|October 27, 2011|
The number of carisoprodol-related ED visits involving misuse or abuse doubled from 15,830 visits in 2004 to 31,763 visits in 2009 (Figure 1). Similar trend patterns were found for both males and females during the same time period (Table 1). The number of carisoprodol-related ED visits involving misuse or abuse by patients aged 50 or older tripled between 2004 and 2009 (from 2,070 to 7,115 visits), and the number of visits by patients aged 35 to 49 nearly doubled (from 6,345 to 12,048 visits). Changes in the number of visits by younger patients (aged 12 to 17, aged 18 to 24, and aged 25 to 34) were not significantly different between 2004 and 2009.
|Source: 2004 to 2009 estimates from the 2009 SAMHSA Drug Abuse Warning Network (DAWN)|
2004 to 2009
|Total ED Visits||15,830||31,763||101%*|
|Aged 12 to 17||835||1,159||39%|
|Aged 18 to 24||2,066||3,403||65%|
|Aged 25 to 34||4,512||8,035||78%|
|Aged 35 to 49||6,345||12,048||90%*|
|Aged 50 or Older||2,070||7,115||244%*|
|* The difference between 2004 and 2009 was statistically significant at the .05 level.
Source: 2004 and 2009 estimates from the 2009 SAMHSA Drug Abuse Warning Network (DAWN).
Approximately one in five of the carisoprodol-related ED visits involving misuse or abuse involved carisoprodol only (18 percent) (Figure 2). One quarter involved one other drug (25 percent), and one third involved two other drugs (33 percent). About 12 percent of visits involved three other drugs, and the remaining 12 percent involved four or more other drugs.
|Number of Other Drugs||Percent|
|With One Other Drug||25%|
|With Two Other Drugs||33%|
|With Three Other Drugs||12%|
|With Four or More Other Drugs||12%|
|Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).|
The majority of carisoprodol-related ED visits involving misuse or abuse also involved other pharmaceuticals (77 percent) (Table 2). Narcotic pain relievers were the most common type of pharmaceutical involved in combination with carisoprodol (55 percent); specific types of narcotic pain relievers frequently involved included hydrocodone (28 percent) and oxycodone (21 percent). Benzodiazepines were combined with carisoprodol in 47 percent of visits, and alprazolam (28 percent) was the most commonly involved benzodiazepine. Both narcotic pain relievers and benzodiazepines were involved in one third of carisoprodol-related ED visits involving misuse or abuse (32 percent). More than half (58 percent) of carisoprodol-related ED visits involved other pharmaceuticals only.
About one in seven carisoprodol-related ED visits involving misuse or abuse (15 percent) also involved illicit drugs. Alcohol was involved in 12 percent of carisoprodol-related ED visits.
of ED Visits
|Total ED Visits||31,763||100%|
|Combinations with Other Pharmaceuticals||24,478||77%|
|Narcotic Pain Relievers||17,478||55%|
|Combinations with Both
Narcotic Pain Relievers and
|Combinations with Other
|Combinations with Illicit
|Combinations with Alcohol||3,750||12%|
|* Because multiple drugs may be involved in each visit, estimates of visits by drug may add to more than the total, and percentages may add to more than 100 percent.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
Of the 31,763 carisoprodol-related ED visits classified as misuse or abuse, one third (35 percent) resulted in hospitalization. Among carisoprodol-related ED visits classified as involving abuse or misuse, 24,478 involved carisoprodol combined with other pharmaceuticals; of these, 38 percent required hospitalization. Of the 17,478 visits involving carisoprodol combined with narcotic pain relievers, 36 percent required hospitalization, and of the 15,032 visits involving carisoprodol combined with benzodiazepines, 42 percent required hospitalization.
Misuse and abuse of carisoprodol is a small but growing problem in the United States and is worthy of public health attention. Although it is a useful medication for short-term (i.e., 2 to 3 weeks) treatment of acute muscle pain, carisoprodol can be dangerous when combined with other sedative medications or with alcohol; when used for extended periods of time and/or in higher doses; or when used by individuals who are at risk for developing addiction.3
Carisoprodol is widely prescribed for a broad array of problems that range from simple muscle sprains to more severe injuries such as those sustained in vehicle accidents, and it can be prescribed alone or in combination with other medications. However, patients may not be aware that carisoprodol can be dangerous in combination with other drugs or alcohol. Prescribers should be mindful that carisoprodol metabolizes to meprobamate, a powerful and potentially addictive depressant, and they should educate patients about the dangers of mixing it with other substances.
Physicians, pain specialists, hospitals, and EDs need to be aware of the potential for abuse or dependence for certain patients with chronic pain symptoms, especially for older adults who commonly take numerous pharmaceuticals daily. Patients may obtain multiple prescriptions without proper management by a primary care provider, depending on how they seek treatment for pain. Since only a very limited number of States have regulatory authority for monitoring unscheduled drugs, providers are in the best position to manage prescribing and dispensing unscheduled, but potentially risky, prescription drugs such as carisoprodol.5 Screening for substance abuse problems or for history of addictive behaviors may be beneficial prior to prescribing carisoprodol. If ED staff identify carisoprodol abuse during an ED visit, a referral to a substance abuse treatment program should be considered.
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States.
Any ED visit related to recent drug use is included in DAWN. All types of drugs—licit and illicit—are covered. Alcohol involvement is documented for patients of all ages if it occurs with another drug. Alcohol is considered an illicit drug for minors and is documented even if no other drug is involved. The classification of drugs used in DAWN is derived from the Multum Lexicon, copyright 2010 Lexi-Comp, Inc., and/or Cerner Multum, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at http://www.samhsa.gov/data/DAWN.aspx.
DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality (SAMHSA/CBHSQ). For more information on other CBHSQ surveys, go to http://www.samhsa.gov/data/. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications.
For publications and additional information about DAWN, go to http://www.samhsa.gov/data/DAWN.aspx.
|The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: firstname.lastname@example.org.
This page was last updated on October 11, 2010.