The Investigation of Tramadol Dependence with No History of Substance Abuse: A Cross-Sectional Survey of Spontaneously Reported Cases in Guangzhou City, China

Haoran Zhang,Zhimin Liu

doi:10.1155/2013/283425

Abstract

The study was to survey and assess the drug dependence and abuse potential of tramadol with no history of substance abuse. Subjects of tramadol dependence with no prior history of substance abuse were surveyed by interview. Physical dependence of tramadol was assessed using 10 items opiate withdrawal scale (OWS), and psychological dependence was assessed by Addiction Research Center Inventory—Chinese Version (ARCI-CV). Twenty-three male subjects (the median age was 23.4 ± 4.1 years) referred to the addiction unit in Medical Hospital of Guangzhou with tramadol abuse problems were included in this cross-sectional study. The control group included 87 heroin addicts, 60 methamphetamine (MA) abusers, and 50 healthy men. The scores of OWS of tramadol were 0.83–2.30; the mean scores of identifying euphoric effects–MBG, sedative effects–PCAG, and psychotomimetic effects–LSD of ARCI were 8.96 ± 3.08, 6.52 ± 3.25, and 6.65 ± 2.50, respectively, F = 4.927, P < 0.001. Scores of MBG scale in tramadol did not differ from those in heroin and MA groups (P > 0.05) but were higher than those in healthy men (P < 0.05). Tramadol with no history of substance abuse has a clear risk of producing high abuse potential under the long-term infrequent abuse and the high doses.

Highlights

Tramadol, marketed in Germany by Grunenthal since 1977, is a centrally acting analgesic with weak μ-opioid agonist properties and inhibition of norepinephrine (NA) and serotonin reuptake
Of the 23 tramadol patients, the median age was (23.4 ± 4.1) years and ranged between 18 and 34 years and 73.9% (17/23) of cases were lower than 25 years. 87.0% (20/23) of the sample had no previous history of drug abuse before tramadol abuse, and 90.0% (21/23) were on tramadol alone or 10.0% on poly drugs
Using spontaneous data from the addiction unit we found that tramadol dependence fulfilling DSM-IV criteria occurs in 23 males with no known history of substance abuse

Summary

Introduction

Tramadol, marketed in Germany by Grunenthal since 1977, is a centrally acting analgesic with weak μ-opioid agonist properties and inhibition of norepinephrine (NA) and serotonin reuptake. It has been postulated that tramadol achieves its analgesic activity from an M1 metabolite with potent opioid properties and through inhibition of reuptake of monoamines [1]. Prior to its United States (US) approval in 1995, tramadol was marketed in Europe for approximately 20 years with little evidence of abuse. The abuse probability of tramadol in USA was 2-3/100,000 and declined to 1/100,000 [2]. The incidence of tramadol abuse has declined to a low level. According to the report of National Drug Abuse Monitoring, the proportion of tramadol use among drug abusers increased from 0.2% in 2004 to 16.0% in 2006; the trend of tramadol use varied very smoothly from 2007 to 2009; the proportion of tramadol use among drug abusers declined sharply from 13.3% in 2009 to 3.4%

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