This article was originally published in French on Univadis.
According to French addiction surveillance data compiled from 2013 through 2018, the problematic use of tramadol is increasing in France, even though prescription levels remain stable.
The rate of dependence among patients treated for pain seems high, and tramadol could become the opioid analgesic responsible for the most deaths in this population.
Diversion of prescriptions, cases in which drugs are obtained from family or friends, and cases in which drugs are bought from dealers or online are on the rise. Drugs obtained in these ways are mainly used recreationally or to combat feelings of anxiety.
It seems important for healthcare professionals to be aware of the addictive potential and the misuse of tramadol ― problems that continue to be underestimated.
Why Is This Important?
The World Health Organization raised the alarm in 2018 in order to highlight the increase in cases of tramadol addiction worldwide. In France, reports of the nonmedical use of tramadol have been made since the early 2010s. Understanding the key factors behind the problematic use of potentially addictive psychotropic substances is essential for the creation of appropriate control or prevention programs.
To examine this question further, the authors cross-referenced several data sources. The first of these were regional addiction surveillance centers. The data were used to identify cases of problematic use reported by healthcare professionals and the factors behind such use. Data were also taken from the following surveillance and survey systems in France:
The Suspicious Prescriptions Indicating Possible Abuse (OSIAP) survey, which enables pharmacies to report suspected fraudulent prescriptions.
The Observation of Illegal or Misused Psychotropic Products (OPPIDUM) tool, which is used to ascertain the nature and reasons for use from patients managed in addiction treatment centers.
The Deaths Related to Drug and Substance Abuse (DRAMES) and the Toxic Deaths with Analgesics (DTA) programs, which make it possible to systematically compile data on deaths related to psychotropic substances within a context of abuse or treatment for pain, respectively.
Between 2013 and 2018, the number of people with a prescription for tramadol remained stable at approximately 5.9 million prescription users. At the same time, there was an increase in monotherapy prescriptions and a decrease in prescriptions for dual therapy in combination with paracetamol.
According to data from the OSIAP survey, the number of suspicious prescriptions involving tramadol increased 1.7-fold between the two dates. The analgesic has become the second most frequently listed substance (11.9%) in suspicious prescriptions.
According to data from the OPPIDUM tool, the number of users who required addiction management care and who reported the use of tramadol more than doubled between 2013 and 2018 (increasing from 0.37% to 0.76%).
Cases involving pharmacy hopping, buying online, and obtaining drugs from friends or family are particularly on the rise.
According to data from toxicology laboratories, the number of deaths associated with tramadol represented 3.2% of deaths reported in the DRAMES program in 2018 (vs 1.7% in 2013); 4.5% of deaths were associated with morphine. In the DTA program, tramadol with associated with 45% of the 109 deaths listed, ahead of morphine (29%).
The analysis of reports made by users in the 2018 addiction surveillance reports shows two main profiles of users: those with a prescription for pain who have essentially become dependent and who developed an addiction (with withdrawal symptoms and cravings) and those using the psychoactive substance for nonmedical, primarily recreational, anxiolytic, or sedative purposes.
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