Effect of Scheduling Tramadol as a Controlled Substance on Poison Center Exposures to Tramadol

Spiller, Henry A.; Scaglione, JM; Aleguas, Alfred; Foster, Howell; Durback-Morris, Lynn; Scharman, Elizabeth J.; Baker, S. David

doi:10.1345/aph.1p064

Cited by 27 publications

(16 citation statements)

References 8 publications

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“…This decrease likely reflects the effects of media activities and myriad public hearings on prescribing behaviors of physicians before the official implementation date. Prior studies have described similar effects . For example, the reported decrease in prescription opioid use and misuse among the Canadian residents of Ontario reflected not just the policy interventions but also the effects of media reporting and public hearings on prescription use disorders surrounding the policy implementations .…”

Section: Discussionmentioning

confidence: 80%

“…There were large inter‐state variations in both the absolute and relative changes in the rates of HCP prescribing before and after the October 2014 federal policy, ranging from a 46.7% decrease in Texas to a 12.7% increase in South Dakota. The variation in HCP prescribing attributable to the state of residence may, in part, reflect quantitative and qualitative differences in laws and policies regulating prescription opioids at the state level, as well as the degree of enforcement of these laws . For example, the degrees of enforcement of Prescription Drug‐Monitoring Programs in all US states vary from states to states with respect to the degree of inter‐state data sharing, enrollment, access mandates, law enforcement access, and data collection interval .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Decline in opioid prescribing after federal rescheduling of hydrocodone products

Raji

Kuo

Adhikari

et al. 2017

Pharmacoepidemiology and Drug

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Decline in opioid prescribing after federal rescheduling of hydrocodone products

Raji

Kuo

Adhikari

et al. 2017

Pharmacoepidemiology and Drug

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“…These data have been used for post-marketing surveillance and evaluating the public health impact of policy changes [9], [12], [13], [14], [15], [16]. As would be expected, not all poisoning deaths are reported to PCs [17], but the application of regression models may allow PC data to be used as an early warning system for poisoning mortality and to strengthen pharmacovigilance [18], as suggested by others [19], [20], [21].…”

Section: Introductionmentioning

confidence: 99%

Using Poison Center Exposure Calls to Predict Methadone Poisoning Deaths

et al. 2012

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Purpose There are more drug overdose deaths in the Untied States than motor vehicle fatalities. Yet the US vital statistics reporting system is of limited value because the data are delayed by four years. Poison centers report data within an hour of the event, but previous studies suggested a small proportion of poisoning deaths are reported to poison centers (PC). In an era of improved electronic surveillance capabilities, exposure calls to PCs may be an alternate indicator of trends in overdose mortality. Methods We used PC call counts for methadone that were reported to the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System in 2006 and 2007. US death certificate data were used to identify deaths due to methadone. Linear regression was used to quantify the relationship of deaths and poison center calls. Results Compared to decedents, poison center callers tended to be younger, more often female, at home and less likely to require medical attention. A strong association was found with PC calls and methadone mortality (b = 0.88, se = 0.42, t = 9.5, df = 1, p<0.0001, R 2 = 0.77). These findings were robust to large changes in a sensitivity analysis assessing the impact of underreporting of methadone overdose deaths. Conclusions Our results suggest that calls to poison centers for methadone are correlated with poisoning mortality as identified on death certificates. Calls received by poison centers may be used for timely surveillance of mortality due to methadone. In the midst of the prescription opioid overdose epidemic, electronic surveillance tools that report in real-time are powerful public health tools.

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“…Epidemiological reports and surveillance studies have indicated that tramadol diversion, abuse and overdose have recently increased in the U.S. (Dart et al, 2011; Spiller et al, 2010; Watson et al, 2003; SAMHSA, 2006), leading several states (Kentucky, Arkansas, Wyoming and Tennessee) to change it to a more stringent category (Schedule IV), while it remains unscheduled nationally. Recent clinical research suggests that the abuse liability of tramadol may have been previously underestimated with respect to oral administration, as the earlier preclinical and clinical studies employed parenteral dosing.…”

Section: Introductionmentioning

confidence: 99%

Abuse liability and reinforcing efficacy of oral tramadol in humans

Babalonis

Lofwall

Nuzzo

et al. 2013

Drug and Alcohol Dependence

117

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BACKGROUND Tramadol, a monoaminergic reuptake inhibitor, is hepatically metabolized to an opioid agonist (M1). This atypical analgesic is generally considered to have limited abuse liability. Recent reports of its abuse have increased in the U.S., leading to more stringent regulation in some states, but not nationally. The purpose of this study was to examine the relative abuse liability and reinforcing efficacy of tramadol in comparison to a high (oxycodone) and low efficacy (codeine) opioid agonist. METHODS Nine healthy, non-dependent prescription opioid abusers (6 male, 3 female) participated in this within-subject, randomized, double blind, placebo-controlled study. Participants completed 14 paired sessions (7 sample, 7 self-administration). During each sample session, an oral dose of tramadol (200, 400 mg), oxycodone (20, 40 mg), codeine (100, 200 mg) or placebo was administered, and a full array of abuse liability measures was collected. During self-administration sessions, volunteers were given the opportunity to work (via progressive ratio) for the sample dose or money. RESULTS All active doses were self-administered; placebo engendered no responding. The high doses of tramadol and oxycodone were readily self-administered (70%, 59% of available drug, respectively); lower doses and both codeine doses maintained intermediate levels of drug taking. All three drugs dose-dependently increased measures indicative of abuse liability, relative to placebo; however, the magnitude and time course of these and other pharmacodynamic effects varied qualitatively across drugs. CONCLUSIONS This study demonstrates that, like other mu opioids, higher doses of tramadol function as reinforcers in opioid abusers, providing new empirical data for regulatory evaluation.

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Effect of Scheduling Tramadol as a Controlled Substance on Poison Center Exposures to Tramadol

Abstract: The decrease in the number of cases of tramadol exposure following its addition to the schedule of controlled substances in Kentucky and Arkansas suggests that adding a drug to the schedule of controlled substances may result in a decrease in poisoning exposures related to that drug.

Cited by 27 publications

References 8 publications

Decline in opioid prescribing after federal rescheduling of hydrocodone products

Decline in opioid prescribing after federal rescheduling of hydrocodone products

Using Poison Center Exposure Calls to Predict Methadone Poisoning Deaths

Abuse liability and reinforcing efficacy of oral tramadol in humans

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