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Review
. 2020 Jun 3:14:1178221820930006.
doi: 10.1177/1178221820930006. eCollection 2020.

Misuse of Tramadol in the United States: An Analysis of the National Survey of Drug Use and Health 2002-2017

Scott A Reines  1 , Bonnie Goldmann  2 , Mark Harnett  1 , Lucy Lu  1
Affiliations
Review

Misuse of Tramadol in the United States: An Analysis of the National Survey of Drug Use and Health 2002-2017

Scott A Reines et al. Subst Abuse. .

Abstract

Objective: To analyze the rates of misuse - that is, use in any way not directed by a doctor - of products containing oral tramadol, a Schedule IV opioid, from the National Survey of Drug Use and Health (NSDUH), as compared to comparator Schedule II opioids (morphine, oxycodone, and hydrocodone) and alprazolam, a commonly prescribed Schedule IV controlled substance in the U.S.

Methods: The NSDUH is a congressionally mandated household survey that collects information on tobacco, alcohol, and drug use, mental health and other health-related issues in the US. A cross-sectional surveillance study design was used to examine lifetime and past year misuse of oral tramadol and comparators of interest among NSHUH respondents aged 12 years or older. Based on when particular data were available, the past-year misuse analysis includes NSDUH data from 2015 to 2017, and the lifetime misuse analysis includes NSDUH data from 2002 to 2014.

Results: In 2015 to 2017, past-year misuse of oral tramadol was approximately 4% of the total number of prescriptions, versus 7% to 8% for all of the comparators when adjusted for drug availability. In 2002 to 2014, lifetime misuse of oral tramadol remained at 1.5% or less over the 13-year period, and was lower than reported for hydrocodone (6%) and oxycodone (4%), respectively. Comparison of oral tramadol and alprazolam showed misuse of tramadol was also much lower than alprazolam. Too few reports of tramadol misuse by injection (n = 7) were reported, versus 570, 1096, and 32 reports of injection of morphine, oxycodone, and hydrocodone, respectively, during the 16-year analysis period to allow for any population-based estimation. Only morphine has an intravenous formulation available and tramadol was not available as an intravenous formulation in the U.S. during that time period.

Conclusions: This analysis shows a low prevalence of oral tramadol misuse, relative to other commonly prescribed opioids, in a nationally representative sample of noninstitutionalized US residents. Estimates of reported oral tramadol misuse have remained relatively stable over time and are substantially lower than those reported for comparators when adjusted for prescription volume. Reports of oral tramadol misuse are also much less than alprazolam, another Schedule IV drug.

Keywords: NSDUH; alprazolam; misuse; opiates; tramadol.

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Conflict of interest statement

Declaration of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Reported past-year misuse as a percentage of total prescriptions (2015-2017) (Source: NSDUH, Symphony Health).
Figure 2.
Figure 2.
Percent of US Population reporting any lifetime misuse (at least once) of oral tramadol, morphine, oxycodone, and hydrocodone (2002-2014) (Source: NSDUH).
Figure 3.
Figure 3.
Reported past-year misuse as a percentage of total prescriptions (2015-2017) (Source: NSDUH, Symphony Health).
Figure 4.
Figure 4.
Percent of US Population Reporting any lifetime misuse (at least once) of oral tramadol and alprazolam (2002-2014) (Source: NSDUH).
See this image and copyright information in PMC

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