Tramadol Abuse Research Articles

Efficacy of Lofexidine in the Outpatient Management of Tramadol Withdrawal Syndrome

Tramadol is recognized as an opioid with non-opiate properties. It has a low affinity for opioid receptors and prevents reabsorption of norepinephrine and serotonin at synapses. It also increases the level of Gamma Aminobutyric Acid (GABA) in the central nervous system [1, 2]. Tramadol is an analgesic for patients suffering from moderate to severe pain [1]. In addition, previous studies have shown that tramadol abuse and suicidal attempts have increased in Iran [3, 4].

Effect of Tramadol Abuse on Male Fertility

Background: addiction is still an increasingly social and health issue worldwide, despite all attempts to overcome it. Analgesics are of the most prevalent substances that are abused. In Egypt and the Middle East, tramadol abuse is highly increasing. This can be correlated to its inexpensive cost, large availability, accessibility and illegal trafficking. Tramadol is a centrally-acting synthetic opioid analgesic that is commonly used to treat different intensities of pain varying from mild to extreme pain conditions. Prolonged administration of tramadol can result in abnormalities of the hypothalamic-pituitary function and decrease in testosterone production. Many experimental studies were done and showed that tramadol affects the level of luteinizing hormone, follicular stimulating hormone, testosterone, estradiol, and prolactin. It also affects sperm quality and motility. We aimed in this review: is to delineate these issues. Conclusion: There is a significant correlation between tramadol abuse and impaired gonadal and male sex hormone and sperm quality parameters.

The effect of tramadol abuse on the quality of sexual life

Objectives Tramadol abuse has spread markedly among the Egyptian people with many myths about its value in improving physical and sexual function. This study aims to assess the different aspects of sexual function in patients with long-term tramadol abuse. Patients and methods The participants of the study were recruited from the Hotline Clinic of Minia Psychiatric Hospital, Upper Egypt during a 6-month period. After taking their consent, 68 individuals with a history and a positive urine analysis test of tramadol abuse were included. They were assessed clinically and by addiction severity index, sexuality scale, and sexual quality of life questionnaire-male version. They were compared with a control group of 43 individuals with no history of drug abuse and negative urine analysis test. Results All the aspects of quality of sexual life were significantly better in the control group than the tramadol abuse group. There was a significant correlation between the number of symptoms and the sexual esteem; and between psychiatric status and sexual esteem and sexual depression; and between family and social problems and sexual esteem and sexual depression. Conclusion Patients with tramadol abuse are more likely to have poor quality of sexual life in comparison to healthy controls.

Preclinical assessment of tramadol abuse potential: Effects of acute and repeated tramadol on intracranial self-stimulation in rats.

Tramadol is a widely used analgesic that activates mu-opioid receptors (MOR) and inhibits serotonin and norepinephrine transporters. This mixed pharmacology may limit both its own abuse potential and its modulation of abuse potential of other MOR agonists. This study used an intracranial self-stimulation (ICSS) procedure to compare abuse-related effects produced by acute or repeated treatment with tramadol or morphine in rats. Abuse potential in ICSS procedures is indicated by a drug-induced increase (or 'facilitation') of ICSS responding. Adult male Sprague-Dawley rats were implanted with electrodes targeting the medial forebrain bundle and trained to respond on a lever for pulses of electrical brain stimulation. Tramadol effects were evaluated after acute administration (3.2-32 mg/kg) in the absence or presence of the opioid antagonist naltrexone, the CYP2D6 hepatic-enzyme inhibitor quinine or a combination of both. Additionally, both tramadol and morphine were also tested before and after repeated tramadol (32 mg/kg/day for six days) or repeated morphine (3.2 mg/kg/day for six days). Acute tramadol produced primarily ICSS rate-decreasing effects that were antagonised by naltrexone but not by quinine or naltrexone + quinine. Tramadol also produced little or no ICSS facilitation after repeated tramadol or repeated morphine, and repeated tramadol did not enhance ICSS facilitation by morphine. By contrast, morphine-induced ICSS facilitation was enhanced by repeated morphine treatment. These results suggest that tramadol has lower abuse potential than other abused MOR agonists and that repeated tramadol exposure produces relatively little enhancement of abuse potential of other MOR agonists.

