Tramadol versus Buprenorphine for the Treatment of Opiate Withdrawal

Abstract

Various drugs have been used for the treatment of opioid withdrawal, e.g., methadone, buprenorphine, and clonidine. Tramadol is a centrally acting synthetic analgesic agent with opiate activity due to low affinity binding of the parent compound and higher affinity binding of the O-demethylated metabolite M1 to mu opioid receptors. As a consequence, there may be a role for the use of tramadol in the treatment of opiate withdrawal. We attempt to assess the efficacy of tramadol in treating moderate heroin withdrawal through a retrospective cohort control study, conducted in a detoxification unit in a community teaching hospital. Out of 100 heroin abusers admitted for detoxification during the review period, 64 patients who were treated either with buprenorphine or tramadol, were included in this study, with 20 participants in the buprenorphine group and 44 in the tramadol group. Both groups were matched for age, sex, and self-reported average quantity of heroin used per day. In the tramadol group, the average CINA maximum was 9.0, and in the buprenorphine group it was 11.2 (P = 0.07). The use of oral clonidine per patient in the tramadol group was 1.6 tablets, and in the buprenorphine group 0.1 tablets (P = 0.002). The length of stay was 3.7 days in the tramadol group and 4.1 days in the buprenorphine group (P = 0.5). Four participants in the tramadol group received three or more doses of buprenorphine because their symptoms were not controlled, and were considered as treatment failures. These preliminary data suggest that tramadol may be comparable to buprenorphine in the management of mild to moderately severe heroin withdrawal. These findings, if reproduced in larger studies with stronger research designs, have potentially great implications for the management of opioid withdrawal in both the inpatient and outpatient setting.

Discriminative Stimulus Effects of Tramadol in Humans

“…In addition, the absence of stimulant-like effects is a further advantage if tramadol is used in a drug-abusing population. These results are in line with several laboratory studies that have supported tramadol as a potential treatment for opioid dependence (Carroll et al, 2006;Lofwall et al, 2007;Lanier et al, 2010) and are also consistent with retrospective studies examining tramadol as a treatment for opioid withdrawal (Tamaskar et al, 2003;Threlkeld et al, 2006). Taken together, these converging lines of work suggest tramadol may be a useful medication for the treatment of patients with low levels of opioid dependence or for the treatment of mild to moderate opioid withdrawal.…”

Modest opioid withdrawal suppression efficacy of oral tramadol in humans

“…Three retrospective reports have suggested that tramadol may be helpful in relieving opioid withdrawal; two reported no difference in treatment retention compared to buprenorphine (Tamaskar et al 2003;Threlkeld et al 2006), but these results were confounded by concomitant clonidine use, and one reported better treatment retention and less opioid withdrawal compared to clonidine (Sobey et al 2003). A fourth study, which was prospective, found tramadol similar in efficacy to low-dose methadone for the treatment of opioid withdrawal (Salehi et al 2005).…”

Tramadol vs. Buprenorphine for the Treatment of Opioid Dependence: A Comparative Study

“…• Tramadol appears to have comparable clinical efficacy as buprenorphine for treatment of patients with low levels of opioid dependence [5,13] • Patients with moderate level of dependence; tramadol has more efficacy in detoxification and relapse prevention with minimum abuse potential.…”

“…• Tramadol has good efficacy [5,6,13] in detoxification and relapse prevention in patients with moderate level of opioid dependence as compared to buprenorphine [15].…”

“…To compare the effects and relative clinical utility of tramadol [5][6][7][8] and buprenorphine [9,10] in the treatment of heroine withdrawal in opioid dependant patients.…”