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Tramadol dependence: a survey of spontaneously reported cases in Sweden.
Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
Nordic School of Public Health, Gothenburg, Sweden.
Linköping University, Department of Medicine and Health Sciences, Forensic Science and Toxicology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
2009 (English)In: Pharmacoepidemiology and drug safety, ISSN 1099-1557Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Tramadol is a weak opioid analgesic, which is generally considered to be safe. However, conflicting data exist on the dependence potential of tramadol. OBJECTIVE: The aim of this study was to investigate occurrence of tramadol dependence and associated risk factors using spontaneously reported adverse drug reactions. METHODS: The Swedish database for spontaneously reported adverse drug reactions, Swedish Drug Information System (SweDIS), was searched for reports on tramadol dependence from 1 January 1995 until 31 December 2006. Selection was conducted based on the DSM-IV definition of dependence. Available information was scrutinised and registered and then presented descriptively. RESULTS: A total of 104 reports of tramadol dependence were identified, of which 60 (58%) concerned women. The median age (range) was 45 (15-84) years. Information on a history of substance abuse was present in 31 patients (30%) and 41 patients (39%) had a documented past or current use of a drug of abuse. Prescribed doses of tramadol ranged between 50-800 mg/day, and ingested doses between 50-4000 mg/day. Time of onset ranged from some weeks up to 4 years. In 72 (69%) cases the reaction was classified as serious, mainly due to hospitalisations for detoxification or discontinuation of tramadol. CONCLUSIONS: There is an occurrence of tramadol dependence in association with analgesic treatment within the recommended dose range. In susceptible patients a severe and serious dependence syndrome may develop. A history of abuse or use of a drug of abuse seems to be an important risk factor. Copyright (c) 2009 John Wiley & Sons, Ltd.

Place, publisher, year, edition, pages
Keyword [en]
drug dependence; spontaneous reporting system; substance abuse; tramadol
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-51223DOI: 10.1002/pds.1838PubMedID: 19827010OAI: diva2:273415
Available from: 2009-10-21 Created: 2009-10-21 Last updated: 2016-08-23
In thesis
1. Psychoactive prescription drug use disorders, misuse and abuse: Pharmacoepidemiological aspects
Open this publication in new window or tab >>Psychoactive prescription drug use disorders, misuse and abuse: Pharmacoepidemiological aspects
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns.

Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors.

Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV).

Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug.

Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 121 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1521
Psychoactive prescription drugs, psychotropic drugs, prescription drug use disorders, prescription drug misuse, abuse, pharmacovigilance, drug utilization, pharmacoepidemiology
National Category
Substance Abuse Forensic Science Social and Clinical Pharmacy Pharmaceutical Sciences
urn:nbn:se:liu:diva-130768 (URN)10.3384/diss.diva-130768 (DOI)9789176857700 (Priint) (ISBN)
Public defence
2016-09-09, Hasselquist-salen, Campus US, Linköping, 09:00 (English)
Available from: 2016-08-23 Created: 2016-08-23 Last updated: 2016-08-23Bibliographically approved

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Tjäderborn, MicaelaAhlner, JohanHägg, Staffan
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