Toxicology of tramadol following chronic exposure based on metabolomics of the cerebrum in mice

Tramadol is an opioid used as an analgesic for treating moderate or severe pain. The long-term use of tramadol can induce several adverse effects. The toxicological mechanism of tramadol abuse is unclear. Metabolomics is a very useful method for investigating the toxicology of drug abuse. We investigated the impact of chronic tramadol administration on the cerebrum of mice, focusing on the metabolites after tramadol administration. The mice received 20 or 50 mg/kg body weight tramadol dissolved in physiological saline daily for 5 weeks via oral gavage. Compared with the control group, the low dose tramadol group showed seven potential biomarkers, including gamma-hydroxybutyric acid, succinate semialdehyde, and methylmalonic acid, which were either up- or down-regulated. Compared with the control group, the high dose tramadol group showed ten potential biomarkers, including gamma-hydroxybutyric acid, glutamine, and O-phosphorylethanolamine, which were either up- or down-regulated. The up-regulated gamma-hydroxybutyric acid and the down-regulated succinate semialdehyde revealed that the neurotransmitter system was disrupted after tramadol abuse. Compared with the low dose tramadol group, there were twenty-nine potential biomarkers in the high dose tramadol group, mainly related to the pentose phosphate pathway and glycerophospholipid metabolism. In conclusion, metabolomics in the tramadol abuse group demonstrated that long-term tramadol abuse can result in oxidative damage, inflammation, and disruption of the GABA neurotransmitter system, which will help to elucidate the toxicology of tramadol abuse.

Free Testosterone and Prolactin Levels and Sperm Morphology and Function Among Male Patients With Tramadol Abuse

Tramadol abuse has become a crisis in Egypt and many other Middle Eastern countries. Tramadol abuse is associated with sexual dysfunction and male infertility, according to recent animal and human studies. The objective of this study was to compare tramadol abuse patients and healthy controls regarding free testosterone and prolactin levels and semen analysis. Sixty patients with opiate use disorders attributed to tramadol (OUD-T) based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic criteria and 30 healthy controls were included in the study. Sociodemographic and clinical data and urine, blood, and semen samples were collected from patients and controls for assessment. Compared with controls, OUD-T patients had higher prolactin and lower free testosterone levels. Patients with OUD-T were more likely to have lower sperm count and higher abnormal motility and forms of sperms compared with controls. Patients with OUD-T were found to be more likely to have lower free testosterone levels and lower sperm counts and vitality, and higher prolactin levels and sperm abnormal forms compared with controls.

Risk and Protective Factors of Tramadol Abuse in the Gaza Strip: The Perspective of Tramadol Abusers and Psychiatrists

We sought to identify the perceptions of users and medical providers regarding the recreational use of tramadol in the Gaza Strip, a society that is affected by severe political and military violence. We conducted qualitative interviews with psychiatrists and tramadol users to identify their perceptions of the individual, community, and socio-political determinants of tramadol use, its effect on quality of life, and the challenges experienced in the recovery process. Thematic analysis was applied to the narratives of 26 interviewees; 13 psychiatrists (12 males, one female; age range = 32–58, mean age = 44.5, SD,=6.9; years of experience = 6–29, mean = 16.6, SD = 6.3), and 13 tramadol users (13 males; age range = 24–52, mean = 35.1, SD = 8.98). Three main themes emerged, namely, conditions contributing to the misuse of tramadol, challenges in recovering from tramadol misuse, and consequences of misuse on individuals and social networks. Participants stated that critical environmental and living conditions, such as unemployment, poverty, stress, health, and mental health-related determinants have led to the use of the opioid. Also, disrupted and weak social services that are unprepared to manage widespread substance use cannot safeguard and assist tramadol users. We conceptualize the data in terms of a socio-ecological model drawing on individual, social and cultural determinants of tramadol use, and discuss the clinical and research implications of the findings.

