Posts Tagged ‘Controlled substances’

So Long Soma

Soma, a well-known brand name of the drug carisoprodol, is prescribed by doctors in the U.S. as a muscle relaxant. However, it does have the potential to cause addiction. Soma is now a Schedule III or Schedule IV controlled substance in about twenty states, and the DEA may soon make it a Schedule IV drug in all states. Carisoprodol has been removed from the market in other nations, due to its potential for addiction.

 All potentially addicting drugs are scheduled, meaning the physician has to have a DEA number to legally prescribe them. Non-scheduled drugs (antibiotics, antidepressants, blood pressure or diabetes medication) aren’t addicting, and the doctor doesn’t need a DEA number to prescribe these. They aren’t tracked by the DEA. Drugs are scheduled I through V, depending on the potential for addiction and the degree of therapeutic usefulness. Schedule I drugs have very high potential for addiction, and very little therapeutic use. Other medications are more beneficial with less risk of addiction. Heroin and Ecstasy are two examples of Schedule I drugs. At the other extreme, Schedule V drugs have some risk of addiction, though fairly low. Examples are low-dose codeine and other low-dose opioids.

 I hate Soma. I can’t remember the last time I wrote a prescription for it. I see too many people who have become addicted to it, or who use it with opioids. There are other better and safer muscle relaxants.

Soma gets metabolized to meprobamate, an old-timey barbiturate. Doctors used barbiturates as sedatives before the safer benzodiazepines came on the market.

 Some addicts say they like the high that they get when they mix Soma with opioids. Since I treat opioid addicts, I see the dangers of mixing Soma with maintenance medications like methadone and buprenorphine. Just like benzodiazepines, Soma has a synergistic effect with opioids, causing more sedation than expected. This is how it can kill. The user takes opioids with Soma, it turns into a barbiturate, and the combination puts the person into a deep sleep. In fact, this combination can make them sleep so deeply that the respiratory center of the brain, which tells us to breathe when we sleep, turns off. The person stops breathing, and without oxygen, vital organs like the brain and heart die, and the person never wakes up.

 At the recent ASAM conference in Washington, D.C., one presenter reminded us of how addicting carisoprodol can be: in one study, around 65% of patients with a personal history of a substance use disorder misused carisoprodol when it was prescribed to them for over three months. And even worse, only 18% of the prescribing doctors knew that this medication is metabolized to meprobamate. (1)

 If you have a history of any sort of addiction disorder and your doctor is prescribing Soma, talk to her. It’s likely that another safer and more effective medication can be found. Soma is only FDA approved for two or three weeks of continuous use, anyway.

  1. Reeves, RR; Carter, S; Pinkofsky, HB; Struve, FA; Bennett, DM; “Carisoprodol (Soma) Abuse Potential and Physician Unawareness; Journal of Addictive Diseases, Vol. 18 (2), 1999, pp 51-56.