Long-term muscle relaxant prescriptions skyrocketed between 2005 and 2016, and older adults were disproportionately the recipients, a new study shows.

Skeletal muscle relaxants should be avoided in patients ages 65 and older due to the risk of falls, fractures, vehicle crashes, abuse, dependence, and overdose, according to American Geriatrics Society guidelines. Yet while office visits for new drug prescriptions remained steady during the study period, long-term prescriptions rapidly increased for adults overall and tripled for elders, reported researchers from the University of Pennsylvania.

In 2016, for example, older adults accounted for 22% percent of all office visits tied to muscle relaxants, although they represented 14% of the U.S. population.

Clinicians could be prescribing the drugs as an opioid alternative for chronic pain management, hypothesized investigator Charles Leonard, PharmD, and colleagues. However, muscle relaxants are not recommended for use longer than three weeks. And there is little evidence that they alleviate ongoing pain any better than Tylenol or Advil, the authors wrote.

What’s more, 70% of patients overall were simultaneously prescribed an opioid. These drugs are known to be dangerous when taken with muscle relaxants, they added.

“Muscle relaxants’ place in therapy is really limited. Based on most guidelines, they’re normally reserved as second- or third-line therapies,” Leonard said. “Our findings suggest that prescribers may be reaching for these drugs sooner than that.”

Investigators analyzed data from the annual National Ambulatory Medical Care Survey, which queries office-based physicians engaged in direct patient care.

The study was published Monday in JAMA Network Open.