I had a question put to me this week at work about the level of addiction to tramadol. On looking at Drugdex found research from USA that nearly 300 people were addicted to it in the first 3 years of being licenced for use there (and 97% of those were previous opiate users). Is it being seen in the UK now and to what extent?

Thanks

Hazel

might be interested in looking at Tramadol usage within the prison setting where it has taken over other opiate based medication usage.

Many opiod addicted patients are using this in a variety of ways and it is becoming popular as a form of currency.

Well,
when i worked in the prison service we did not prescribe any opiates unless pregnant ladies or palliative care. Was extremley rare otherwise. Just created fights/bullying etc.
I remember male prisoners heads being knocked in for a few tylex!

things have certainly changed recently - increases in opiate based products been prescribed and the keenness of prisoners to request same.


The addition of lots of litigation does aid this - this doesn't really happen in normal general practice

all the pain relief none of the euphoria I ate a box a few years ago that left me a but skew wiff

short is the pain, long is the adornement

agree may well be a problem - it seems to becoming the 'acceptable' dihydrocodeine - had an interesting one couple of days ago - a young man who had (his choice) detoxed off 120 mls methadone and started on naltrexone (his choice) before going on hols to Greece with his partner, fell off a pedalo, dislocated his shoulder, was given tramodol (100mg) for pain and went into extreme withdrawls

Chris,
yes it is like a honeymoon period still for tramadol, it is almost seen as innocuous. In not too long we will have some conversion for it to methadone no doubt, that is if one is not already done.

I work in primary care alongside addiction services which rely on frequent urine testing to demonstrate compliance (Oh dear!).
I read on one of the forum pages (back in 2002) about tramadol not being detected by urine screening.
I appreciate it may be a last resort after NSAIDs etc for painrelief, but on a few occasions have prescribed it short term for acute pain-relief.
Am I still right in saying that urine or saliva kits will not detect tramadol?
Can anyone confirm this?

quote:

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Originally posted by Dr Chris Ford:
agree may well be a problem - it seems to becoming the 'acceptable' dihydrocodeine - had an interesting one couple of days ago - a young man who had (his choice) detoxed off 120 mls methadone and started on naltrexone (his choice) before going on hols to Greece with his partner, fell off a pedalo, dislocated his shoulder, was given tramodol (100mg) for pain and went into extreme withdrawls

---

Chris, find this rather curious. I have certainly heard from ppl in American that Tramadol can throw opiate/opoid addicted individuals into withdrawal in a way like bupe can (antagosnist). But if this person was on naltraxone (antagonist again) surely he would already have been in withdrawal or non-opiate addicted?

We have used tramadol a number of times now, for patients on methadone who were given DHC when in hospital or who break a leg etc. It seems to provide reasonable analgesia and we don't get asked for it early etc. Patients have told me they can buy it in prison but it doesn't do much for them. All anecdotal I know!

I converted a patient from Buprenorphine which she was using for analgesia to Tramadol and she got quite severe withdrawals. Settled on morphine

susi

woops - drew you are right it is curious - I forgot the buprenorphine he was using before he was going to start on the naltrexone - I used the wrong word! apologises - my dyslexia!
but also extreme anxieties about tramodol cause being handed out like smarties as the 'safe option'

It makes me wonder whether this preparation with less than the usual dose of pracetamol was delivered in a fashion as the company knew ppl would get addicted to it. I asked the rep and she said the reason the dose was less than 500mg of paracetamol was that is was proved to be sufficient.
Yup and when buspar came out it would get all our patients of benzo's and we could swap them straight over to it no withdrawals blah blah etc.
See my previous post re solpadeine addiction.
oh and zopiclone is not addictive etc. etc., we see all this rubbish year on year.

Tom,
I have resurrected this for your information
regards
Simon

when tramadol first came to this country it was reported at the docs'n'dentists-in-recovery meeting that health professionals in the States were becoming addicted to it..........docs usually being the "canary" for exciting new addictive pharmaceuticals......

Interesting subject I have just seen my first pure tramadol addict.-buying about 20 a day plus his monthly 100 script.

I tried him on subutex after a 2 day washout but he wasnt able to tolerate it.
i cannot find an exact methadone conversion: ?3-5ml per 30mg tramadol or tramadol 50mg=60mg codeine
the patient eventually stopped with 1 week cold turkey at his choice.

quote:

Originally posted by Sally Read:
We have used tramadol a number of times now, for patients on methadone who were given DHC when in hospital or who break a leg etc. It seems to provide reasonable analgesia and we don't get asked for it early etc. Patients have told me they can buy it in prison but it doesn't do much for them. All anecdotal I know!

I thought tramadol precipitates withdrawal in methadone addicts??? see link below

http://www.erowid.org/experiences/exp.php?ID=34250

Tramadol usage in prisons has taken over the use of other opiod based analgesia. It is currently big currency 7 x 50mg Tramadol capsules costing around 1/2 oz of tobacco.

Thanks for that Drew - I don't know why tramadol should ppt withdrawal and note it didn't actually happen to the person on your link. Does anyone else know about this?

quote:

know why tramadol should ppt withdrawal and note it didn't actually happen to the person on your link. Does anyone else know about this?

sorry i should have read the whole link.
http://www.rxlist.com/rxboard/general.pl?noframes;read=1501