Abstract
Purpose of Review
Deaths associated to tramadol, a synthetic opioid, are rising globally. Herein, we characterize prescription patterns of tramadol relative to other opioids in the USA from 2012 to 2015, by geographic region and physician specialty.
Recent Findings
Data on opioid was obtained using Truven Health Analytics MarketScan for the years 2012–2015. Inclusion criteria included subjects living in the USA with ages from 12 to 64 years. Patterns of prescription of tramadol were contrasted with other prescription opioids including hydrocodone, codeine, oxycodone, oxymorphone, methadone, and fentanyl. Between 2012 and 2015, prescriptions for tramadol increased by 22.8%. The absolute rate of prescription varies considerably per region, with tramadol representing nearly 20% of opioid prescriptions in the South, which, in turn, represents nearly 50% of all prescriptions in the USA. Significant differences were seen when comparing prescribers of tramadol with other opioids (p < 0.0001). Tramadol was more frequently prescribed by family practice (40% vs. 32%) and internal medicine physicians (19% vs. 16%). Family medicine, internal medicine, and non-physician prescribers responded by 67.2% of all tramadol prescriptions in 2015. The proportion of patients receiving tramadol from non-physician prescribers increased by 56% between 2012 and 2015 (p < 0.001) IOM.
Summary
Tramadol prescriptions rates have continuously increased both nationally and throughout all US regions. Important differences exist among regions and physician specialties. These results may be helpful in the creation of regional policies to monitor reasons for this increase and to avoid excessive use of tramadol.
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References
Dowell D, Haegerich TM, Chou RCDC. Guideline for prescribing opioids for chronic pain - United States. 2016 MMWR Recomm Rep. 2016;65(1):1–49. https://doi.org/10.15585/mmwr.rr6501e1.
Kahan M, Mailis-Gagnon A, Tunks E. Canadian guideline for safe and effective use of opioids for chronic non-cancer pain: implications for pain physicians. Pain Res Manag. 2011;16(3):157–8.
Groenewald CB, Rabbitts JA, Gebert JT, Palermo TM. Trends in opioid prescriptions among children and adolescents in the United States: a nationally representative study from 1996 to 2012. Pain. 2016;157(5):1021–7. https://doi.org/10.1097/j.pain.0000000000000475.
Dart RC, Surratt HL, Cicero TJ, Parrino MW, Severtson SG, Bucher-Bartelson B, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–8. https://doi.org/10.1056/NEJMsa1406143.
Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000-2010. Med Care. 2013;51(10):870–8. https://doi.org/10.1097/MLR.0b013e3182a95d86.
Boudreau D, Von Korff M, Rutter CM, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf. 2009 Dec;18(12):1166–75. https://doi.org/10.1002/pds.1833.
Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med. 2010;363(21):1981–5. https://doi.org/10.1056/NEJMp1011512.
Reinhart M, Scarpati LM, Kirson NY, et al. The economic burden of abuse of prescription opioids: a systematic literature review from 2012 to 2017. Appl Health Econ Health Policy. 2018. https://doi.org/10.1007/s40258-018-0402-x.
Herzberg D, Guarino H, Mateu-Gelabert P, Bennett AS. Recurring epidemics of pharmaceutical drug abuse in America: time for an all-drug strategy. Am J Public Health. 2016;106(3):408–10. https://doi.org/10.2105/AJPH.2015.302982.
Passik SD, Webster L. Opioid analgesics: does potency matter? J Opioid Manag. 2014;10(4):263–75. https://doi.org/10.5055/jom.2014.0214.
Chandanwale AS, Sundar S, Latchoumibady K, et al. Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a phase III, 5-day open-label study. J Pain Res. 2014;7:455–63. https://doi.org/10.2147/JPR.S67817.
Cepeda MS, Camargo F, Zea C, et al. Tramadol for osteoarthritis: a systematic review and metaanalysis. J Rheumatol. 2007;34(3):543–55.
Sonis J. Tramadol for acute pain: a review of the evidence. Am Fam Physician. 2005;72(10):1964 author reply 1964, 1966.
Imamura T. Significant efficacy of tramadol/acetaminophen in elderly patients with chronic low back pain uncontrolled by NSAIDs: an observational study. Open Orthop J. 2015;9:120–5. https://doi.org/10.2174/1874325001509010120.
Harati Y, Gooch C, Swenson M, Edelman SV, Greene D, Raskin P, et al. Maintenance of the long-term effectiveness of tramadol in treatment of the pain of diabetic neuropathy. J Diabetes Complicat. 2000;14(2):65–70.
