Potential for Tramadol Abuse by Patients Visiting Pharmacies in Northern Iran

Background: It has been almost three decades since tramadol was introduced to the market as a centrally acting analgesic. It is claimed to have weak opioid properties and a low dependence potential in opioid-addicted patients. This study was designed to investigate the suspicion of potential tramadol abuse among patients visiting pharmacies in Babol, one of the major cities in northern Iran. Methods: Under supervision by pharmacists, a questionnaire designed to monitor drug abuse was filled out for every patient who requested tramadol from Babol’s pharmacies during 6 months (Aug. 2007 till Feb. 2008). The data obtained were used to derive descriptive statistics and to make a comparison with results from other countries. Results: Of 162 patients (or someone on their behalf) who had sought tramadol from a pharmacy, 92 (56%) patients did not have a prescription. At least 103 (64%) patients reported criteria for addiction (ie, for feeling of psychological well being, unable to cease taking the drug, more than two weeks of tramadol use). In total, 145 (89%) patients were aged younger than 30 years, and 90 (55%) patients were aged younger than 18 years. More than 63% of patients reported a history of addiction or drug abuse. Most of the patients with no prescription (88%) had abuse/addiction criteria. Conclusion: Patients who request tramadol from pharmacies in Babol seem to have a high potential for drug abuse, in particular those who do not have prescriptions. The high prevalence of people under 18 years of age seeking tramadol could be a worldwide trend. We recommend further governmental support for pharmacies to deal with tramadol abusers in northern Iran.