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. 2020 Jun 1;3(6):e207664.
doi: 10.1001/jamanetworkopen.2020.7664.

Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016

Samantha E Soprano  1   2 , Sean Hennessy  1   2   3   4 , Warren B Bilker  1   2   5 , Charles E Leonard  1   2   3
Affiliations

Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016

Samantha E Soprano et al. JAMA Netw Open. .

Abstract

Importance: Little is known to date about national trends in the prescribing of skeletal muscle relaxants (SMRs), the use of which is associated with important safety concerns, especially in older adults and in those who use concomitant opioids.

Objective: To measure national trends in SMR prescribing over a 12-year period.

Design, setting, and participants: This cross-sectional study used data from the National Ambulatory Medical Care Survey from January 2005 to December 2016. Data were analyzed from August 21, 2018, to July 18, 2019. The study included patients with ambulatory care visits who had encounters with non-federally funded, office-based physicians in the United States.

Exposures: SMR use, categorized as newly prescribed or continued therapy at the office visit.

Main outcomes and measures: Ambulatory care visits-overall and stratified by calendar year, geographic region, and patient age, sex, and race-in which an SMR was newly prescribed or continued were quantified. Among office visits in which an SMR was newly prescribed, diagnoses were assessed. Concomitant medications were quantified for all office visits, stratified by new or continued therapy. Survey visit weights were used to estimate nationally representative measures, and age-standardized rates were generated by geographic region using US Census data.

Results: This study included a total of 314 970 308 office visits (mean [SD] age, 53.5 [15.2] years; 194 621 102 [61.8%] men and 120 349 206 [38.2%] women). In 2016, there were 30 730 262 (95% CI, 30 626 464-30 834 060) US ambulatory care visits in which an SMR was either newly prescribed or continued as ongoing therapy. Patients in these visits 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%]). During the study period, office visits with a prescribed SMR nearly doubled from 15.5 million (95% CI, 15.4-15.6 million) in 2005 to 30.7 million (95% CI, 30.6-30.8 million) in 2016. Although visits for new SMR prescriptions remained stable, office visits with continued SMR drug therapy tripled from 8.5 million (95% CI, 8.4-8.5 million) visits in 2005 to 24.7 million (95% CI, 24.6-24.8 million) visits in 2016. Older adults accounted for 22.2% (95% CI, 21.8%-22.6%) of visits with an SMR prescription. Concomitant use of an opioid was recorded in 67.2% (95% CI, 62.0%-72.5%) of all visits with a continuing SMR prescription.

Conclusions and relevance: This study found that SMR use increased rapidly between 2005 and 2016, which is a concern given the prominent adverse effects and limited long-term efficacy data associated with their use. These findings suggest that approaches are needed to limit the long-term use of SMRs, especially in older adults, similar to approaches to limit long-term use of opioids and benzodiazepines.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Leonard reported serving on the Executive Committee of the University of Pennsylvania's Center for Pharmacoepidemiology Research and Training. The Center receives funding for education from Pfizer. Dr Leonard reported receiving grants from the US National Institutes of Health, grants from the American Diabetes Association, nonfinancial support from John Wiley and Sons, and personal fees from the American College of Clinical Pharmacy and the University of Florida College of Pharmacy outside the submitted work. In addition, Dr Leonard reported that he is a special government employee of the US Food and Drug Administration. Dr Hennessy reported receiving grants from US National Institutes of Health during the conduct of the study. Dr Hennessy reported directing the University of Pennsylvania’s Center for Pharmacoepidemiology Research and Training, which receives educational funding from Pfizer, and he reported serving as a consultant for several pharmaceutical companies on unrelated matters. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. National SMR Utilization Stratified by New vs Continued Use, 2005-2016
SMR indicates skeletal muscle relaxant.
Figure 2.
Figure 2.. National SMR Utilization Rates Among Adults Aged 65 Years or Older, Stratified by New vs Continued Use, 2005-2016
SMR indicates skeletal muscle relaxant.
See this image and copyright information in PMC

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