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non-prescribed use, regular tramadol use and dependence, tramadol-induced poisoning and mortality in Iran. Consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol-associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug-poisoning records were estimated through a random-effects model. A total of 84 records were included. Pooled estimates of last 12-month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI)=4.1-5.9] and 0.8% (95% CI=0.2-1.8) among males and females, respectively. The estimates for last 12-month use among Iranian male and female university students were 4.8% (95% CI=1.9-8.9) and 0.7% (95% CI=0.3-1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty-two studies provided data on tramadol-induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug-poisoning patients was 13.1% (95% CI=5.7-22.9). The overall estimates of seizures and mortality among tramadol-poisoning patients were 34.6% (95% CI=29.6-39.8) and 0.7% (95% CI=0.0-1.9), respectively. The pooled percentage of tramadol-related fatalities among drug-poisoned cases was 5.7% (95% CI=0.5-15.4). Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol-related deaths have been reported in recent years.

A REVIEW STUDY ON TRAMADOL ABUSE AMONG EGYPTIAN UNIVERSITY STUDENTS

Tramadol, which is a medication used for moderate and severe pains, has caused drug abuse and addiction to the Egyptian community. This study aimed to observe the prevalence of tramadol abuse among Egyptian university students. By following the PRISMA reporting guideline, a systematic review of evidence was conducted. Search strategy was conducted through PubMed-NCBI to yield appropriate published literature between 2014-2019, as well as performed literature screening, eligibility criteria, and data extraction. The process of selection yielded a total number of 2 studies to be eligible for the review inclusion criteria. The characteristics evaluated that correlate to tramadol were classified into four groups: gender, smoking, alcohol consumption, and failure in exams before. In general, tramadol showed positively associated with other prevalence characteristics. Tramadol is the second most commonly abused drug among university students in Egypt. The review highlights that tramadol abuse has become a common phenomenon among Egyptian university students which necessitates for ample attention. Future research is recommended to identify the causal effects of tramadol abuse and its role as a potential gateway drug.
 Peer Review History: 
 Received 2 January 2020; Revised 22 February; Accepted 1 March, Available online 15 March 2020
 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.
 Received file 
 
 Average Peer review marks at initial stage: 5.5/10
 Average Peer review marks at publication stage: 7.0/10
 Reviewer(s) detail:
 Name: Hebatallaha A Moustafa
 Affiliation: Ain Shams University, Egypt
 E-mail: anasweety2003@yahoo.com
 
 Name: Dr. Hassan A.H. Al-Shamahy
 Affiliation: Sana'a University, Yemen
 E-mail: shmahe@yemen.net.ye
 
 Name: Dr. Ali Abdullah Al-yahawi
 Affiliation: Al-Razi university, Department of Pharmacy, Yemen
 E-mail: alyahawipharm@yahoo.com
 Comments of reviewer(s): 
 
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Tramadol abuse among workers in an industrial city in mid-Nile Delta region, Egypt.

Tramadol abuse is an increasingly alarming phenomenon among Egyptian Community especially among workers and drivers. Study profile and factors affecting tramadol abuse among industrial workers in Mid-Nile Delta Region. A cross sectional study among minibus drivers, construction and textile industries workers. From each target group 300 males were chosen randomly. The total sample size was 900 persons. Interview questionnaire was used for data collection. Diagnosis of tramadol abuse was according DSM-5 Criteria. Intake of tramadol was high among construction workers (92.3%) followed by bus drivers (53.0%) and lastly textile workers (25.3%). The main source of tramadol was friends (45.4%) followed by drug dealers (16.6%). The main reason of abuse was to improve mood (54.3%) followed by relief of pain and help to continue work (37.3%). Tramadol is prevalent among industrial workers due to different reasons related to the work load and stressful events. Ever intake of tramadol was high among construction workers followed by bus drivers and lastly textile workers. Drug testing for workers in workplace is a must to ensure community safety.

