More People Landing in the ER After Abusing Muscle Relaxant: Report

THURSDAY Nov. 3, 2011 -- The number of people winding up in the emergency room because of the misuse or abuse of the prescription muscle relaxant carisoprodol has more than doubled, a new federal report warns.

Between 2004 and 2009, such visits went from 15,830 to 31,763, investigators from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) found.

The sedative effect of carisoprodol (sold as Soma, Soprodal or Vanadom) is useful when taken properly for the short-term relief of acute muscle pain, but it can become dangerous when combined with other prescription drugs, recreational drugs or alcohol. SAMHSA officials noted that the vast majority of carisoprodol-related ER visits during the study period involved at least one other prescription drug.

"We're not talking about an epidemic, but we are talking about a larger number of people ending up in the ER with misuse of this medication," said Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality.

"Either they're prescribed it, or they get it from other people," Delany noted. "But, either way they think it's a safe drug, in the sense that it's not heroin or something like that. But it is a drug. And if it's misused, it can be a problem."

In the report, the SAMHSA team explained that when carisoprodol is ingested, it is converted by the liver into a chemical with anti-anxiety properties. This means that, even when taken on its own, patients run the risk of developing a physical and/or psychological dependence.

The U.S. Food and Drug Administration has therefore recommended that patients take the medication only for limited periods of time (two to three weeks). If taken in tandem with narcotic painkillers, other anti-anxiety medications or alcohol, carisoprodol's sedative effect ratchets up markedly, they added.

Despite these dangers, the drug is not currently classified by the federal government as a controlled substance.

Among the report's highlights: ER visits related to carisoprodol misuse were up across all age groups.

The most dramatic bump was seen among patients over the age of 50, whose visits tripled in the study period (from nearly 2,100 to more than 7,100 visits). Visits among those aged 35 to 49 roughly doubled (from more than 6,300 to more than 12,000).

More than three-quarters (77 percent) of carisoprodol-related ER visits due to either abuse or misuse involved at least one other prescription drug. Narcotic painkillers were the most common additional medication, found among 55 percent of visits. Benzodiazepines were the second most common, found among 47 percent of visits.

About 18 percent of visits involved carisoprodol alone, but one-quarter involved a second drug, and one-third involved two additional medications. Roughly 12 percent of ER cases involved three other drugs, while another 12 percent involved another four or more. Alcohol was implicated in 12 percent of carisoprodol-related ER visits.

What's more, over one-third of all the misuse and abuse visits (35 percent) required hospitalization of the incoming patient, the report revealed.

The SAMHSA team concluded that though carisoprodol abuse and misuse in the United States continues to be a relatively small problem, it is one that is notably on the increase.

"But in many ways this is really a provider concern," Delaney added. "So I would say that providers, whether they're prescribing it or seeing patients in the ER, need to be aware of what's going on. And they need to be asking questions, so they're really making sure that a person isn't mixing substances in a way that's going to be causing problems."

Dr. Michael Brodsky, psychiatrist at the UCLA David Geffen School of Medicine, suggested that the SAMHSA report is both sobering and worrisome.

"First of all, doctors are by and large aware that this is a problematic medication," he said. "Short-term use for the relief of an acute muscle injury is a very reasonable thing to do. In fact, it probably speeds up the healing process. But it's relatively addictive. Not as much as cigarettes. But addictive in the way that you might say Michael Jackson was addicted to sleep medicine," Brodsky explained.

"Which means that, typically, people start taking it innocently. They have an injury, so they get a 10- or 14-day prescription. And they like the effect. They feel calm. They sleep well. They may even get a subjective sense of emotional well-being," Brodsky added. "And so they continue it inappropriately, and often combine it with other medications, particularly other sedatives. In that way it's very similar to the problem with traditional prescription painkillers like codeine, Vicodin, Percocet, or morphine," he noted.

"So this report is not a good sign, because it suggests that the upswing in the abuse of this drug is part of a tidal wave of change, a shift away from concern over illicit drugs to a major concern over prescription drug uses, misuses and abuses. It's definitely not good news," Brodsky said.

More information

For more on carisoprodol, visit the U.S. National Institutes of Health.

Posted: November 2011


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