A case of iatrogenic tramadol addiction
Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analgesic in routine clinical practice. It has reportedly low abuse potential. There are, however, a few reports of tramadol misuse among health care professionals and persons with a family history of addiction.

Published in the Indian Journal of Medical Sciences, the authors describe the clinical profile of three women developing addiction to tramadol. In all these cases tramadol was initially prescribed for pain by the physician.

These three cases illustrate the possibility of abuse of tramadol even in the absence of high risk factors, i.e., history of addiction, if it is continued for a longer time. Tramadol and preparations containing tramadol and paracetamol combination are not scheduled medications unlike other opioid medications and can be easily procured.

In our country, the risk further increases in view of poorly monitored dispensing practices in medical shops and dispensing without prescription. Apart from abuse liability, there is also risk of overdose leading to seizure as well as respiratory depression which can be fatal as in the case of other opioids.

The combination of paracetamol with tramadol (case 2), raises the concern of hepatic toxicity with overdose. These three reports highlight the fact that an effective painkiller can be misused and the physician should be aware of the abuse potential of tramadol.

Major takeaway:-
It is important to check for past or family history of substance addiction, associated concomitant disorders, limited duration of prescription along with good follow up, and educating the person regarding the risk of abuse all of which will help to minimize the problem.

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