Tramadol administration induced hippocampal cells apoptosis, astrogliosis, and microgliosis in juvenile and adult male mice, histological and immunohistochemical study

ABSTRACT Tramadol is a common analgesic, frequently used for relieving moderate or severe pain and widely used to delay ejaculation. However, repeated large doses have several adverse effects, especially on the brain tissue. So, this study was designed to assess the potentially deleterious effects of chronic administration of tramadol on principal fields of the hippocampus in adult and juvenile male albino mice. Thirty swiss male albino mice were divided equally into three groups: Group Ia (control adult) 3 months old, Group Ib (control juvenile) 3-week postnatal mice, Group II (tramadol treated adult mice) and Group III (tramadol treated juvenile mice). Both treated groups received tramadol tablets dissolved in water in a dose of 40mg/kg for 1 month by gastric tube. Tramadol treated groups showed degenerative changes in dentate gyrus (DG) granule cells, pyramidal neurons of CA1and CA3 fields in the form of electron-dense or rarified cytoplasm, dilated rER and mitochondrial changes. Additionally, immunohistochemical results revealed significantly increased in caspase 3 positive cells in different hippocampal principal fields. Astrogliosis and microgliosis were proved by the increased immunoreactivity of astrocytes to glial fibrillary acidic protein (GFAP) and microglia to CD68. Morphometric findings showed a significant reduction of both surface area of granule and pyramidal cells, and in thickness of DG, CA1, CA3 layers. Moreover, most of these morphological changes were aggravated in the juvenile-treated group. So, it can be concluded that tramadol abuse can induce an altered morphological change on the principal fields of the hippocampus in adult and juvenile mice.

Hypoxic-ischemic encephalopathy in a young man due to tramadol overdose

Objective: Tramadol is a synthetic analgesic with two mechanisms. The opioid and non-opioid mechanisms are responsible for tramadol side effects. Non-opioid side effects of tramadol are due to the reuptake inhibitions of serotonin and norepinephrine. Some of the side effects include anaphylactoid reactions, CNS depression, hypoglycemia, hypotension, respiratory depression, seizures, and serotonin syndrome. Seizure may happen in therapeutic doses. If the frequency of tramadol seizures increases, ischemic brain injury and hypoxic-ischemic encephalopathy can be induced. Case Report: We report a young man with a history of tramadol abuse that was admitted with status epilepticus in Imam Reza hospital in Mashhad, Iran. Due to his altered mental status, he was intubated and antiepileptic agents were prescribed. He was transferred to ICU. After regaining consciousness, he was extubated and with the prescription of rehabilitation support he was discharged. Conclusion: Tramadol is a synthetic analgesic agent with less potential for dependence. It is important to mention that the overdose of this drug is common. This drug has two mechanisms. This paper reports a case that developed generalized tonic clonic seizures due to tramadol and hypoxic ischemic encephalopathy. With adequate treatment and supportive care, patient’s mental status improves and he/she can be discharged.

Histological And Immunohistochemical Study On The Effect Of Tramadol Abuse On Cerebral Cortex And Hippocampus In Male Albino Rabbits

Background: Tramadol is an analgesic used in moderate and severe pain however, tramadol abuse among adolescence leads to various alterations in brain histological structure that leads to psychiatric and physical abnormalities.Aim of the Work: This study aimed to evaluate the effects of tramadol abuse in male albino rabbits on the cerebral cortex and the hippocampus and the effect of its withdrawal.Material and Methods: Thirty male albino rabbits were divided into three groups; the control group, the tramadol treated group in which rabbits were received tramadol 42 mg/ kg/ day for ten days then the dose was increased to 84 mg/kg/day for another ten days then 168 mg/kg/day for another ten days. The tramadol recovery group in which rabbits were received the same doses as the previous group then the tramadol intake was stopped and the rabbits were sacrificed after 4 weeks. In the present study, the histological and immunohistochemical studies of the cerebral cortex and hippocampus were evaluated.Results: tramadol abuse among the tramadol treated group caused neuronal cell disorganization in cerebral cortex and hippocampus in the form of cell apoptosis, wide intercellular space, degenerative vacuolation and diffuse chromatolyses and strong positive Caspase–3 antibody reaction. After stoppage of tramadol there were many normal neurons with decease the percentile of cell apoptosis, wide intercellular space, degenerative vacuolation and diffuse chromatolyses and mild positive Caspase–3 antibody reaction.Conclusion: Tramadol abuse induced neurotoxicity and histological changes in brain tissue although, after stoppage of tramadol intake there was incomplete regression of brain histopathological alterations

Facilitators to the continuous abuse of tramadol among the youth: A qualitative study in Northern Ghana.

