{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T18:22:54Z","timestamp":1774117374873,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>Concurrent use of skeletal muscle relaxants (SMRs) and opioids has been linked to an increased risk of injury. However, it remains unclear whether the injury risks differ by specific SMR when combined with opioids. We conducted nine retrospective cohort studies within a US Medicaid population. Each cohort consisted exclusively of person\u2010time exposed to both an SMR and one of the three most dispensed opioids\u2014hydrocodone, oxycodone, and tramadol. Opioid users were further divided into three cohorts based on the initiation order of SMRs and opioids\u2014synchronically triggered, opioid\u2010triggered, and SMR\u2010triggered. Within each cohort, we used Cox proportional hazard models to compare the injury rates for different SMRs compared to methocarbamol, adjusting for covariates. We identified 349,543, 139,458, and 218,967 concurrent users of SMRs with hydrocodone, oxycodone, and tramadol, respectively. In the oxycodone\u2010SMR\u2010triggered cohort, the adjusted hazard ratios (HRs) were 1.86 (95% CI, 1.23\u20132.82) for carisoprodol and 1.73 (1.09\u20132.73) for tizanidine. In the tramadol\u2010synchronically triggered cohort, the adjusted HRs were 0.69 (0.49\u20130.97) for metaxalone and 0.62 (0.42\u20130.90) for tizanidine. In the tramadol\u2010SMR\u2010triggered cohort, the adjusted HRs were 1.51 (1.01\u20132.26) for baclofen and 1.48 (1.03\u20132.11) for cyclobenzaprine. All other HRs were statistically nonsignificant. In conclusion, the relative injury rate associated with different SMRs used concurrently with the three most dispensed opioids appears to vary depending on the specific opioid and the order of combination initiation. If confirmed by future studies, clinicians should consider the varying injury rates when prescribing SMRs to individuals using hydrocodone, oxycodone, and tramadol.<\/jats:p>","DOI":"10.1002\/cpt.3248","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T09:21:36Z","timestamp":1710408096000},"page":"117-127","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Risk of Injury with Concurrent Use of Opioids and Skeletal Muscle Relaxants"],"prefix":"10.1002","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3240-8153","authenticated-orcid":false,"given":"Cheng","family":"Chen","sequence":"first","affiliation":[{"name":"Center for Real\u2010World Effectiveness and Safety of Therapeutics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4726-9413","authenticated-orcid":false,"given":"Sean","family":"Hennessy","sequence":"additional","affiliation":[{"name":"Center for Real\u2010World Effectiveness and Safety of Therapeutics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen M.","family":"Brensinger","sequence":"additional","affiliation":[{"name":"Center for Real\u2010World Effectiveness and Safety of Therapeutics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3832-6212","authenticated-orcid":false,"given":"Todd A.","family":"Miano","sequence":"additional","affiliation":[{"name":"Center for Real\u2010World Effectiveness and Safety of Therapeutics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warren B.","family":"Bilker","sequence":"additional","affiliation":[{"name":"Center for Real\u2010World Effectiveness and Safety of Therapeutics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Psychiatry, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sascha","family":"Dublin","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"},{"name":"Department of Epidemiology, School of Public Health University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1520-2898","authenticated-orcid":false,"given":"Sophie P.","family":"Chung","sequence":"additional","affiliation":[{"name":"AthenaHealth, Inc.  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