Tramadol

Young, James W S; Juurlink, David N.

doi:10.1503/cmaj.121592

Cited by 15 publications

(13 citation statements)

References 6 publications

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“…We did not specify continuous prescribing. Opioids included in the definition were codeine, dihydrocodeine, fentanyl (mucosal and topical), hydrocodone, hydromorphone, meperidine, methadone, morphine, oxycodone, oxymorphone, pentazocine, propoxyphene, tapentadol, and tramadol …”

Section: Methodsmentioning

confidence: 99%

Prevalence and characteristics of hospitalized adults on chronic opioid therapy

et al. 2013

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Background As chronic opioid therapy (COT) becomes more common, complexity of pain management in the inpatient setting increases; little is known about medical inpatients on COT. Objective To determine the prevalence of COT among hospitalized patients and to compare outcomes among these patients relative to those not receiving COT. Design Observational study of inpatient and outpatient administrative data Participants All Veterans with acute medical admissions to 129 Veterans Administration (VA) hospitals during fiscal years 2009-2011, residing in the community, and with outpatient pharmacy use. Measurements We defined COT as 90 or more days of opioids prescribed in the 6 months prior to hospitalization. Patient characteristics included demographic variables and major comorbidities; outcomes included 30-day readmission and death during hospitalization or within 30 days, with associations ascertained using multivariable logistic regression. Results Of 122,794 hospitalized Veterans, 31,802 (25.9%) received COT. These patients differed from comparators in age, sex, race, residence, and presence of chronic non-cancer pain, COPD, complicated diabetes, cancer, and mental health diagnoses including PTSD. After adjustment for demographic factors, comorbidities, and admission diagnosis, COT was associated with hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [95% CI]: 1.10-1.20) and death (OR: 1.19, 95% CI 1.10-1.29). Conclusions COT is common among medical inpatients; patients on COT differ from patients without COT beyond dissimilarities in pain and cancer diagnoses. Occasional and chronic opioid use are associated with increased risk of hospital readmission, and COT is associated with increased risk of death. Additional research relating COT to hospitalization outcomes is warranted.

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Section: Methodsmentioning

confidence: 99%

Prevalence and characteristics of hospitalized adults on chronic opioid therapy

et al. 2013

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“…Tramadol was included, as it is has addiction and abuse potential. 18,19 Codeine was excluded, as it may be prescribed for non-pain conditions. Prevalent opioid receipt during a given year was defined as the receipt of at least one opioid prescription during that year.…”

Section: Opioid Receiptmentioning

confidence: 99%

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

et al. 2014

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BACKGROUND: Improved understanding of temporal and regional trends may support safe and effective prescribing of opioids. OBJECTIVE: We describe national, regional, and facilitylevel trends and variations in opioid receipt between fiscal years (FY) 2004 and 2012. DESIGN: Observational cohort study using Veterans Health Administration (VHA) administrative databases. PARTICIPANTS: All patients receiving primary care within 137 VHA healthcare systems during a given study year and receiving medications from VHA one year before and during a given study year. MAIN MEASURES: Prevalent and incident opioid receipt during each year of the study period. KEY RESULTS: The overall prevalence of opioid receipt increased from 18.9 % of all veteran outpatients in FY2004 to 33.4 % in FY2012, a 76.7 % relative increase. In FY2012, women had higher rates of prevalent opioid receipt than men (42.4 % vs. 32.9 %), and the youngest veterans (18-34 years) had higher prevalent opioid receipt compared to the oldest veterans (≥80 years) (47.6 % vs. 17.9 %). All regions in the United States saw increased rates of prevalent opioid receipt during this time period. Prevalence rates varied widely by facility: in FY2012, the lowest-prescribing facility had a rate of 13.5 %, and the highest of 50.8 %. Annual incident opioid receipt increased from 8.8 % in FY2004 to 10.2 % in FY2011, with a decline to 9.8 % in FY2012. Incident prescribing increased at some facilities and decreased at others. Facilities with high prevalent prescribing tended to have flat or decreasing incident prescribing rates during the study time frame. CONCLUSIONS: Rates of opioid receipt increased throughout the study time frame, with wide variation in prevalent and incident rates across geographical region, sex, and age groups. Prevalence and incidence rates reflect distinct prescribing practices. Areas with the highest prevalence tended to have lower increases in incident opioid receipt over the study period. This likely reflects facilitylevel variations in prescribing practices as well as baseline rates of prevalent use. Future work assessing opioid prescribing should employ methodologies to account for and interpret both prevalent and incident opioid receipt.

