Compared with other short acting opioids, patients prescribed tramadol may be at greater risk of prolonged use following surgery, according to a study published in The BMJ.

To better understand the risk of chronic use of tramadol, a team of researchers from the Mayo Clinic conducted an observational study using claims data which identified 444,764 patients who underwent surgeries across the US from January 1, 2009 and June 30, 2018. Among these patients, 357,884 prescriptions for opioids were filled following the surgery; hydrocodone was most commonly prescribed (53.0%), followed by oxycodone (37.5%) and tramadol (4.0%).

Results of the study showed that 7.1% of patients had at least 1 refill of their opioid prescription 90-180 days after surgery (defined as additional use), while 1% refilled their prescription 180-270 days after surgery (defined as persistent use). In addition, 0.46% of patients were categorized as long-term users (Consortium to Study Opioid Risks and Trends [CONSORT] definition: ≥10 opioid refills or ≥120 days’ supply).

“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% CI 1.00 to 1.13; risk difference 0.5 percentage points; P =.049), 47% increase in the adjusted risk of persistent opioid use (1.25 to 1.69; 0.5 percentage points; P <.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 =.013),” the authors reported.

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Tramadol is currently classified as a Schedule IV controlled substance as it is considered to have a lower abuse potential than Schedule II opioids. “Given that tramadol is not as tightly regulated as other short-acting opioids, these findings warrant attention,” said lead author Cornelius Thiels, DO, a general surgery resident in Mayo Clinic School of Graduate Medical Education.

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