Acute toxicity related to misuse (nonmedical use) of tramadol: Experience of the European Drug Emergencies Network Plus

Abstract

Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1 January 2014 to 31 December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia; n = 11, 7.5% of all presentations to this centre), Riga (Latvia; n = 4, 4.9%) and Munich (Germany; n = 17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/Glasgow coma score ≤ 8 and 9 of these had a respiratory rate <12 breaths/min. These presentations potentially pose a significant burden on emergency departments with a large proportion requiring admission to hospital for ongoing care.

Evaluation of Medicine Abuse Trends in Community Pharmacies: The Medicine Abuse Observatory (MAO) in a Region of Southern Europe

“…However, it is suggested that the purpose could be also to obtain a particular effect [37,38]. Recently, the Euro-DEN Plus also evaluated tramadol misuse and concluded that although is low in frequency, admissions related to tramadol misuse can be a significant burden on emergency departments [39].…”

Opioids in the United Kingdom: safety and surveillance during COVID-19

“…Surveillance of treatment for substance use disorders (including opioid use disorder) and coprescription of other drugs was also examined [ 23 ], as were long-term outcomes for mothers of infants with neonatal abstinence syndrome [ 24 ]. Further articles were not specifically focused on surveillance in the United Kingdom but included UK data; for example, Layne et al [ 25 ] examined nonmedical use of tramadol in several European countries.…”

Regional, national and international datasets: How they improve our understanding of the acute harms associated with prescription medicine misuse

“…The large number of presentations reported to the original Euro‐DEN project and the subsequent expanded Euro‐DEN Plus project relating to misuse of prescription medicines allows a better description of the patterns of acute toxicity. An example of this is the description of the pattern of acute harm/toxicity seen in Euro‐DEN Plus presentations related to tramadol published in this themed issue 33 . Additionally, there is the ability to look at the association between severe toxicity and different drugs used recreationally, including prescription medicines.…”