Current Trends in Tramadol-Related Fatalities, Tehran, Iran 2005–2008

Abstract

Tramadol is a widely prescribed drug. Abuse of tramadol as well as tramadol-related deaths have been increasing in Iran. The objective of the present study is to evaluate the trends of tramadol-related deaths that occurred between 2005 and 2008 in Tehran, Iran. Biological samples obtained during the autopsy were analyzed. Tramadol was detected in 294 cases by itself or together with other drugs. The majority of the cases were young male adults. Tramadol-related deaths in 2008 were 32.5 times more than in 2005. These results suggest that tramadol-related fatalities are growing in Iran especially among substance abusers.

Potential for Tramadol Abuse by Patients Visiting Pharmacies in Northern Iran

“…Our finding that young individuals are now abusing tramadol is consistent with previously reported tramadol intoxication rates among Iranian youngsters,14,15,17 and highlights further its potential risk for abuse among teenagers. A different age pattern for abuse of prescription drugs in the US has been reported in some studies,18,19 and the relatively young age profile of patients who are probably addicted to opioids in our study is of concern, because abuse of tramadol young in life might aggravate further the current prevalence of drug abuse in adults, and could lead to a socioeconomic issue in the future.…”

“…Tramadol was introduced to the market in Iran in 1997 as a centrally acting medicine with mild opioid properties. 14 Despite early warnings about its potential for abuse by opioid-addicted individuals, access to the medication through Iran’s retail pharmacies has been easy, and the concern has now been raised that tramadol is becoming a common medication of abuse, especially among youngsters 15…”

Promising Effects of Intravenous Lipid Emulsion as an Antidote in Acute Tramadol Poisoning

“…13,14 Some of the most frequent manifestations of tramadol overdose are tachycardia and seizure, and, in some cases, death (mostly due to cardiopulmonary arrest). 21 There are many reports of the occurrence of seizures after tramadol overdose, and some of these occur with therapeutic doses.…”

“…12 We hypothesized that ILE might be effective in tramadol poisoning by studying an animal model of acute toxicity in rabbits. This is a reasonable thesis, as (1) there are numerous novel and promising effects of ILE in different published and unpublished papers; (2) there is high prevalence of poisoning and abuse with tramadol in Iran 13,14 and some other countries of the Middle East; 15,16 (3) tramadol has log P = 1.35 and is readily soluble in both water and ethanol; and (4) importantly, there are no experimental or human studies with regard to the efficacy of ILE in tramadol toxicity.…”

Evaluation of Abuse and Dependence in Addiction Monitoring Systems: Tramadol as an example

“…In the majority of cases the subjects concerned were young men, with a large proportion of abusers of psychoactive substances. [24] In the UK, the number of deaths implicating tramadol rose from 83 in 2008 to 154 in 2011. [25] This information was taken into account by the Advisory Council on the Misuse of Drugs, which in 2013 recommended a reinforcement of the legislation concerning tramadol.…”