Study aimConsidering the alarming rate at which young people abuse tramadol, as evidenced by the numerous media reports on the subject, this qualitative study was conducted to explore the facilitators to the abuse of tramadol by young people.Design and methodsA qualitative exploratory descriptive design was employed in conducting the study. A total of 18 participants were purposively sampled. Data for the study were collected through two focused group discussions and three in‐depth‐interviews. Thematic analysis was used to analyse the data.ResultsThe findings of the study revealed four main themes. These themes were initiating factors of abuse; desirable physical effects; desirable psychological effects; and undesirable effects. It was revealed that many young people initially get into tramadol abuse because of peer pressure, curiosity or post‐traumatic addiction. However, they often continue the practice for various physical and psychological gratifications including euphoria, attentiveness, high energy levels, pain relief and improved sexual performance. The study also revealed some unpleasant side effects of tramadol abuse such as severe vomiting, loss of appetite, seizures, emotional aloofness and irritability. Many of the participants in this study also expressed willingness to quit tramadol abuse because of social discrimination and the enormous side effects that come with the abuse of the drug.

Impact of tramadol abuse on clinical outcome of lumbar discectomy patients’

Background dataLittle data exists regarding the effect of chronic preoperative tramadol abuse on the clinical outcomes after surgery. Lumbar discectomy is a very common procedure that has a predictably high success rate for relief of radicular pain. In addition, the patient population presenting for this procedure has a high propensity for preoperative narcotic use. PurposeThe study aims to identify an association between preoperative tramadol abuse and clinical outcome after lumbar discectomy. Study designA descriptive controlled, non-randomized, clinical study. Patients and methodsSixty patients underwent surgery for lumbar disc herniation. They were divided into two groups; control group and tramadol abuse group. Each group included 30 patients. They were operated between 2015 and 2016. Participants were evaluated pre-operatively and post-operatively every three months. Strict history taking regarding preoperative and postoperative pain medication utilization, operative time, hospital stay and complications were assessed. Pain was scored by a VAS for both lower limbs and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. ResultsIn Tramadol abuse group, 12 (40%) continued to use tramadol after surgery. Tramadol abuse group showed worse clinical outcome parameters including worse VAS for low back pain and lower limb pain, worse Prolo economic, functional rating scale. In addition, tramadol abuse group showed significantly higher complications rate in the early post-operative and during the follow up period. ConclusionTramadol abuse before lumbar discectomy was found to be associated with continued tramadol abuse after surgery and worse functional outcomes following surgery. Surgeons may want to counsel their patients about the potential for inferior clinical outcomes if narcotics were used before surgery.

Sexual Dysfunctions among Male Patients with Tramadol Abuse

Sexual Dysfunctions among Male Patients with Tramadol Abuse

Recognition of tramadol abuse, dispensing practices, and opinions about its control policy among community pharmacists in Bangkok, Thailand

Abstract Background Tramadol is classified as a pharmacist-only (restricted) medicine by the Food and Drug Administration of Thailand (Thai FDA). Because of concern about its abuse, in September 2013 the Thai FDA announced a policy to control the distribution of tramadol in community pharmacies. Objectives To identify tramadol dispensing practices by community pharmacists in Bangkok, their recognition of tramadol abuse and the Thai FDA control policy announcement; and opinions about the tramadol control policy. Methods This descriptive cross-sectional study was conducted in community pharmacies located in Bangkok. Pharmacists on duty were interviewed from September 2015 to April 2016. Results Data from 305 pharmacists working in 305 pharmacies revealed that tramadol, both single (tramadol alone) and combination (tramadol plus acetaminophen) formulations, was available in 185 pharmacies (60.7%). Most pharmacists dispensed tramadol to supply regular medicine along with previous prescriptions (74%). Among 305 pharmacists, 304 (99.7%) recognized tramadol abuse in combination with cold–cough remedies and carbonated beverages can create euphoria. Most (97.7%) knew about the announcement of the tramadol control policy, and most (82.6%) thought that the policy was practical. Approximately 43% of pharmacists agreed that the policy was effective in reducing the tramadol abuse problem, whereas 36.7% disagreed. Moreover, 60.3% disagreed with rescheduling tramadol as a prescription-only medicine. In their opinion, tramadol should still be available in pharmacies, to be dispensed by community pharmacists to patients with medical necessity. Conclusions Further studies nationwide in Thailand are likely to be useful to represent and compare information in different parts of the country.

