Researchers from the Perelman School of Medicine at the University of Pennsylvania have revealed a concerning trend of increased prescribing of skeletal muscle relaxants (SMRs) in older adults, often in combination with opiates.  Despite increased vigilance and warnings about medications to avoid in older adults, these published findings show otherwise.  Read more about this study published in JAMA Network Open in June 2020. 

Senior author Charles E. Leonard, PharmD, MSCE, assistant professor of epidemiology at Perelman School of Medicine, and colleagues set out to measure and evaluate national trends of prescribing skeletal muscle relaxants over a 12-year period by conducting a cross-sectional study of 314,970,308 office-based ambulatory care visits and data collected from the National Ambulatory Medical Care Survey for January 2005 to December 2016. The visits were evaluated overall, were stratified by calendar year, and included patient demographics (race, sex, and age) as well as geographic location. The team considered newly prescribed or continued SMRs as well as concomitant medications and diagnoses.

According to Dr. Leonard, “There are few studies on the short-term efficacy and safety of skeletal muscle relaxants, and almost no data on their long-term effects, so it is very concerning that patients, and particularly older adults, are using these drugs for an extended period of tim.” He added, “Providers seem to be reaching for them despite incomplete information on their potential benefits and risks.” 

The study patients had a mean age of 53.5 [±15.2] years, and the cohort was 61.8% men and 38.2% women. During 2016, when there were 30,730,262 visits associated with a continued or new prescription of a SMR, patients were most frequently female (58.2% [95% CI, 57.9%-58.6%]), white (53.7% [95% CI, 53.4%-54.0%]), and aged 45 to 64 years (48.5% [95% CI, 48.2%-48.9%]). Older adults accounted for 22.2% (95% CI, 21.8%-22.6%) of visits with an SMR prescribed. 

The overall prescribing of SMR was roughly doubled with 30.7 million (95% CI, 30.6-30.8 million) prescriptions in 2016 compared with 15.5 million (95% CI, 15.4-15.6 million) in 2005. The most significant increase was a continuation of use, versus the number of visits for newly prescribed SMR, which had remained relatively stable according to researchers. A notable concern was that combined use of an opioid was recorded in 67.2% (95% CI, 62.0%-72.5%) of cases.

The researchers believe that this trend may be a prescribing reaction to the growing opiate epidemic as a pharmcotherapeutic alternative to an opiate regimen when chronic pain management was needed. Dr. Leonard and his colleagues hypothesized that the growing opioid epidemic may have led clinicians to prescribe muscle relaxants as an alternative to opioids for long-term pain management.    

“Muscle relaxants’ place in therapy is really limited. Based on most guidelines, they’re normally reserved as second- or third-line therapies,” Dr. Leonard said. “Our findings suggest that prescribers may be reaching for these drugs sooner than that.  The team concluded that “this evidence of increasing continuing use of skeletal muscle relaxants, their disproportionately high use in older adults, and their concomitant use with opioids all represent trends with potentially adverse clinical and public health consequences.”

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