Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Our study compared the incidence
of tramadol mentions by substance-abusing physicians (n = 595) relative
to other drugs of abuse. This comparison provides a simple estimate of relative
abuse incidence that bypasses errors of analysis and/or interpretation frequently
involved in other studies. We consider the relatively high abuse incidence
of tramadol to be indicative of significant abuse liability.
The fact that the ISC reported cases to MEDWATCH does not negate our point that frequent reports have continued. Neither
MEDWATCH nor the annual TESS reports provide
data on abuse incidence; however, the high number of reports must be concerning.
The TESS data cited by Dr Adams and colleagues are misleading as they combine
oxycodone alone and oxycodone-containing combination drugs into a single category
but measure tramadol alone. Tramadol in combination with acetaminophen (approved
in 2001) is not listed separately in the TESS reports. The first TESS report
listing tramadol (2001, Table 22B)1 shows 2236
intentional exposures for oxycodone (alone) and 2109 for tramadol (alone).
It also shows 378 for codeine and 327 for meperidine, other popular opioids
in our study. For this and later TESS reports, it is misleading to compare
tramadol alone with other opioids in combination. Tramadol has consistently
occupied a high standing in these reports.
Skipper GE, Brase DA. Tramadol Abuse and Dependence Among Physicians—Reply. JAMA. 2005;293(16):1977-1978. doi:10.1001/jama.293.16.1977-b