Opioid Use Disorders Attributed to Tramadol Among Egyptian University Students

Bassiony, Medhat M.; Abdelghani, Mohamed; El-deen, Ghada Mohamed Salah; Hassan, Mervat S.; El-Gohari, Hayam; Youssef, Usama Mahmoud

doi:10.1097/adm.0000000000000380

Cited by 42 publications

(46 citation statements)

References 31 publications

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“…Although tramadol remains largely unregulated in the developing world, the rates of misuse and awareness of the risks have been increasing outside the US. 38 39 40 41 Data to support the avoidance of long acting opioids in the acute setting remain strong, 42 43 44 but no clear data are available on the risks versus benefits of other short acting opioids compared with tramadol. Therefore, the choice to prescribe tramadol rather than another short acting opioid remains largely dependent on the provider and scenario.…”

Section: Discussionmentioning

confidence: 99%

Chronic use of tramadol after acute pain episode: cohort study

Thiels

Habermann

Hooten

et al. 2019

BMJ

100

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ObjectiveTo determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids.DesignObservational study of administrative claims data.SettingUnited States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018.ParticipantsOpioid-naive patients undergoing elective surgery.Main outcome measureRisk of persistent opioid use after discharge for patients treated with tramadol alone compared with other short acting opioids, using three commonly used definitions of prolonged opioid use from the literature: additional opioid use (defined as at least one opioid fill 90-180 days after surgery); persistent opioid use (any span of opioid use starting in the 180 days after surgery and lasting ≥90 days); and CONSORT definition (an opioid use episode starting in the 180 days after surgery that spans ≥90 days and includes either ≥10 opioid fills or ≥120 days’ supply of opioids).ResultsOf 444 764 patients who met the inclusion criteria, 357 884 filled a discharge prescription for one or more opioids associated with one of 20 included operations. The most commonly prescribed post-surgery opioid was hydrocodone (53.0% of those filling a single opioid), followed by short acting oxycodone (37.5%) and tramadol (4.0%). The unadjusted risk of prolonged opioid use after surgery was 7.1% (n=31 431) with additional opioid use, 1.0% (n=4457) with persistent opioid use, and 0.5% (n=2027) meeting the CONSORT definition. Receipt of tramadol alone was associated with a 6% increase in the risk of additional opioid use relative to people receiving other short acting opioids (incidence rate ratio 95% confidence interval 1.00 to 1.13; risk difference 0.5 percentage points; P=0.049), 47% increase in the adjusted risk of persistent opioid use (1.25 to 1.69; 0.5 percentage points; P<0.001), and 41% increase in the adjusted risk of a CONSORT chronic opioid use episode (1.08 to 1.75; 0.2 percentage points; P=0.013).ConclusionsPeople receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short acting opioids.

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Section: Discussionmentioning

confidence: 99%

Chronic use of tramadol after acute pain episode: cohort study

Thiels

Habermann

Hooten

et al. 2019

BMJ

100

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“…In the last decade, tramadol misuse has increased significantly in the Middle Eastern and African regions, turning this issue into a notable public health problem [108]. Studies from Egypt showed a high rate of 8.8 to 12.3% of tramadol use among high school and university students [106,109]. Self‐reported prevalence of knowing someone who currently uses tramadol was 2.4% in the Iraqi general population [110].…”

Section: Discussionmentioning

confidence: 99%

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

et al. 2020

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Background and Aims Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non‐prescribed use, regular tramadol use and dependence, tramadol‐induced poisoning and mortality in Iran. Methods Consistent with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol‐associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug‐poisoning records were estimated through a random‐effects model. Results A total of 84 records were included. Pooled estimates of last 12‐month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI) = 4.1–5.9] and 0.8% (95% CI = 0.2–1.8) among males and females, respectively. The estimates for last 12‐month use among Iranian male and female university students were 4.8% (95% CI = 1.9–8.9) and 0.7% (95% CI = 0.3–1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty‐two studies provided data on tramadol‐induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug‐poisoning patients was 13.1% (95% CI = 5.7–22.9). The overall estimates of seizures and mortality among tramadol‐poisoning patients were 34.6% (95% CI = 29.6–39.8) and 0.7% (95% CI = 0.0–1.9), respectively. The pooled percentage of tramadol‐related fatalities among drug‐poisoned cases was 5.7% (95% CI = 0.5–15.4). Conclusion Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol‐related deaths have been reported in recent years.

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“…The abuse potential of tramadol has become a particular concern in Egypt and other African countries (40), which have also observed increases in the importation of illicit and adulterated tramadol (41). Tramadol abuse among adolescents and young adults in those countries has been reported to be as high as 8.8% - 12.3%, respectively (42, 43). These countries petitioned the WHO to consider placing tramadol under international control (41) and the WHO Expert Committee on Drug Dependence responded in 2018 by conducting a critical review of tramadol.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans

et al. 2019

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Background: Tramadol is an opioid-analgesic that has shown epidemiological evidence of abuse. This review evaluates the evidence for tramadol abuse potential in humans. Methods: A systematic literature search for human abuse liability examinations of tramadol was conducted in September 2018 and yielded 13 total studies. Studies were all within-subject, double-blind, placebo-controlled human laboratory comparisons of tramadol to opioid comparators. Results are organized based upon the route of tramadol administration (oral, parenteral) and the participant population (persons with and without current opioid physical dependence). Outcomes were categorized into self-report ratings of positive and negative effects, observer-ratings of effects, time course of effects, likelihood tramadol was identified as an opioid, and tramadol self-administration. Results: Results indicated the relative abuse potential of tramadol was lower than the opioids to which it was compared. Tramadol produced highest positive effect ratings when administered orally to persons with no opioid physical dependence. Relative to other opioids, it produced substantial negative ratings, generally demonstrated a slower onset of effects, and was less likely to be identified by participants as an opioid, though it did produce a higher rate of self-administration relative to other opioids in the one study reporting that outcome. Results suggest that the abuse potential of tramadol is highest when it is administered orally to non-dependent individuals, and that it likely decreases as the dose increased and when it was administered parentally or to persons with opioid physical dependence. Conclusion: Taken together, individuals may be less likely than with other opioids to escalate tramadol doses, transition from oral to parenteral routes of administration, or continue using tramadol once opioid physical dependence develops. In that way, the human abuse potential of tramadol appears to be different from and lower than other opioid analgesic medications.

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Opioid Use Disorders Attributed to Tramadol Among Egyptian University Students

Cited by 42 publications

References 31 publications

Chronic use of tramadol after acute pain episode: cohort study

Chronic use of tramadol after acute pain episode: cohort study

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans

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