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April 27, 2005

Tramadol Abuse and Dependence Among Physicians—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(16):1977-1978. doi:10.1001/jama.293.16.1977-b

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.

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