Tramadol tied to higher risk for prolonged use than other opioids

  • Thiels CA & al.
  • BMJ
  • 14 May 2019

  • International Clinical Digest
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Takeaway

  • Surgical patients who received tramadol alone for postoperative pain were 47% more likely to develop persistent opioid use and 41% more likely to become chronic opioid users compared with patients who received other short-acting opioid.

Why this matters

  • Tramadol, which is scheduled at a lower risk level than hydrocodone or oxycodone, has seen a surge in usage in recent years for postoperative pain and currently is one of the most commonly prescribed opioids in the U.S.
  • The authors suggest the FDA should consider rescheduling tramadol to a higher risk level.

Study design

  • Study of 444,764 opioid-naive patients who underwent elective surgery.
  • Funding: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Key results

  • 3.0% of patients received tramadol alone and 74.9% received ≥1 short-acting opioid other than tramadol.
  • Receipt of tramadol alone at discharge vs other short-acting opioids was associated with a higher risk for:
    • additional opioid use (adjusted risk ratio [aRR], 1.06; P=.049),
    • persistent opioid use (aRR, 1.47; P<.001 and>
    • chronic opioid use (aRR, 1.41; P=.013).

Limitations

  • Observational study.

Coauthored with Antara Ghosh, PhD