Tramadol - Substance Use Disorder

Peer group discussion points

1. Tramadol misuse covers a spectrum ranging from recreational use through to full addiction.

• What are some indicators of drug-seeking behaviour that you need to be aware of?
• Has anyone been in the situation they have suspected drug-seeking behaviour relating to Tramadol? What were the factors that alerted you to a potential problem?

2. Pressure to prescribe can be a common experience in primary care. When thinking about drugs of misuse there are some specific strategies or planned responses that can be used if under pressure to prescribe.

• Discuss within the group the strategies that were mentioned in the MedTalk and reflect on how useful they might be.
• What other strategies have people used or attempted to use when under pressure to prescribe Tramadol/drugs of misuse? How successful were these?

3. Tramadol is commonly prescribed in primary care. The first prescription of Tramadol has been shown to have implications regarding potential future development of dependence with the number of days of the first prescription being the important risk factor.

• If you were to prescribe Tramadol, discuss in the group some of the prescribing strategies which can reduce your prescribing risk

4. Non-pharmacological strategies are important for the ongoing management of chronic non-malignant pain.

• Are there any techniques or resources you use in practice to help your patients with chronic non-malignant pain?
• Do you think these techniques or resources are effective in the populations you see with chronic non-malignant pain?

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