Tramadol: Is it a Controlled Substance or Not?

Recently, I found out that Tramadol (also know as Tramadol hydrochloride and Ultram in the USA) is now considered a controlled substance in New York State. Tramadol is “a centrally acting synthetic analgesic used to treat moderate to moderately severe pain” for conditions such as rheumatoid arthritis, restless legs syndrome, and fibromyalgia. Tramadol induces serotonin release while inhibiting the reuptake of norepinephrine. It is suggested as also effective for alleviating symptoms associated with depression, anxiety, and different phobias.

However, there is disagreement on whether or not Tramadol should be endorsed for the treatment of depression and anxiety. Commonly it is considered as a last resort treatment when other methods have failed. It is strongly advised that when used as a last resort treatment option a psychiatrist should be consulted.

In Canada, the medication is known as Ralivia and Zytram XL.  Tramadol is also trademarked as Conzip, Ryzolt, and Ultracet. The medication was originally launched in 1977 as  Tramal by a German pharmaceutical company. Tramadol was originally marketed as having “weak narcotic effects” and low risk for abuse. This marketing campaign turned out as false. Tramadol has been demonstrated to work mainly through “morphine-like activity.” 

In May 2009, the US Food and Drug Administration (FDA) issued a Warning letter to Johnson & Johnson about the misrepresentation of Tramadol. The FDA alleged that the promotional website by the manufacturer overstated the effectiveness of the medication, and minimized the potential serious side effects and risks.

Due to a significant amount of reported cases of abuse and dependence, the prescribing information for Tramadol was changed. The warnings include information such as stronger language regarding the potential habituating of Tramadol, and the possibility of experiencing difficultly breathing. It is strongly suggested that Tramadol is not to be used in place of other opiate medications for substance addicts weaning and management of long-term opiate addiction.

Tramadol is not listed as a federally controlled drug, but its class status changes from state to state. Arkansas, Tennessee, Illinois, New Mexico, Ohio, West Virginia, Kentucky, Wyoming, Mississippi, North Dakota, Oklahoma, and the US military also classify Tramadol as a schedule IV controlled substance. Other states might follow suite in the future considering Tramadol habit-forming properties. The suggested maximum dosage per day is 400mg via oral admission, and 600mg via parenteral admission.

Tramadol comes in a variety of forms including: capsules, tablets, suppositories, effervescent tablets and powders, ampoules of sterile solution for SC, IM, and IV injection, preservative-free solutions for injection, liquids, transdermal patches, and multi-agent topical gels, creams, and solutions. Clients taking SSRIs, SNRIs, TCAs, MAOIs, and/or other strong opioids are strongly encouraged to consult with their doctor regarding dose adjustment, or whether to use Tramadol at all. In addition, if a client is over the age of 75 or under the age of 18, and/or has severely reduced kidney and/or liver function consultation is also encouraged before starting Tramadol.

As mental health professionals, it is important to know what classification Tramadol is listed under in the state and/or country of practice. Awareness of substance misuse and/or addiction is crucial. It is suggested when working with a new or established client to have an updated medication list on file. Talking with the client and obtaining a HIPPA release to consult with other members of the treatment team is another suggestion.

Information for article is cited from the following links:

Written By Audrey Haven
SJS Staff Writer

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