Emergency department visits associated with the misuse or abuse of tramadol more than doubled from 2005 to 2011, while visits for adverse reactions to tramadol increased 1.5-fold, according to two reports from the Substance Abuse and Mental Health Services Administration.
The first report showed that while tramadol prescriptions rose 88% from 23.3 million in 2008 to 43.8 million in 2013, the number of emergency department visits related to the misuse or abuse of the opioid rose from 6,255 in 2005 to 21,649 in 2011 – a 250% increase.
Women made up a slight majority of these visits over the course of those 5 years, but the greatest increase was observed among patients aged 55 or older, with ED visits for abuse or misuse of tramadol increasing 481%, from 892 visits in 2005 to 5,181 visits in 2011.
“The current report illustrates that tramadol misuse or abuse may be contributing to the overall problem of narcotic pain reliever misuse or abuse among older adults,” wrote Donna M. Bush, Ph.D., of SAMHSA’s Center for Behavioral Health Statistics and Quality (CBHSQ). “Prevention efforts targeted to this population as well as their medical care providers may help reduce ED visits and subsequent hospitalizations, and should remain a public health priority.”
Meanwhile, the second report by the same author showed that about half of the 54,397 ED visits associated with tramadol in 2011 were related to adverse reactions.
Overall, the number of visits for adverse reactions increased 172%, from 10,091 visits in 2005 to 27,421 visits in 2011, with women accounting for about three-quarters of all visits and patients over 65 years accounting for one-third. Most of the tramadol-related visits to emergency departments involved other drugs, Dr. Bush reported.
When combined with other drugs such as benzodiazepines, other narcotic pain relievers, and alcohol, tramadol’s sedative effects can be enhanced. She urged physicians who are prescribing tramadol to warn patients about these dangers. Dr. Bush also advised the emergency department staff to be aware of the symptoms of serotonin syndrome, which can occur when tramadol is taken in combination with some other drugs, including common antidepressants.
CBHSQ, the government’s lead agency for behavioral health statistics, is part of SAMHSA.