Muscle Relaxers

Muscle relaxers are commonly misused and abused. More than 6 million people in the United States misused a prescription tranquilizer in 2020. 

The Drug Enforcement Administration (DEA) reports that carisoprodol, a popular muscle relaxer known by the brand name Soma, is one of the most regularly diverted prescription pharmaceuticals. 

What Are Muscle Relaxers?

Muscle relaxers are sedative and tranquilizer medications that are used to treat muscle spasms and tension. They have a sedative effect and commonly work on the central nervous system by slowing it down or interfering with nerve transmission that can signal your muscles to spasm. 

These medications can be prescribed to reduce muscle spasms caused by medical conditions, such as multiple sclerosis (MS) or cerebral palsy, or to relieve muscle tension, spasms, and pain related to injury or trauma. They are usually intended for short-term relief.

Muscle relaxers are generally pills or tablets that can be abused orally by swallowing or chewing them. They can be crushed and snorted, smoked, or injected. They are sometimes mixed with alcohol. 

These medications are commonly abused for their relaxing and sedative effects. They are used recreationally to achieve a “high.” 

Regular use and abuse of muscle relaxers can lead to drug dependence, withdrawal symptoms, and addiction. 

Key Facts About Muscle Relaxers

• Muscle relaxers are commonly prescribed. Prescription rates doubled for skeletal muscle relaxers between 2005 and 2016. Many of these medications are being prescribed long term, even though they are only approved for short-term use, increasing the odds for abuse and addiction. 
• Benzodiazepines, carisoprodol, and cyclobenzaprine are some of the most commonly abused skeletal muscle relaxants, accounting for more than 50,000 visits to emergency departments (EDs) in 2011. They are also commonly mixed with alcohol. Close to 20 percent of these ED visits involved alcohol and muscle relaxants, amplifying the potential side effects, including drug dependence and overdose. 
• Muscle relaxer abuse can have serious side effects. In 2017, there were more than 10,000 case mentions of cyclobenzaprine (a popular skeletal muscle relaxant) to American Association of Poison Control Centers, as well as nearly 100 deaths. 
• Muscle relaxers are addictive substances. More than 1 million people aged 12 and older in the United States had a prescription tranquilizer or sedative use disorder in 2020.

What Are Common Side Effects of Muscle Relaxers?

Muscle relaxers are often sedative medications, so common side effects of these drugs are drowsiness and sedation. Additional side effects can include the following:

• Dizziness
• Headache
• Lowered blood pressure
• Muscle weakness
• Nausea and vomiting
• Confusion
• Agitation
• Lightheadedness
• Fatigue
• Irritability
• Nervousness

What Are the Different Types of Muscle Relaxers?

There are two main types of muscle relaxers: antispasmodics (centrally acting skeletal muscle relaxants) and antispastics. 

Skeletal muscle relaxers are prescribed to relieve muscle spasms and related pain. Antispastics are designed to treat muscle spasticity and reduce muscle tension.

Common antispasmodics include the following:

• Carisoprodol (Soma)
• Cyclobenzaprine (Flexeril, Amrix)
• Methocarbamol (Robaxin)
• Metaxalone (Metaxall, Skelaxin)
• Chlorzoxazone (Lorzone, Parafon Forte DSC)
• Tizanidine (Zanaflex)
• Orphenadrine (Norflex)

These are common antispastics:

• Diazepam (Valium)
• Baclofen (Gablofen, Lioresal)
• Dantrolene (Dantrium)
• Lorazepam (Ativan)

Common Street Names for Muscle Relaxers

When diverted and sold through the black market, muscle relaxers often go by slang or street names. The terms used will depend on which drug or type of muscle relaxer it is. 

Benzodiazepines are often called benzos, downers, nerve pills, and tranks. Valium specifically is often called V, vallies, candy, chill pills, blues, and French blues. 

Additional street names for muscle relaxers include the following:

• Soma coma (when mixed with codeine)
• Dance
• Houston or Las Vegas cocktail (when mixed with opioids)
• DS 

How Do Muscle Relaxers Impact the Mind & Body?

Muscle relaxers impact the central nervous system, having a depressant and sedative effect. Different medications can have variable effects on the brain and body. 

For example, benzodiazepines (like Valium) are sedative medications that increase the impact of the neurotransmitter GABA in the brain, which inhibits actions of the central nervous system. This means things like heart rate, blood pressure, and body temperature all decrease. Stress levels and muscle tension lessen, which promotes relaxation. 

Baclofen, on the other hand, is believed to block nerve signals coming from the spinal cord that can cause muscles to spasm, which then decreases spasms and pain. Other muscle relaxers, such as dantrolene, work directly on the skeletal muscles to relax them. Most skeletal muscle relaxers prevent nerves from sending pain signals to the brain, which can lead to muscle spasms, and/or have a sedative effect to minimize muscle spasms. 

Muscle relaxants can also be mind-altering, which means that they can also have a euphoric effect, causing a kind of relaxed “high.”

What Are the Signs & Symptoms of Muscle Relaxer Abuse & Addiction?

Muscle relaxers are often misused. Any use outside of a legitimate and necessary prescription is considered abuse. 

