Prescription Muscle Relaxers: Uses, Types & Misuse
Last Updated Dec 2, 2021
Muscle relaxers aren’t typically associated with addiction, but the rate of their abuse seems to have risen. They may be combined with other drugs to try and elevate their effects, which can be dangerous.
Relevant Stats Relating to Muscle Relaxer Abuse
There isn’t a large body of hard data on muscle relaxer abuse. The DEA has noted a rise in the diversion and abuse of several relaxers, such as carisoprodol (sold as Soma), over the last decade. At least some of these drugs are often abused as a secondary drug meant to elevate the effects of a person’s primary drug of choice.
An estimated 45 percent of prescriptions meant to treat lower back pain are for the skeletal muscle relaxants carisoprodol, cyclobenzaprine, and metaxalone. Furthermore, many of the use cases for muscle relaxers appear poorly studied, with several comparative trials coming from the 1960s and 1970s and being of low quality.
When used for treating muscle pain and spasms, for which relaxers are not considered a first-line treatment, efficacy declines over time.
Generally speaking, what quality data and research are available suggests muscle relaxers should not be used for this purpose, as nonsteroidal alternatives exist. Nothing suggests these steroidal options are better on their own or used in combination with nonsteroidal options.
With this said, there are exceptions in particular use cases for particular relaxers.
As touched on earlier, muscle relaxants are understudied, and the scenarios where they represent the ideal treatment option aren’t always clear. However, they do serve legitimate medical purposes, although they often aren’t the first-line treatment option. In other words, they may only be considered if an option with fewer adverse effects and/or greater evidence for efficacy isn’t helping.
There is at least limited evidence that muscle relaxants can help with the following issues:
- Muscle spasms
- Muscle spasticity
- Back and neck pain (when caused by the above)
Some people believe these drugs can help with fibromyalgia, but the evidence doesn’t support this.
Types of Muscle Relaxers
Broadly, there are two types of muscle relaxants:
These drugs are meant to treat spasms, and they do so by blocking nerves from signaling the brain. Spasms are involuntary muscle cramps, where muscles may suddenly forcibly contract and cannot relax. They’re also referred to as muscle cramps.
These drugs treat spasticity, and they do so in a fairly similar way to antispasmodic agents, by blocking nerve signals from the spinal cord and/or acting directly on skeletal muscle to relax spasms. Spasticity refers to abnormal muscle stiffness or abnormal muscle tone, which can cause pain and discomfort and may affect movement.
These drugs are associated with a number of side effects, with users commonly experiencing the following issues:
- Dry mouth
- Somnolence (drowsiness)
Other side effects that can occur include the following:
- Urinary retention
- Increased intraocular pressure (IOP)
- Gastrointestinal irritation
Several medications in this group have a risk of hepatotoxicity, or liver damage, especially if misused. This has the potential to be life-threatening. It is also possible to have an allergic reaction to these medications, which can also be life-threatening.
Are Muscle Relaxers Addictive?
Evidence suggesting that any muscle relaxers are particularly addictive is limited. However, carisoprodol (Soma) has long been associated with a fairly high abuse potential among people who already have a history of drug use.
Withdrawal reactions have also been reported, meaning that Soma does seem to cause at least some physical dependence, although animal tests suggest this is not normal even at significantly (5x) higher doses than prescription levels.
As already noted, the real danger is people attempting to use muscle relaxants to elevate the effects of other drugs. Polydrug use can often greatly increase a person’s risk of developing health complications. Several muscle relaxers have at least some noted abuse risk, including these:
How Long Do Muscle Relaxers Stay in Your System?
While the specifics may vary depending on the specific drug, one of the most common drugs, Flexeril (cyclobenzaprine), is said by one drug testing company to be detectable in urine 3 to 8 days after a person’s last use. Blood tests provide a similar window, with the company stating that testing can detect Flexeril in someone’s blood within 3 to 4 days of their last use.
It is detectable in saliva for a shorter time. The company states it can detect it up to 36 hours after last use.
Flexeril has an average half-life of 18 hours and will usually be completely eliminated from a person’s system within 4 days. Testing for Flexeril, and other muscle relaxers, is fairly rare.
Signs of Abuse
The muscle relaxers with significant abuse potential are generally associated with elevating mood and sometimes causing a notable sense of euphoria in a user. These drugs are also associated specifically with polydrug use, meaning they’re used in combination with other drugs, so a person can potentially show signs of drug abuse not directly associated with muscle relaxers specifically.
Treatment for Abuse
If a person cannot stop misusing drugs on their own, they need to seek treatment or they’re at serious risk of damaging their physical and mental health. Abusing muscle relaxers specifically has the potential to damage your liver, especially when combined with other drugs that can also affect the liver, such as alcohol.
The first major step in recovering from problems with drug misuse and addiction is talking to a mental health professional who specializes in addiction treatment. They can help work with you to outline a treatment plan customized to your needs.
You may benefit from undergoing withdrawal at a specialized treatment facility, although reports of physical dependence and significant withdrawal from muscle relaxants are scattered, and it seems to only occur at very high doses. Regardless, these facilities can help if you are experiencing withdrawal symptoms of any kind, whether related to muscle relaxants or other substances you’re struggling with, that are serious enough to make quitting difficult.
Generally, addiction recovery involves a combination of regular individual, group, and family therapy. A core part of this counseling is identifying why you use drugs, finding ways to channel the impulses that lead you to use drugs in healthier ways, and working to build a strong support network to better help you resist drug use when you’re struggling in your recovery journey.
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Skeletal Muscle Relaxants Drug Class Review. (February 2016). University of Utah.
Carisoprodol Abuse in Adolescence. (November 2020). Cureus.
Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016. (June 2020). JAMA Network Open.
Abuse Liability of Centrally Acting Non-Opioid Analgesics and Muscle Relaxants – A Brief Update Based on a Comparison of Pharmacovigilance Data and Evidence From the Literature. (June 2014). International Journal of Neuropsychopharmacology.
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