Could tramadol solve the opioid crisis?

In 2015, 52,000 deaths in the US were attributed to opioid use. Now William Brownfield, the country’s Assistant Secretary of State for International Narcotics and Law Enforcement Affairs, has warned that the crisis could easily spread to Britain.

Speaking to ITV News, he said: ‘Our experience suggests that Fentanyl moves very, very, quickly. Once criminal trafficking organisations figure it out, and determine both how low cost and how easy it is to transport, and how they are able to develop a market for it, it can move from a non-issue to a crisis in the shortest possible time.’

New research published by JAMA Psychiatry suggests that the prescription painkiller tramadol is more effective at managing withdrawal symptoms in patients with opioid use disorder than other treatments.

Detoxification – or medically supervised withdrawal – is a widely used treatment for opioid use disorder. However, failing to adequately manage opioid withdrawal symptoms can contribute to people leaving treatment.

The randomised clinical trial compared the drug with clonidine and buprenorphine in a residential research setting.

Researchers from the Johns Hopkins University School of Medicine conducted the trial with 103 (mostly male) patients. During a seven-day taper, clonidine, buprenorphine or tramadol hydrochloride extended-release, which is an approved analgesic with low abuse potential, were used.

The clinical trial showed tramadol extended-release suppressed withdrawal more than clonidine and was comparable to buprenorphine during a residential tapering program.

The paper concludes: ‘These data suggest that tramadol ER is a promising and valuable medication for the management of opioid withdrawal in patients undergoing treatment for opioid use disorder. Future studies should evaluate whether relapse varies following supervised withdrawal with tramadol ER vs. other medications and whether tramadol ER can be used to transition patients to naltrexone treatment.’

Instant analysis

This is an interesting study which provides some promising information on the use of tramadol for opioid withdrawal. The main drawbacks of the study, as openly discussed in the report, are the relatively small, predominantly male study group and the limited relapse information. Further studies could provide more information on this.

Research score: 3/5

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  • Karl Melange

    Using Tramadol for “detox” is a potentially poor decision for two primary reasons:
    1. More and more we recognize that the “detox” approach seldom works with relapse rates exceeding 90%. A more protracted (months not days) maintenance assisted treatment approach is the most evidenced based way to save lives and support long term recovery.
    2. I’ve seen far too many patients who get a taste for tramadol and decide to abuse it. Here is the rub. While withdrawal from opioids feels like death…it is not a fatal experience. Withdrawal however from those dependent on high doses of tramadol can indeed be lethal due to seizure.
    Tramadol may have a role to play…but we must be cautious and note not just the benefits, but the potential risks.

    • I Am Your Father

      Tramadol gives soldiers the edge.

  • Jack

    In my opinion Tramadol is almost worthless for severe pain for most people, and has significant psychotropic side effects. I fail to see the rationale behind using it for detox.