Administration US-DE. Drug scheduling [cited 2018 08/07/2018]. Available from: https://www.dea.gov/druginfo/ds.shtml
Handley SA, Flanagan RJ. Drugs and other chemicals involved in fatal poisoning in England and Wales during 2000 - 2011. Clin Toxicol (Phila). 2014 Jan;52(1):1–12. https://doi.org/10.3109/15563650.2013.872791.
Board INC. Report of the international narcotics control board for 2012. New York: United Nations; 2013. [cited 2018 08/07/2018]. Available from: http://incb.org/documents/Publications/AnnualReports/AR2012/AR_2012_E.pdf.
Analytics TH. Market scan studies - abbreviated bibliography 2018 [cited 2018 09/14/2018]. Available from: http://truvenhealth.com/Portals/0/Assets/2017_Truven_Health_MarketScan_Bibliography.pdf.
DeGrauw X, Thurman D, Xu L, Kancherla V, DeGrauw T. Epidemiology of traumatic brain injury-associated epilepsy and early use of anti-epilepsy drugs: an analysis of insurance claims data, 2004-2014. Epilepsy Res. 2018 Jul 23;146:41–9. https://doi.org/10.1016/j.eplepsyres.2018.07.012.
Young JC, Lund JL, Dasgupta N, et al. Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended-release long-acting opioids. Pharmacoepidemiol Drug Saf. 2018. https://doi.org/10.1002/pds.4572.
Puenpatom RA, Szeinbach SL, Ma L, et al. Daily average consumption of 2 long-acting opioids: an interrupted time series analysis. Am Health Drug Benefits. 2012;5(1):52–60.
Analytics TH. The Truven Health MarketScan Databases for health services researchers 2018. Available from: https://truvenhealth.com/portals/0/assets/2017_MarketScan_Databases_Health_Services_Researchers.pdf.
Dowell D, Haegerich TM, Chou RCDC. Guideline for prescribing opioids for chronic pain--United States, 2016. JAMA. 2016;315(15):1624–45. https://doi.org/10.1001/jama.2016.1464.
Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015;49(3):409–13. https://doi.org/10.1016/j.amepre.2015.02.020.
Vadivelu N, Kai AM, Kodumudi V, Sramcik J, Kaye AD. The opioid crisis: a comprehensive overview. Curr Pain Headache Rep. 2018 Feb 23;22(3):16. https://doi.org/10.1007/s11916-018-0670-z.
Pezalla EJ, Rosen D, Erensen JG, Haddox D, Mayne TJ. Secular trends in opioid prescribing in the USA. J Pain Res. 2017;10:383–7. https://doi.org/10.2147/JPR.S129553.
O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region - United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(34):897–903. https://doi.org/10.15585/mmwr.mm6634a2.
Liang Y, Turner BJ. National cohort study of opioid analgesic dose and risk of future hospitalization. J Hosp Med. 2015;10(7):425–31. https://doi.org/10.1002/jhm.2350.
Rowe C, Wheeler E, Stephen Jones T, Yeh C, Coffin PO. Community-based response to fentanyl overdose outbreak, San Francisco, 2015. J Urban Health. 2018;96:6–11. https://doi.org/10.1007/s11524-018-0250-x.
Phalen P, Ray B, Watson DP, Huynh P, Greene MS. Fentanyl related overdose in Indianapolis: estimating trends using multilevel Bayesian models. Addict Behav. 2018;86:4–10. https://doi.org/10.1016/j.addbeh.2018.03.010.
Mercado MC, Sumner SA, Spelke MB, Bohm MK, Sugerman DE, Stanley C. Increase in drug overdose deaths involving fentanyl-Rhode Island, January 2012-March 2014. Pain Med. 2018;19(3):511–23. https://doi.org/10.1093/pm/pnx015.
Dasgupta N, Beletsky L, Ciccarone D. Opioid crisis: no easy fix to its social and economic determinants. Am J Public Health. 2018;108(2):182–6. https://doi.org/10.2105/AJPH.2017.304187.
Minegishi T, Garrido MM, Pizer SD, et al. Effectiveness of policy and risk targeting for opioid-related risk mitigation: a randomised programme evaluation with stepped-wedge design. BMJ Open. 2018;8(6):e020097. https://doi.org/10.1136/bmjopen-2017-020097.
Morin KA, Eibl JK, Franklyn AM, Marsh DC. The opioid crisis: past, present and future policy climate in Ontario, Canada. Subst Abuse Treat Prev Policy. 2017;12(1):45. https://doi.org/10.1186/s13011-017-0130-5.