Retrospective study of addictive drug-induced acute toxicity of cases admitted to the Poison Control Centre of Ain Shams University Hospital (2015\u20132016)

BackgroundThe acute toxicity with addictive drugs is one of the most common problems in the emergency department. This is a global problem affecting societies as it deals with young people at the age of work and productivity. This study aims to recognize the prevalence of addictive drug-induced acute toxicity regarding socio-demographic factors, common clinical presentation, and outcome of management.MethodsThis is a descriptive retrospective study conducted on patients admitted to the Poison Control Centre of Ain Shams University Hospital during the period between the start of January 2015 and the end of December 2016. The total number of cases was 803 cases collected and analyzed regarding the socio-demographic data, condition of poisoning, prevalence of addictive drugs, route of intake, common clinical presentation, management plan, and final outcome of management. Data was analyzed using the computer software package SPSS 22.ResultsA total of 803 cases were reviewed, their age ranged from 1 month to 83 years with mean ± SD 21.6 ± 16.8 years, and most cases were male (72.9%), living in urban areas (67.4%), and of single marital status (66.6%). Accidental overdose characterized most (86.8%) cases. Tramadol was the most commonly abused drug (36.5%), and most of the drugs were ingested orally. Disturbed conscious level was the most common clinical presentation in all drugs, and most of the cases were vitally stable and had normal sodium, potassium, ABG, and blood glucose level. Most of the cases received medical treatment in ICU (60%) and 93.5% improved while 6.5% died.ConclusionsDrug abuse is a serious problem in many countries especially among young males. Tramadol abuse and toxicity is increasing every day in the Egyptian community. Like other cases of poisoning, treatment of acute toxicity with addictive drugs is mainly supportive and symptomatic.

Disappearance of Tramadol and THC-COOH in Hair After Discontinuation of Abuse. Two Different Profiles.

The retrospective calendar of an individual's drug use requires a multisectional analysis in which the length of hair, corresponding to the full temporal window available, is cut into shorter sections to measure drug use during shorter periods of time (generally 1 cm corresponds to ~1 month). Segmental hair analysis is used to verify both previous drug history and recent enforced abstinence. However, after drug discontinuation, the fresh new hair growth segment cannot be immediately negative, due to the contribution of dormant hair. The objective of the study was to test hair samples from chronic tramadol and cannabis users after the discontinuation of both drugs and to evaluate the delay to wait until the hair will become negative. Hair specimens were obtained from eight subjects with a known history of tramadol abuse. Hair was collected 3-6 months after tramadol discontinuation. Tramadol was tested by liquid chromatography coupled to tandem mass spectrometry (LC-MS-MS) with a LOQ at 5 pg/mg. A second set of hair specimens were obtained from 15 subjects with a known history of cannabis abuse. Hair was collected 6-9 months after cannabis discontinuation. THC-COOH was tested by LC-MS-MS with a LOQ at 0.2 pg/mg. The hair stands were cut into L × 1 cm segments, according to their length (L), and tested for the respective drug. It was asked to each subject to clearly indicate the date of drug discontinuation. Assuming a rate of hair growth of 1 cm/month, the segment corresponding to the time of last drug use was calculated. The older segment just before this one was considered as the 100% of the response. THC-COOH and tramadol concentrations in this segment ranged from 2.3 to 8.9 and 895 to 21,010 pg/mg, respectively. After cessation of drug consumption, the presence of both drugs in new growing hair segments continued for a certain period with a more or less broad transition zone. Negative hair results were obtained ~3-4 and 6-7 months after cessation of tramadol and cannabis abuse.

TRAMADOL ABUSE.

12Jan 2019 TRAMADOL ABUSE. Saleh M Kh E A Alkhubaizi. Department of Medicine, Adan Hospital, Kuwait.