Can nurse practitioners with a Schedule 3A (Drug Enforcement Administration) DEA registration in Texas prescribe Soma (carisoprodol)?

Nurse Practitioners with Schedule 3A DEA Registration Cannot Prescribe Soma (Carisoprodol) in Texas

Nurse practitioners with a Schedule 3A DEA registration in Texas cannot prescribe Soma (carisoprodol) because carisoprodol is classified as a Schedule IV controlled substance due to its abuse potential.

Understanding Carisoprodol's Classification and Risks

Carisoprodol (Soma) is a centrally acting muscle relaxant with substantial barbiturate-like biological action and significant abuse potential. The FDA has reported that carisoprodol abuse has escalated in the past decade in the United States, making it one of the most commonly diverted drugs 1.

Key concerns about carisoprodol include:

• It is classified as a controlled substance (Schedule IV) due to its abuse and addiction potential
• It metabolizes to meprobamate, which is also a Schedule IV controlled substance
• It has numerous adverse effects including sedation, seizures, drug dependence, withdrawal, tachycardia, and postural hypotension 1
• Withdrawal from carisoprodol can cause severe symptoms requiring slow tapering (over 4-9 days) rather than abrupt discontinuation 1

DEA Registration Limitations for Nurse Practitioners

The Schedule 3A DEA registration in Texas is a limited registration that does not include authority to prescribe Schedule IV controlled substances like carisoprodol. This restriction is in place specifically because of the documented abuse potential of medications like Soma.

Research has consistently demonstrated carisoprodol's abuse potential:

• It modulates GABA(A) receptors in a manner similar to highly addictive central nervous system depressants 2
• Multiple case reports document patterns of carisoprodol abuse 3, 4
• Patients prescribed carisoprodol are at risk for meprobamate dependence 5

Clinical Implications and Alternatives

For nurse practitioners with Schedule 3A DEA registration who need to manage patients with muscle spasm:

1. Consider non-controlled muscle relaxants that may be within prescriptive authority:

   • Cyclobenzaprine (though it should be held on day of operations) 1
   • Metaxalone (though it should be held on day of operations) 1
   • Tizanidine (which can be taken preoperatively including day of surgical procedure) 1

2. Consider referral to a provider with appropriate DEA registration if carisoprodol is specifically indicated

Important Cautions

Even for providers who can prescribe carisoprodol, the Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends:

• Holding carisoprodol on the day of operation
• If time permits, tapering off or switching to an alternative agent before surgical procedures 1
• Limiting use to short-term treatment of acute musculoskeletal conditions involving significant muscle spasm 3

Red Flags for Potential Abuse

Providers should be aware that a significant percentage of physicians are unaware of carisoprodol's abuse potential 6. Warning signs include:

• Patients requesting the drug by name
• "Lost" prescriptions
• Using carisoprodol chronically
• Denying efficacy of less mind-altering alternatives 3

In conclusion, nurse practitioners with Schedule 3A DEA registration in Texas must work within their prescriptive authority limitations, which do not include Schedule IV controlled substances like carisoprodol.