Muscle relaxers are medications prescribed to alleviate discomfort from muscle spasms, spasticity, and musculoskeletal pain. They work by affecting the central nervous system to reduce muscle activity or pain signals. This article clarifies the status of various muscle relaxers.
Understanding Controlled Substances
A controlled substance is a drug or chemical whose manufacture, possession, or use is regulated by the government due to its potential for abuse or addiction. The Drug Enforcement Administration (DEA) classifies drugs based on their medical use and potential for abuse or dependence. This classification system, established under the Controlled Substances Act (CSA) of 1970, includes five schedules.
Schedule I drugs have no accepted medical use in the United States and a high potential for abuse (e.g., heroin, LSD). As the schedule number increases, the potential for abuse and dependence generally decreases. Schedule II substances have a high potential for abuse but accepted medical uses, with abuse potentially leading to severe psychological or physical dependence. Schedule III drugs have a moderate to low potential for dependence, while Schedule IV substances have a low potential for abuse and dependence. Schedule V drugs have the lowest potential for abuse and typically contain limited quantities of certain narcotics.
Controlled Status of Muscle Relaxers
The controlled status of muscle relaxers varies significantly by medication. Some are classified as controlled substances due to their potential for abuse, dependence, or sedative effects, while others are not.
Carisoprodol (Soma) is classified as a Schedule IV controlled substance in the United States. It has potential for abuse and can lead to physical dependence. Its active metabolite, meprobamate, is also a tranquilizer with abuse potential.
In contrast, cyclobenzaprine, often marketed as Flexeril, is generally not classified as a controlled substance by the DEA. Despite not being controlled, cyclobenzaprine can still cause sedative effects and has been anecdotally reported to be misused for its euphoric or relaxing properties, sometimes in combination with other central nervous system depressants. Methocarbamol (Robaxin) and tizanidine (Zanaflex) are also not controlled substances. While methocarbamol has a low potential for abuse, tizanidine, despite not being controlled, can still lead to dependence if misused, particularly at higher doses or with prolonged use.
Prescription and Safety Guidelines
Strict regulations govern the prescription and dispensing of muscle relaxers, especially those classified as controlled substances. Prescriptions for Schedule IV controlled substances, like carisoprodol, have specific requirements, including limits on refills, typically no more than five refills within six months of the prescription’s issue date. All activities involving controlled muscle relaxers, from prescribing to dispensing, are subject to federal and state laws.
Patients taking any muscle relaxer should adhere strictly to their healthcare provider’s instructions. These medications are generally intended for short-term use, often not exceeding two to three weeks, as prolonged use can lead to increased tolerance and physical dependence. Common side effects include drowsiness, dizziness, and fatigue, which can impair mental and physical abilities, making activities like driving or operating machinery unsafe. Combining muscle relaxers with alcohol or other central nervous system depressants, such as opioids or sedatives, can significantly intensify these side effects and increase the risk of overdose, respiratory depression, and even death.
Proper disposal of unused medication is also important to prevent misuse and diversion. If discontinuing a muscle relaxer after extended use, a gradual reduction in dosage, supervised by a doctor, is often necessary to avoid withdrawal symptoms like nausea or sleep disturbances.