Signs of muscle relaxer abuse can include the following:

• Taking more than the prescribed dose at once
• Taking the medication in between doses or after a prescription has run out
• Using the medication in any way other than intended, such as chewing it, crushing it and snorting it, smoking it, or injecting it
• Exaggerating symptoms to get more of the medication
• Doctor shopping (going to multiple doctors for additional prescriptions)
• Intense mood swings
• Changes in sleeping, eating, and socializing habits

Symptoms of addiction include the following:

• Taking more of the medication than intended in a sitting
• Being unable to stop taking it even after trying several times
• Drug tolerance (needing more of the medication to feel the effects)
• Drug dependence (withdrawal symptoms when the medication wears off)
• Inability to fulfill regular obligations at home, school, or work; an overall decline in performance 
• Changes in behavior and personality
• Increased social isolation and lack of desire to do things previously enjoyed
• Using the medication in potentially risky physical situations
• Continuing to take the medication despite knowing it will have serious mental health, social, and/or physical effects
• Spending a lot of time thinking about the medication, obtaining and using it, and recovering from its effects

Mixing Muscle Relaxers With Other Substances 

Muscle relaxers are most commonly mixed with alcohol, which is a particularly dangerous combination. Both alcohol and muscle relaxers are sedatives and depressant substances, and the mixture can be potentially fatal. 

Mixing two substances of the same type — in this case, two central nervous system depressants — can lead to a life-threatening overdose as well as damage to the heart, brain, and other organs, the Centers for Disease Control and Prevention (CDC) warns. 

Muscle relaxers, particularly benzodiazepines, are also often combined with opioids. In 2020, 16 percent of all opioid overdose deaths also involved a benzodiazepine. These two medications can both lead to serious complications, including slowing down life-sustaining functions of the central nervous system to dangerously low levels. 

Mixing alcohol or other drugs with muscle relaxers increases all potential complications. It can enhance the effects of each substance, causing increased sedation, intoxication, and even death.

What Are the Withdrawal Symptoms Associated With Muscle Relaxers?

Muscle relaxers are habit-forming substances. This means that with regular use, drug dependence can form. This occurs when your brain and body get used to the substance, and the drugs make changes to the chemical makeup of the brain. 

When the medication is no longer active in your system, withdrawal symptoms can occur. Withdrawal symptoms can include the following:

• Racing heart rate
• High blood pressure
• Breathing issues
• Irritability
• Depression
• Anxiety
• Nausea and vomiting
• Diarrhea
• Headache
• Tremors
• Muscle tension
• Sweating
• Sleep issues
• Trouble focusing and concentrating
• Agitation
• Hypersensitivity
• Drug cravings

Can You Overdose on Muscle Relaxers?

Yes, you can overdose on muscle relaxers. These medications are central nervous system depressants that slow down vital and life-sustaining functions of the brain and body. A toxic dose is generally between three and five times the therapeutic dose. 

The risk for overdose goes up drastically if you mix these medications with other substances, particularly other central nervous system depressants such as alcohol or opioids. 

Muscle relaxer overdose can be fatal, and an overdose is a medical emergency.

Overdose Symptoms 

Overdose symptoms can begin within 30 minutes to 2 hours after taking a toxic dose of a muscle relaxer. Overdose symptoms can include the following:

• Lethargy
• Muscle weakness
• Loss of coordination
• Slurred speech
• Blurred vision
• Drowsiness or unconsciousness
• Shallow breathing and respiratory arrest
• Decreased heart rate and blood pressure
• Hallucinations
• Seizures
• Shock
• Coma
• Death

Treatment Options for Addiction to Muscle Relaxers

Muscle relaxers are medications that are not typically recommended to be stopped cold turkey, or suddenly, due to the potential withdrawal symptoms. 

Typically, one of the first aspects of addiction treatment includes detox. During detox, the muscle relaxer can be tapered off slowly to minimize withdrawal complications. Other medications can also be used to manage specific withdrawal symptoms. 

Detox should be followed with a comprehensive treatment plan that can include either outpatient or inpatient rehab. Inpatient treatment programs offer the highest level of care and support, while outpatient programs can provide more flexibility when needed. 

Muscle relaxer addiction treatment programs will typically include the following components:

• Behavioral therapies
• Medication management
• Educational programs
• Group and individual counseling
• Dual diagnosis treatment for any co-occurring medical or mental health conditions
• Support groups
• Recovery planning and aftercare support

Addiction is a treatable condition, and no two treatment plans will be exactly alike. 

Muscle relaxant abuse is often the result of medical or mental health issues, and these co-occurring disorders will require simultaneous treatment provided by a team of medical and mental health professionals. A comprehensive addiction treatment program can help you develop coping skills, learn stress management techniques, and build healthy lifestyle habits that can carry you into long-term recovery.

References

Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. (2021). Substance Abuse and Mental Health Services Administration.

Carisoprodol. (December 2019). Drug Enforcement Administration.

Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016. (June 2020). Primary and Clinical Pharmacology.

Considerations for the Appropriate Use of Skeletal Muscle Relaxants for the Management of Acute Low Back Pain. (June 2014). Pharmacy & Therapeutics. 

Cyclobenzaprine. (March 2020). Drug Enforcement Administration.

Side Effects and Risks of Muscle Relaxers. (March 2019). Spine-Health.

Polysubstance Use Facts. (February 2022). Centers for Disease Control and Prevention.

Benzodiazepines and Opioids. (April 2022). National Institute on Drug Abuse.

Carisoprodol Abuse in Adolescence. (November 2020). Cureus.

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.