What is the addiction risk associated with tramadol?

Journal of Family Practice, Jan, 2005 by Todd McDiarmid, Leslie Mackler, David M. Schneider

* RECOMMENDATIONS FROM OTHERS

Ortho-McNeil's revised 2001 product package insert for Ultram states, "Tramadol may induce psychic and physical dependence of the morphine type (mu-opioid). Dependence and abuse, including drug-seeking behavior and taking illicit actions to obtain the drug are not limited to those patients with prior history of opioid dependence" (italics in original, emphasizing 2001 addition). The risk for patients with a history of substance abuse has been observed to be higher. (10)

REFERENCES

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(10.) Murray L, ed. Physicians' Desk Reference. 58th ed. Montvale, NJ: Thomson PDR; 2004:2496.

* CLINICAL COMMENTARY

Though it may not have high abuse potential, prescribe tramadol cautiously

Although tramadol appears to have a low potential for abuse, the literature does reveal evidence of abuse, addiction, and withdrawal, even in patients without a history of such problems. We do not know if tramadol is less addictive than other narcotics in high-risk patients. For patients at risk for dependence, tramadol is a reasonable alternative to other opioids, but abuse appears more likely in these patients. Tramadol may be most appropriate for treatment of acute painful conditions, but it can be administered chronically under a watchful eye. Providers should prescribe it cautiously, particularly in patients with a history of abuse or addiction, at least until more definitive evidence surfaces.

David M. Schneider, MD, Sutter Medical Center Family Practice Residency Program, Santa Rosa, Calif

Todd McDiarmid, MD, Leslie Mackler, MSLS, Moses Cone Health System, Greensboro, IVC