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To the Editor: Historically, new opioid pain medications have been introduced as having low abuse liability and then later found to have significant risk. Tramadol achieves its analgesic activity from an M1 metabolite with potent opioid properties and through inhibition of reuptake of monoamines.¹ Following release of this product, reports of tramadol abuse began to occur and package insert warnings regarding abuse have been heightened 3 times. The US Food and Drug Administration’s (FDA’s) MEDWATCH system has received hundreds of spontaneous reports of tramadol-associated abuse, dependence, and withdrawal.² Among individual opioids listed in the 2001 and 2002 annual reports of the American Association of Poison Control Centers Toxic Exposure Surveillance System, tramadol ranked second to oxycodone in number of exposure cases.³ Other reports, sponsored by the manufacturer, have suggested low abuse liability; however, their conclusions are problematic due to methodologic issues. For example, in 1 report⁴ the total number . . . [Full Text of this Article]

Gregory E. Skipper, MD
gregskipper@usa.net
Alabama Physician Health Program
Montgomery

Carol Fletcher, PhD, RN
Veterans Health Administration
Michigan Health Professional Recovery Program
Ann Arbor, Mich

Rosei Rocha-Judd
Alabama Physician Health Program

David Brase, PhD
Rockville, Md

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RELATED LETTERS

Tramadol Abuse and Dependence Among Physicians
Edgar H. Adams, Richard C. Dart, Janet S. Knisely, and Sidney H. Schnoll
JAMA. 2005;293(16):1977.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Tramadol Abuse and Dependence Among Physicians
Adams et al.
JAMA 2005;293:1977-1977.
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