Older adults prescribed concerning amount of muscle relaxants

Office visits for ongoing prescribing of skeletal muscle relaxant drugs tripled from 2005 to 2016, according to a new study published in JAMA Network Open.

Researchers found that the number of office visits resulting in new muscle relaxant prescriptions remained stable at approximately 6 million per year from 2005 to 2016. However, office visits for continued muscle relaxant drug therapy skyrocketed from 8.5 million in 2005 to 24.7 million in 2016.

What worries researchers the most is that muscle relaxants were prescribed more to older adults—they accounted for 22.2% of all muscle relaxant office visits in 2016, even though older adults make up about 14.5% of the population in the United States. National guidelines warn that this class of drugs should almost always be avoided in older adult patients. According to the American Geriatrics Society, muscle relaxants can have serious side effects including falls, fractures, abuse, dependence, and overdose, which is why older adults should avoid them. In general, muscle relaxants should be limited to a 3-week duration when prescribed.

Researchers of the study hypothesized that the opioid epidemic may have led clinicians to prescribe muscle relaxants as an alternative to opioids for long-term pain management. Their research findings proved that 67% of the continued muscle relaxant visits in 2016 also recorded therapy with an opioid.

"For older adults, I think the message should be to avoid using muscle relaxants, especially when we consider the side effects and increased risk of falls and fractures, and to find alternatives for pain management," said lead author Samantha Soprano, MPH, in a press statement.

In the same press statement, Charles Leonard, PharmD, MSCE, an assistant professor of Epidemiology at the Perelman School of Medicine at the University of Pennsylvania who was also involved in the research, said muscle relaxants may not be any more effective in managing pain than medications like Tylenol or Advil. 

FDA warns against co-prescribing muscle relaxants and opioids because of the risk of serious side effects, including slowed or difficult breathing and even death.

The results of the study were based on publicly available data from the National Ambulatory Medical Care Survey, which is an annual survey for non-federally funded office-based physicians.