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To the Editor: We would like to raise some issues regarding the Research Letter on tramadol abuse and dependence among physicians by Dr Skipper and colleagues.¹ First, the authors refer to hundreds of spontaneous tramadol-related reports to MEDWATCH, and Brinker et al² note that reports of tramadol abuse continue after one would expect a decline in reporting. However, the independent steering committee (ISC) monitoring tramadol is involved in active case finding, without which the reports would have declined. In the most recent period (2002-2004), data from the ISC master database, which is composed of all abuse- or dependence-related reports to the company plus those obtained through case finding, indicate a total of 216 reported cases of abuse or dependence. Of these, 146 (67%) were generated by the ISC. In 2004, only 5 of 28 cases were spontaneous reports.

Second, the authors report that tramadol ranks second . . . [Full Text of this Article]

Edgar H. Adams, ScD
ehadams@comcast.net
E. Adams Consulting
Princeton, NJ

Richard C. Dart, MD, PhD
Rocky Mountain Poison and Drug Center
Denver, Colo

Janet S. Knisely, PhD
Virginia Commonwealth University
Richmond

Sidney H. Schnoll, MD, PhD
Purdue Pharma LP
Stamford, Conn

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RELATED LETTER

Tramadol Abuse and Dependence Among Physicians
Gregory E. Skipper, Carol Fletcher, Rosei Rocha-Judd, and David Brase
JAMA. 2004;292(15):1818-1819.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Tramadol Abuse and Dependence Among Physicians—Reply
Gregory E. Skipper and David A. Brase
JAMA. 2005;293(16):1977-1978.
EXTRACT | FULL TEXT