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Comment & Response
February 2018

Tramadol Extended-Release and Opioid Withdrawal Management—Legal Implications—Reply

Author Affiliations
  • 1Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco
JAMA Psychiatry. 2018;75(2):215. doi:10.1001/jamapsychiatry.2017.3827

In Reply We appreciate this clarification being made for JAMA Psychiatry readers from Williams. When our study1 commenced in 2010, tramadol had scientific promise as an opioid treatment medication because it was unscheduled, and human laboratory and small-scale clinical trials indicated it adequately suppressed opioid withdrawal. The reclassification of tramadol to Schedule IV in 2014 limited its potential as an opioid treatment and made its use for this indication more challenging. Williams is correct that Title 21 CRF §1306.072 stipulates a health care professional seeking to dispense narcotics for opioid maintenance or detoxification must be registered as part of a narcotic treatment program (section A) and must use medications approved by the US Food and Drug Administration for these indications (section D).