432 Characteristics and Predictors of Tramadol Misuse Results from the 2015 National Survey on Drug Use and Health

Abstract

The non-medical use of prescription medications, especially opioids, continues to be a serious public health concern impacting emergency departments, with the death rate from synthetic opioids increasing by 72.2% from 2014 - 2015. Tramadol prescriptions have increased substantially over the last decade, including by emergency physicians. The objective of the current study is to determine the predictors of tramadol misuse by utilizing the nationally representative National Survey of Drug Use and Health (NSDUH) data. NSDUH, managed by Substance Abuse and Mental Health Services Administration (SAMHSA), is the annual public use self-report based dataset collecting information on the nature and extent of substance use and misuse in the US. The 2015 NSDUH data files were analyzed for this study using a cross-sectional study design. The respondents were classified into two groups, past year tramadol users, and misusers, based on the screening questions assessing past year use and misuse of tramadol products. The prevalence of selected demographic, clinical factors and substance use and abuse, including prescription medications, was assessed descriptively for the two population groups using cross-tabulated frequencies and chi-sq tests. Logistic regression methods were used to outline the predictors of tramadol abuse adjusting for the selected covariates. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were reported. Overall, the 2015 NSDUH survey comprised of 57,146 respondents, of which 3,211 respondents (5.6%) reported using tramadol products over the last year. Among the total tramadol users, 439 (13.7%) respondents reported misusing these products in the previous year. The prevalence of tramadol misuse in the total 2015 NSDUH sample was 0.8%. The proportion of males (40.3% vs 32.7%, p=0.001), unmarried (75.9% vs 61.3%, p<0.001), non-Hispanic whites (69% vs 65%, p=0.01), and Hispanics (14.9% vs 9.3%, p=0.0001) was higher in past year tramadol misusers. The use and misuse of other substances in the previous year was more prevalent in the tramadol misusers. Tramadol misuse was significantly more likely among previous year users of oxycodone (OR: 2.45, 95% CI: 1.52 - 3.96, p=0.0002), and morphine (OR: 4.46, 95% CI: 2.04 - 9.73, p=0.0002), while hydrocodone and morphine users had a 40% and 52% decreased risk, respectively. Previous year oxycodone misuse (OR: 1.79, 95% CI: 1.07 - 2.99, p=0.01), morphine misuse (OR: 4.71, 95% CI: 2.07 - 10.73, p=0.0002), sedative misuse (OR: 2.76, 95% CI: 1.31 - 5.83, p=0.007), and heavy alcohol use (OR: 1.79, 95% CI: 1.10 - 2.94, p=0.01) were significant predictors of tramadol misuse. In contrast, the risk of tramadol misuse was significantly lower in the ages 26 - 34 years (OR: 0.46, 95% CI: 0.22 - 0.98, p=0.04), and non-Hispanic Native Americans (OR: 0.46, 95% CI: 0.22 - 0.98, p=0.04). Tramadol is often prescribed in the emergency department. The results indicate a substantial prevalence of tramadol misuse based on the analysis of a nationally representative sample of survey respondents. Prominent demographic and clinical differences exist in the respondents who reported using and misusing tramadol products. Certain opioids were highlighted as predictors of tramadol misuse. Emergency physicians should be aware of the potential of tramadol misuse and potential predictive factors of such misuse.