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“…This study examined patterns of tramadol use, a prescription‐only but nonscheduled opioid formulation, since its approval in comparison with use of (scheduled) “strong opioids” in Canada during the period 2007‐2016. This examination was relevant given recent intervention efforts to reduce dispensing rates of (scheduled) “strong opioids,” the potential interaction dynamics of such efforts with tramadol as an unscheduled opioid, and related experiences in Canada as well as elsewhere . As described above, these experiences have exemplified “substitution effects” and subsequent changes in alternative opioid use in cases of one or several groups of opioids being more restrictively controlled.…”

Section: Discussionmentioning

confidence: 99%

“…Tramadol is an atypical analgesic, which is hepatically metabolized into an opioid agonist based on unique mechanisms of action; it is indicated for the treatment of moderate to moderately severe pain, and both moderate effectiveness and abuse liability are documented . Tramadol was approved for medical use in Canada in 2005; a distinct feature is that, different from other opioids, the drug has not been scheduled under the Controlled Drugs and Substances Act (CDSA), based on assumptions of low abuse potential . This “unscheduled” status exempts the drug from certain safeguards and control mechanisms (eg, prescription monitoring) in regard to its use …”

Section: Introductionmentioning

confidence: 99%

Tramadol dispensing patterns and trends in Canada, 2007‐2016

Fischer

Kurdyak

Jones

2018

Pharmacoepidemiology and Drug

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Purpose Opioid use and associated mortality and morbidity have substantially increased in Canada, which recent interventions have aimed to reduce. Tramadol is an atypical prescription‐only (but unscheduled under Canada's narcotics law) opioid analgesic and not subject to controls for other (eg, strong) opioids. Given experiences in different jurisdictions, tramadol may have been increasingly dispensed as a “substitute” drug during a period with increasingly restrictive controls for other (scheduled) opioids. Methods We examined the annual population‐level retail dispensing (as a proxy for use) of tramadol and (scheduled) “strong opioids” in Canadian provinces for 2007‐2016 based on data from a representative national sample of community pharmacies, covering the majority of episodes of opioid dispensing. Data for both aforementioned formulation categories were converted into defined daily doses (DDD)/1000 population/day and examined descriptively and by segmented regression analyses (to identify significant breakpoints in trends). Results Tramadol use strongly increased in all provinces until 2009. After 2009, tramadol dispensing levels either decelerated their increase or plateaued; “strong opioid” dispensing levels, in comparison, increased strongly until 2011 and decelerated or decreased for the remaining period. Tramadol was consistently dispensed at lower levels than “strong opioids.” Conclusions Tramadol and “strong opioids” showed similar (bifurcated) use trends, with initial increases and subsequent inflections, yet reductions in dispensing occurred earlier for tramadol than for “strong opioids” (the latter occurring following with recent interventions). Distinct from experiences with differential opioid control regimes elsewhere, there is no evidence that tramadol figured as a “substitution” drug for increasingly restricted “strong opioids” in Canada.

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Tramadol

Cited by 15 publications

References 6 publications

Prevalence and characteristics of hospitalized adults on chronic opioid therapy

Prevalence and characteristics of hospitalized adults on chronic opioid therapy

Trends in Prevalent and Incident Opioid Receipt: an Observational Study in Veterans Health Administration 2004–2012

Tramadol dispensing patterns and trends in Canada, 2007‐2016

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