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Tramadol Isn’t Addictive, Right?

June 12, 2019

Written by Clay Smith

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Use of tramadol post-op was associated with an increased risk of prolonged use compared with other short acting opiates.

Why does this matter?
Tramadol is a, “synthetic weak μ-opioid receptor agonist,” and is, “phenotypically distinct from conventional short acting opioids.” It also has some SNRI and SSRI effects. As such, tramadol has been seen as an opioid alternative and as possibly less likely to have abuse potential. It is schedule IV in the US, as opposed to morphine or oxycodone, which are schedule II. Is it less addictive?

Trama-do or Trama-don’t?
Using Medicare Advantage claims data, a cohort of >350,000 opioid naive patients undergoing elective surgery were more likely to have prolonged opiate use when tramadol was prescribed compared to three other short acting opiates. They statistically adjusted for known confounders, such as total morphine milligram equivalents (MME) at discharge and others. Risk of any additional opiate prescription fill 90-180 days post-op was 6% higher with tramadol vs other short acting opiates; risk of persistent use ≥90 days increased 47%; chronic use increased 41%, all statistically significant. It is a myth that tramadol is safer or less addictive than other short acting opiates. This suggests it may be even more risky for prolonged use.

Chronic use of tramadol after acute pain episode: cohort study. BMJ. 2019 May 14;365:l1849. doi: 10.1136/bmj.l1849.

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Reviewed by Thomas Davis