Voelker R. A day in the life: facing the opioid epidemic in Huntington, West Virginia. JAMA. 2018;319(14):1423–4. https://doi.org/10.1001/jama.2018.1353.
Beheshti A, Lucas L, Dunz T, et al. An evaluation of naloxone use for opioid overdoses in West Virginia: a literature review. Am Med J. 2015;6(1):9–13. https://doi.org/10.3844/amjsp.2015.9.13.
Bolash RB. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(16):1573–4. https://doi.org/10.1056/NEJMc1501822.
Smolina K, Gladstone E, Morgan SG. Determinants of trends in prescription opioid use in British Columbia, Canada, 2005-2013. Pharmacoepidemiol Drug Saf. 2016 May;25(5):553–9. https://doi.org/10.1002/pds.3989.
Raji MA, Kuo YF, Adhikari D, Baillargeon J, Goodwin JS. Decline in opioid prescribing after federal rescheduling of hydrocodone products. Pharmacoepidemiol Drug Saf. 2018;27(5):513–9. https://doi.org/10.1002/pds.4376.
Jones CM, Lurie PG, Throckmorton DC. Effect of US Drug Enforcement Administration’s rescheduling of hydrocodone combination analgesic products on opioid analgesic prescribing. JAMA Intern Med. 2016;176(3):399–402. https://doi.org/10.1001/jamainternmed.2015.7799.
Oehler EC, Day RL, Robinson DB, Brown LH. Has the rescheduling of hydrocodone changed ED prescribing practices? Am J Emerg Med. 2016;34(12):2388–91. https://doi.org/10.1016/j.ajem.2016.09.002.
Schultz S, Chamberlain C, Vulcan M, et al. Analgesic utilization before and after rescheduling of hydrocodone in a large academic level 1 trauma center. J Opioid Manag. 2016;12(2):119–22. https://doi.org/10.5055/jom.2016.0323.
Health MDo. Patterns of opioid prescribing in Minnesota: 2012 and 2015 [cited 2018 08/17/2018]. Available from: http://www.health.state.mn.us/divs/hpsc/hep/publications/opioidbrief20185.pdf.
Control CfD. Prescription drug time and dosage limit Laws. 2017 [cited 2018 11/04/2018]. Available from: https://www.cdc.gov/phlp/docs/menu_prescriptionlimits.pdf
Hassamal S, Miotto K, Dale W, et al. Tramadol: understanding the risk of serotonin syndrome and seizures. Am J Med. 2018. https://doi.org/10.1016/j.amjmed.2018.04.025.
Beyaz SG, Sonbahar T, Bayar F, Erdem AF. Seizures associated with low-dose tramadol for chronic pain treatment. Anesth Essays Res. 2016;10(2):376–8. https://doi.org/10.4103/0259-1162.177181.
Somerville NJ, O’Donnell J, Gladden RM, et al. Characteristics of fentanyl overdose - Massachusetts, 2014-2016. MMWR Morb Mortal Wkly Rep. 2017;66(14):382–6. https://doi.org/10.15585/mmwr.mm6614a2.
Tiscione NB, Alford I. Carfentanil in impaired driving cases and the importance of drug seizure data. J Anal Toxicol. 2018;42(7):476–84. https://doi.org/10.1093/jat/bky026.
Reinhart M, Scarpati LM, Kirson NY, Patton C, Shak N, Erensen JG. The economic burden of abuse of prescription opioids: a systematic literature review from 2012 to 2017. Appl Health Econ Health Policy. 2018;16(5):609–32. https://doi.org/10.1007/s40258-018-0402-x.
Hwang CS, Kang EM, Kornegay CJ, Staffa JA, Jones CM, McAninch JK. Trends in the concomitant prescribing of opioids and benzodiazepines, 2002-2014. Am J Prev Med. 2016;51(2):151–60. https://doi.org/10.1016/j.amepre.2016.02.014.
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Luisa M. Bigal conducted this study as part of a paid internship at Teva Pharmaceuticals. Kristen Bibeau is a full-time employee at Incyte Corporation and was a full-time employee at Teva at the time of data collection. Stephanie Dunbar is a full-time employee at Teva.
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Bigal, L.M., Bibeau, K. & Dunbar, S. Tramadol Prescription over a 4-Year Period in the USA. Curr Pain Headache Rep 23, 76 (2019). https://doi.org/10.1007/s11916-019-0777-x
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DOI: https://doi.org/10.1007/s11916-019-0777-x