Tramadol (Ultram®) was released into the market in 1995 as a non-controlled substance. It is indicated for the treatment of moderate to moderately severe pain in adults. When initially released, there was hope that Tramadol® could effectively be used in those with non-cancer related pain and have less abuse potential as commonly known opioids exhibit due to its pharmacologic properties.
However, this was not the case. Since 2008, Tramadol usage has been steadily climbing with reports of close to 40 million prescriptions being filled annually in US pharmacies. In the state of Florida alone, overdoses caused by Tramadol have also increased at an alarming rate and thereby filling Emergency Rooms statewide.
Beginning August 18, 2014, all Tramadol containing products (Tramadol, Tramadol ER, Ultracet®) will now be classified as a Schedule IV controlled substance. Although ten states had already re-classified Tramadol as a controlled substance, this final rule now officially classifies Tramadol as a controlled substance in all states for which special handling will commence. By designating Tramadol a controlled substance, it will now be subject to limited refills per prescription and potentially quantity limits as well.
This action that was taken is similar to what was seen with Carisoprodol back in 2011. It is the hope that by designating Tramadol as a C IV controlled substance, its subsequent misuse and possible diversion will decline. Ironically, some studies state that when Tramadol is used in combination with Carisoprodol the overall abuse rates increase by 30%.
Only time will tell if this is a positive move, but this will be welcomed in the workers’ compensation arena where all too often, misuse and abuse of opioid medications are a fact of life.
The final rule can be found a the following link: