Increase of high-risk tramadol use and harmful consequences in France from 2013-2018: evidence from the triangulation of addictovigilance data (2022)

AIM: To assess recent developments in non-medical tramadol use, tramadol use disorder, illegal procurement, and deaths.
METHODS: Repeated cross-sectional analysis of data collected nationwide from 2013-2018. Analysis through the multisource monitoring of the French Addictovigilance Network: 1) validated reports of high-risk tramadol use, 2) record systems collecting information from: toxicology experts investigating analgesic-related deaths (DTA) and deaths related to substance abuse (DRAMES), and pharmacists for forged prescriptions (OSIAP), and 3) survey in drug users, with investigation of patterns of use while visiting in addiction specialised structures (OPPIDUM).
RESULTS: Despite a plateauing level of tramadol exposure in the French population, the proportion of tramadol reports increased by 1.7 times (187 cases in 2018, 3.2% (95%CI: [2.74-3.63%]), versus 1.9% (95%CI: [1.49-2.42%] in 2013). Trends were similar in OSIAP (11.9% of forged prescriptions in 2018 (95%CI, [10.56-13.45%]); 1.7 times increase), in OPPIDUM (0.76% (95%CI, [0.55-1.02]); 2.2 times increase), and DRAMES (3.2% of drug abuse-related deaths in 2018 (95%CI, [1.89-5.16]) versus 1.7% in 2013 (95%CI, [0.65-3.84]). Tramadol was the first opioid in analgesic-related deaths in DTA (45% in 2018). Two profiles of high-risk tramadol users were identified: 1) patients treated for pain or with tramadol persistence when pain disappeared (mainly women; mean age 44 years), and 2) individuals with non-medical use for psychoactive effects (mainly men; mean age 36 years).
CONCLUSION: The triangulation of the data obtained through addictovigilance monitoring evidenced a recent increase of high-risk tramadol use. Those findings had a practical impact on the limitation of the maximal duration of tramadol prescription.