{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T09:51:21Z","timestamp":1787737881837,"version":"build-2784847793"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T00:00:00Z","timestamp":1584403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>The\u00a0recent opioid prescribing guideline cautions about the concomitant prescribing of opioids and skeletal muscle relaxants (SMRs) given the additive central nervous system depressant effect. However, the clinical relevance remains unclear. In this retrospective cohort study,\u00a0we compared the risk of opioid overdose associated with concomitant use of opioids and SMRs vs. opioid use alone. Adjusted hazard ratios were 1.09 (95% confidence interval (CI), 0.74\u20131.62) and 1.26 (95% CI, 1.00\u20131.58) in the incident and prevalent opioid user cohorts, respectively, generating a combined estimate of 1.21 (95% CI, 1.00\u20131.48). This risk seemed to increase with treatment duration (\u2264 14\u00a0days: 0.91 and 95% CI, 0.67\u20131.22; 15\u201360\u00a0days: 1.37 and 95% CI, 0.81\u20132.37; &gt;60 days: 1.80 and 95% CI, 1.30\u20132.48) and for baclofen (1.83 and 95% CI, 1.11\u20133.04) and carisoprodol (1.84 and 95% CI, 1.34\u20132.54). Concomitant users with daily opioid dose \u226550 mg (1.50 and 95% CI, 1.18\u20131.92) and benzodiazepine use\u00a0(1.39 and 95% CI, 1.08\u20131.79) also had elevated risk. Clinicians should be cautious about these potentially unsafe practices to optimize pain care and improve patient safety.<\/jats:p>","DOI":"10.1002\/cpt.1807","type":"journal-article","created":{"date-parts":[[2020,2,5]],"date-time":"2020-02-05T10:19:30Z","timestamp":1580897970000},"page":"81-89","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population\u2010Based Cohort Study"],"prefix":"10.1111","volume":"108","author":[{"given":"Yan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Delcher","sequence":"additional","affiliation":[{"name":"Institute for Pharmaceutical Outcomes &amp; Policy Department of Pharmacy Practice &amp; Science College of Pharmacy University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Jung Jenny","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida USA"},{"name":"Center for Drug Evaluation and Safety (CoDES) University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary M.","family":"Reisfield","sequence":"additional","affiliation":[{"name":"Department of Psychiatry College of Medicine University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida USA"},{"name":"Center for Drug Evaluation and Safety (CoDES) University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Tighe","sequence":"additional","affiliation":[{"name":"Center for Drug Evaluation and Safety (CoDES) University of Florida Gainesville Florida USA"},{"name":"Department of Anesthesiology College of Medicine University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almut G.","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida USA"},{"name":"Center for Drug Evaluation and Safety (CoDES) University of Florida Gainesville Florida USA"},{"name":"Department of Epidemiology College of Public Health and Health Professions &amp; College of Medicine University of Florida Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,17]]},"reference":[{"key":"e_1_2_9_1_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm675152e1"},{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6450a3"},{"key":"e_1_2_9_3_1","volume-title":"Drug overdose deaths in the United States, 1999\u20132017","author":"Hedegaard H.","year":"2018"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1406143"},{"key":"e_1_2_9_5_1","unstructured":"US Food and Drug Administration.FDA drug safety communication: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning<https:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm518473.htm> (2016). Accessed August 15 2018."},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S122853"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnx038"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1999.9479612.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.117"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j760"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2698"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.07.004"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.2.207"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000738"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnx031"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3776"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5790"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2018.09.001"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4157"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwj047"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/03610910902859574"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7084"},{"key":"e_1_2_9_26_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0","year":"2011"},{"key":"e_1_2_9_27_1","first-page":"e164","article-title":"Medicaid prior authorization and opioid medication abuse and overdose","volume":"23","author":"Cochran G.","year":"2017","journal-title":"Am. J. Manag. Care"},{"key":"e_1_2_9_28_1","volume-title":"2015 National Survey on Drug Use and Health: Detailed Tables","author":"Center for Behavioral Health Statistics and Quality","year":"2016"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-1560-2_7"},{"key":"e_1_2_9_30_1","first-page":"365","article-title":"Choosing a skeletal muscle relaxant","volume":"78","author":"See S.","year":"2008","journal-title":"Am. Fam. Phys."},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcpt.12999"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcpt.12655"},{"key":"e_1_2_9_33_1","first-page":"137","article-title":"Potentiation of opiates by administration of baclofen and proglumide during the intraoperative period [in Italian]","volume":"54","author":"Massei R.","year":"1988","journal-title":"Minerva Anestesiol."},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2015.10.001"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.4635"},{"key":"e_1_2_9_36_1","article-title":"Muscle relaxants for non\u2010specific low back pain","volume":"004252","author":"Tulder M.W.","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2004.05.002"},{"key":"e_1_2_9_38_1","unstructured":"Flexeril [package insert]. (McNeil Consumer Healthcare Fort Washington PA 2013)."},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000245"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-152-2-201001190-00006"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTN.0000000000000250"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.107693"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1023\/B:APIH.0000003017.78877.56"},{"key":"e_1_2_9_44_1","first-page":"1171","article-title":"Overdose deaths involving prescription opioids among Medicaid enrollees \u2013 Washington, 2004\u20132007","volume":"58","author":"Centers for Disease Control and Prevention","year":"2009","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"e_1_2_9_45_1","first-page":"1","article-title":"Unintentional overdose deaths in the North Carolina Medicaid population prevalence, prescription drug use, and medical care services","volume":"162","author":"Whitmire J.T.","year":"2010","journal-title":"SCHS Studies"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13702"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000146453.76528.7c"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.17061\/phrp27341702"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.8071"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.370"}],"container-title":["Clinical Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcpt.1807","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpt.1807","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cpt.1807","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpt.1807","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T08:37:26Z","timestamp":1699346246000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/10.1002\/cpt.1807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,17]]},"references-count":50,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,7]]}},"alternative-id":["10.1002\/cpt.1807"],"URL":"https:\/\/doi.org\/10.1002\/cpt.1807","archive":["Portico"],"relation":{},"ISSN":["0009-9236","1532-6535"],"issn-type":[{"value":"0009-9236","type":"print"},{"value":"1532-6535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,17]]},"assertion":[{"value":"2019-10-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}