Increase of high‐risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data

Abstract

The aim of this paper is to assess recent developments in non-medical tramadol use, tramadol use disorder, illegal procurement and deaths. Methods: This study used repeated cross-sectional analysis of data collected nationwide from 2013 to 2018. Analysis was conducted through multisource monitoring of the French Addictovigilance Network of: (1) validated reports of high-risk tramadol use, (2) record systems collecting information from toxicology experts investigating analgesic-related deaths (DTA) and deaths related to substance abuse (DRAMES), and pharmacists for forged prescriptions (OSIAP), and (3) survey of drug users, with investigation of patterns of use while visiting addiction-specialised institutions (OPPIDUM).Results: Despite a plateauing level of tramadol exposure in the French population, the proportion of tramadol reports increased 1.7-fold (187 cases in 2018, 3.2% (95% confidence interval [CI]: 2.74-3.63%), versus 1.9% (95% CI: 1.49-2.42% in 2013).

Chronic low back pain comorbidity count and its impact on exacerbating opioid and non‐opioid prescribing behavior

“…45,48 Increasing trends of tramadol use including dependency and consequential impairments to health are published worldwide. [49][50][51] The trend in the United States follows a similar pattern as reported by Mullins et al, 52 who indicate a 70.6% increase in tramadol prescription from emergency department visitations between 2007 and 2018 Mullins et al concluded that overall opioid utilization remained either stable or decreased while tramadol use continued to rise. Recently, tramadol has been associated with an increased risk of all-cause mortality in patients with osteoarthritis, 53 a disconcerting finding given the extent of comorbid joint arthritis observed in our study.…”

“…However, tramadol is neither a benign substance nor is it non‐addictive as evidenced by its adverse effects, including seizures and various drug interactions 45,48 . Increasing trends of tramadol use including dependency and consequential impairments to health are published worldwide 49–51 . The trend in the United States follows a similar pattern as reported by Mullins et al, 52 who indicate a 70.6% increase in tramadol prescription from emergency department visitations between 2007 and 2018 Mullins et al concluded that overall opioid utilization remained either stable or decreased while tramadol use continued to rise.…”

Trends in Fatal Poisoning Among Drug Users in France From 2011 to 2021

“…In light of the US crisis, the French harm-reduction model, the legal framework for access to strong opioids, and the multimodal approach to pain treatment may prove inspiring . In contrast, our data suggest an increase in tramadol-related deaths, which is consistent with an increase in illegal ways of procurement, high-risk use driven by its psychoactive effects sought to control withdrawal symptoms, and self-medication for anxiety or depressive symptoms …”

“It worked for my friend”: non-medical use of tramadol among manual labourers in Anambra state, Nigeria

“…Also, some participants reported that they cannot stop using the drug and they feel tensed if they cannot get their supply. These signs re-echo the fact that craving and continuing use of tramadol can trigger dependency (Dunn et al, 2019;Roussin et al, 2022;Zhang and Liu, 2013).…”

“…Tramadol inhibits the re-uptake of noradrenaline and serotonin (Boostani and Derakhshan, 2012) and is thought to have a lower abuse and dependency potential than other opioid analgesics such as morphine, oxycodone, codeine and hydrocodone (Green et al , 2021; Reines et al , 2020; World Health Organization [WHO], 2014). Scholars have shown that the use of opioid analgesics for pain management is complicated by the fact that opioids can produce euphoric effects and are often misused (Dunn et al , 2019; Roussin et al , 2022; Zhang and Liu, 2013).…”