Tramadol appears to stem abuse of opiates

Clinical Psychiatry News, Feb, 2008 by Doug Brunk

CORONADO, CALIF. -- Tramadol may be effective primary medical treatment for opiate dependence, results from a small study demonstrate.

"I think it's safe to try for somebody who hasn't succeeded on Suboxone for some reason or for someone who can't afford Suboxone," Dr. Thomas E. Radecki said in an interview during a poster session at the annual meeting of the American Academy of Addiction Psychiatry. "However, there is a great need at this point for randomized, controlled research to compare (tramadol) to Suboxone and drug-free treatments."

In an open trial, 69 patients aged 18-50 years with a DSM-IV diagnosis of opiate dependence were initially administered 150 mg tramadol four times a day for the first 2-3 days of detoxification, and then encouraged to reduce the dosage to no more than 100 mg four times a day.

Office visits initially were once a week for two visits, then every 2 weeks until stable, and then every 3-4 weeks. Patients had random urine toxicology screens, said Dr. Radecki, a psychiatrist in Clarion, Pa.

Of the 69 patients, 65 (94%) kept at least one follow-up appointment and the median time of therapy to date is 21 weeks.

Enough clinical data were available to evaluate tramadol's effectiveness in 59 patients. Of these, 68% were still in treatment and opiate free. "This compares favorably to Suboxone," he said. Three patients experienced seizures because of taking higher than recommended doses of tramadol.

Dr. Radecki pointed out that tramadol is somewhat less addictive than Suboxone.

He estimated that tramadol costs each patient $16 per month; Suboxone costs each patient $300 per month. In his practice, that translates into a savings of more than $174,000 per year.

Dr. Radecki had no relevant financial relationships to disclose.

BY DOUG BRUNK

San Diego Bureau