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    Could tramadol solve the opioid crisis?

    13 July 2017

    In 2015, 52,000 deaths in the US were attributed to opioid use. Now William Brownfield, the country’s Assistant Secretary of State for International Narcotics and Law Enforcement Affairs, has warned that the crisis could easily spread to Britain.

    Speaking to ITV News, he said: ‘Our experience suggests that Fentanyl moves very, very, quickly. Once criminal trafficking organisations figure it out, and determine both how low cost and how easy it is to transport, and how they are able to develop a market for it, it can move from a non-issue to a crisis in the shortest possible time.’

    New research published by JAMA Psychiatry suggests that the prescription painkiller tramadol is more effective at managing withdrawal symptoms in patients with opioid use disorder than other treatments.

    Detoxification – or medically supervised withdrawal – is a widely used treatment for opioid use disorder. However, failing to adequately manage opioid withdrawal symptoms can contribute to people leaving treatment.

    The randomised clinical trial compared the drug with clonidine and buprenorphine in a residential research setting.

    Researchers from the Johns Hopkins University School of Medicine conducted the trial with 103 (mostly male) patients. During a seven-day taper, clonidine, buprenorphine or tramadol hydrochloride extended-release, which is an approved analgesic with low abuse potential, were used.

    The clinical trial showed tramadol extended-release suppressed withdrawal more than clonidine and was comparable to buprenorphine during a residential tapering program.

    The paper concludes: ‘These data suggest that tramadol ER is a promising and valuable medication for the management of opioid withdrawal in patients undergoing treatment for opioid use disorder. Future studies should evaluate whether relapse varies following supervised withdrawal with tramadol ER vs. other medications and whether tramadol ER can be used to transition patients to naltrexone treatment.’

    Instant analysis

    This is an interesting study which provides some promising information on the use of tramadol for opioid withdrawal. The main drawbacks of the study, as openly discussed in the report, are the relatively small, predominantly male study group and the limited relapse information. Further studies could provide more information on this.

    Research score: 3/5

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