primary care and, notably, nurse practitioners or physician assistants (deemed the “advanced practitioners”) were increasingly responsible for writing the prescriptions. These patterns undoubtedly reflect a subtle shift of power we see all too often, which is the decentralization of expert authority, the broadening of prescribing reach, and the embedding of pharmaceuticals into the daily routine of primary care and advanced practice.
Why is there cause for concern? Because the drug is utilized far beyond its original approved uses. It is now heavily prescribed off‑label, often for neuropathic pain and other conditions where evidence is weak or mixed. That raises a red flag and begs the question: when a drug becomes this ubiquitous, this normalized, the deeper question is not “Is it safe?” but “Who benefits from its ubiquity?” For example, when older adults—who are already often vulnerable and often on numerous medications—are given more and more of this drug, the structural risk becomes part of the strategy. There are risks of dizziness, drowsiness, gait disturbance, and potential respiratory problems when gabapentin is combined with opioids. Yet those risks are quietly ignored, rarely given proper attention. This is unacceptable.
With the clear pattern of drug profit over patient care and patient health in full view—this time with gabapentin—it seems like a good time to look at its history. Under the brand name Neurontin, manufactured by Parke-Davis (a subsidiary of Warner-Lambert), the U.S. Food and Drug Administration approved gabapentin as an adjunctive therapy for treating partial seizures in 1993. Pfizer took ownership of gabapentin in 2000 when it acquired the pharmaceutical company Warner-Lambert. In early 2009, as the dust settled following lawsuits alleging injuries from the illegal marketing of Neurontin, the widespread criminality under both Warner-Lambert’s and Pfizer’s rule was overwhelmingly apparent. Key findings noted in an analysis published by the VA Health Systems research exclaimed:
“The NeurontinTM marketing campaign involved the systematic use of deception and misinformation to create a biased evidence base and to manipulate physicians’ beliefs and prescribing behaviors. For example, a “publication strategy” was designed to increase use of the drug for neuropathic pain and bipolar disorder—off-label indications with great revenue potential.
This comprehensive marketing campaign involved many individuals and institutions that apparently failed to recognize the serious ethical and legal issues regarding their actions.”
Following the lawsuits and after paying $430 million over illegal promotion of Neurontin, Pfizer released a statement, as shared by Newsweek, saying that it was “committed to the communication of medically or scientifically significant results of all studies, regardless of outcome. Company policy requires that, in all cases, study results are reported by Pfizer in an objective, accurate, balanced, and complete manner with a discussion of the strengths and limitations of the study and are reported regardless of the outcome of the study.” Wow, we know that is not Pfizer’s genuine belief, judging from the catastrophic, deadly, and dangerous mRNA COVID-19 shots.
Still, thankfully, the increase in prescribing of gabapentin slowed after 2016—but only slightly. The momentum remained, yet some states began reclassifying gabapentin as a controlled substance or adding it to prescription monitoring programs, making clear that the regulators themselves recognized that something had shifted. But the fact that such state‑level changes were required underscores how the federal agencies had already allowed the prescribing of the drug to go too far.
It is also revealing how prescriptions written by advanced practitioners soared—from about 2.5 prescriptions per 1,000 persons in 2010 to nearly 19.5 per 1,000 in 2024. Why does that matter? Because this shift is more than healthcare—it is about the delegation of power. The widening of prescribing power feels less like progress and more like a fast-track for Big Pharma—another way to push pills instead of addressing the real issues beneath the surface. The objective appears to be not at all about healing. Undoubtedly, it’s about managing people through medication while ignoring the root causes.
From a critical vantage point, pharmaceutical interests and allied regulatory and medical bureaucracies act less like dedicated custodians of health and more like profit-driven distribution networks. When a drug intended for a relatively narrow use becomes one of the top five dispensed products in the U.S., legitimacy is no longer the primary issue—scale is. And scale means profit, control, dependency.
What we are witnessing with gabapentin is the result of a convergence of Big Pharma, Big Government, and deep state dynamics. In other words, the normalization of a drug as a commodity across populations, the absorption of off‑label uses into standard practice, and the minimizing of adverse effects when they threaten the flow of the system. Older patients, women, and non‑specialist prescribers all become nodes in a network of dispensing. Make no mistake, that network isn’t organic. It is engineered.
With this latest study on the proliferation of gabapentin, the obvious questions persist and can be applied to many billion-dollar drugs. Who set the incentives for overprescribing gabapentin? Why did off‑label use explode? Why did the system allow primary care and advanced practitioners to become rapid gateways for gabapentin? Why has the risk‑/benefit conversation been quiet while the prescription metrics doubled?
Ultimately, the data from this study isn’t just about a drug. No indeed. Instead, it is about a broken system that prefers expansion over sufficiency, prescribing over prevention, and treatment over root cause. And in that system, your health becomes another data point, another sale, another ledger entry. We must push back—not by denying the utility of medications, but by demanding transparency, accountability, and structural clarity. Because, as we’ve been lecturing, when drugs become a business, the patient becomes a commodity. And that remains the more profound crisis beneath the numbers.
