Tramadol - Not the Safer Opioid

Dr Helen Fulcher, Goodfellow GP Advisor talks with Northland general practitioner and addiction medicine specialist Dr Alistair Dunn about the concerns around the prescription drug tramadol.

Topics covered include:

  • Why is tramadol not is safe as to prescribe as has been previously considered?
  • The effects of tramadol , side effects and it’s potential for addiction
  • How do we manage and reduce risk if we are going to prescribe tramadol?
  • Take home messages.


This MedTalk was recorded in September 2018



Peer group discussion points

1. Tramadol is a synthetic opioid analgesic, indicated for treating moderately severe pain. The potential for abuse and dependence exists as with any opioid, hence it has recently been reclassified as a Class C controlled drug like codeine.

  • Do you tend to prescribe Tramadol to treat acute or chronic pain? Discuss within the group your experiences with Tramadol prescribing. Have you had any negative experiences with tramadol prescribing (e.g. significant side effects, difficulty withdrawing or deprescribing the tramadol)?
  • Has anyone been in the situation where a patient has become addicted to Tramadol or where you have suspected substance use disorder relating to Tramadol?
  • How have any negative experiences changed your prescribing practice (if at all)?

2. The MedTalk mentions setting some ‘ground rules’ or contracting with the patient when prescribing Tramadol such as: weekly prescribing, setting a review date, agreeing to a maximum daily dose and setting an expectation at the start of prescribing about the short-term nature of the prescribing.

  • In your experience with prescribing Tramadol have you used any of these techniques? What was particularly useful? Discuss within the group any techniques you may have used that are not on this list that you have found useful.

3.    Tramadol is commonly prescribed in primary care.

  • Has anyone undertaken an audit of Tramadol (or opioid) prescribing in their practice? What did it show? Did you make any changes to your systems or practice based on these findings? If no one has undertaken an audit, would it be useful to undertake one? Why/why not?

4.    Reflecting on the MedTalk and the peer group discussions you have had, what could you do differently (if anything) in your practice to improve the prescribing of Tramadol?

This MedTalk is supported by

Date Published: 
Friday, September 28, 2018
This presentation is intended for qualified health practitioners professional development and should not be relied upon for any other purpose. Any opinions offered are those of the presenter or other speaker and do not necessarily represent the views of Goodfellow Unit.