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Patients who receive tramadol after surgery have a higher risk of longer-term use of the drug, according to a study published Wednesday in The BMJ, formerly known as the British Medical Journal.
Tramadol is classified by the U.S. Drug Enforcement Administration as a Schedule IV controlled substance, whereas opioids like oxycodone and hydrocodone are listed as Schedule II drugs because of their risk of addiction.
Researchers from the Mayo Clinic in Rochester, Minnesota, who conducted the study, used data from OptumLabs Data Warehouse to examine the records of nearly a half million patients who underwent 20 common surgeries in the U.S. from Jan. 1, 2009, to June 30, 2018.
The team found that of the approximately 350,000 patients who filled a prescription for opioids after surgery, 7% had at least one refill 90 to 180 days after surgery, 1% refilled their prescription 180 to 270 days after surgery, categorizing them as persistent users, and 0.5% had 10 or more prescription fills or 120 more days supplied, classifying them as long-term users. Patients in all three categories were more likely to have received a prescription for tramadol.
"We found that people who got tramadol were just as likely as people who got hydrocodone or oxycodone to continue using opioids past the point where their surgery pain would have been expected to be resolved," said senior author Molly Jeffery, scientific director of research for the Mayo Clinic Division of Emergency Medicine. "This doesn't tie to the idea that tramadol is less habit forming than other opioids."
The researchers also found that tramadol use has been increasing over the study period, and at 4%, it was the third most prescribed opioid in this study. Hydrocodone was prescribed the most at 51% followed by oxycodone at 38%.
Given the findings and the fact that tramadol is not as highly regulated as many other opioids, the researchers said additional dialogue is needed regarding the drug’s treatment by the DEA.
The U.S. Drug Enforcement Administration began labeling tramadol, an opioid pain medication, as a Schedule IV controlled substance on Monday, according to a final rule published in the Federal Register.