SAMHSA reports highlight rise in tramadol-related hospital emergency department visits

Thursday, May 14, 2015

Two new reports by the Substance Abuse and Mental Health Services Administration (SAMHSA) reveal sharp rises in the number of hospital emergency departments visits involving the drug tramadol between 2005 and 2011. One report focuses on hospital emergency department visits related to adverse reactions associated with the drug, while the other report tracks visits related to the misuse or abuse of the drug.

Tramadol is a prescription opioid medication typically used for the management of moderate, severe or chronic pain. It is the active ingredient in such brand name medications as Ultram, Ultracet, Conzip, Ryzolt and Rybix ODT.

Like any medication tramadol can cause adverse reactions. These adverse reactions can include seizures and a potentially fatal reaction (if untreated) known as serotonin syndrome. Medical problems can also arise if tramadol is combined with anti-anxiety medications (e.g., benzodiazepines), alcohol or other narcotic pain relievers.

Deliberate misuse of tramadol, particularly at higher than prescribed doses or in combination with other substances (including illicit substances) can heighten the risk of these harmful reactions.

The report indicated the estimated number of tramadol-related emergency department visits involving adverse reactions increased by145 percent from 10,901 visits in 2005 to 25,884 visits in 2009. The numbers of visits stabilized from 2010 (25,887 visits) to 2011 (27,421 visits).

In 2005, there were more than 2 million medication-related emergency department visits in the US, compared to more than 4 million in 2011.

Although tramadol-related visits involving adverse reactions rose by 226 percent among males from 2005 (2,484 visits) to 2011 (8,092 visits), visits among females were at significantly higher levels throughout this period. Females accounted for 75 percent of all visits in 2005 (7,604 visits) and continued to account for the majority of cases through 2011 (19,329 visits).

Increases in the hospital emergency department visits related to the misuse or abuse of tramadol have risen 250 percent during this period – from 6,255 visits in 2005 to 21,649 visits in 2011. Emergency department visits for misuse or abuse involving males rose 303 percent (from 2,333 visits in 2005 to 9,411 visits in 2011), but female levels remained consistently higher throughout this period (from 3,922 visits in 2005 to 12,238 visits in 2011).

The greatest increase in tramadol-related misuse or abuse emergency department visits occurred among patients aged 55 and older. This group experienced a 481 percent increase from 892 visits in 2005 to 5,181 visits in 2011. Other notable increases occurred among patients aged 45 to 54 (389 percent), and patients aged 25 to 34 (231 percent).

There was a significant difference between the disposition of visits involving adverse reactions and those involving misuse or abuse. Although the majority of visits in both cases resulted in the patients being treated and released, a far higher percentage of emergency visits involving the misuse of the drug required hospitalization or transfer to another health facility (38 percent for misuse visits versus 17 percent for adverse reaction visits).

"Tramadol and other pain relievers can help to alleviate pain, but they must be used carefully and in close consultation with a physician," said SAMHSA Chief Medical Officer Elinore McCance-Katz, MD. "Like all medications tramadol can cause adverse reactions, which can be even more severe if the drug is misused. We must all work to lower the risks of taking prescription drugs. Simple steps such as following directions for use, letting your doctor know if you are experiencing a problem, locking up medications for safe storage and proper disposal of unused medications are easy steps people can take to help reduce potential harm to themselves and others.”

In an effort to address the problem of prescription opioid medication misuse SAMHSA currently funds a national cooperative agreement grant that promotes physician training in the appropriate prescribing of opioids and opioid-related compounds in the fields of addiction and pain. This grant program -- the Providers' Clinical Support System - Opioid Therapies (PCSS-O) focuses on training and mentoring health professionals in safe use of opioids for the treatment of pain. The primary aim of this project is to significantly increase the number of providers who are using opioids and other pharmacological strategies safely and effectively in the treatment of pain.

SAMHSA’s efforts are part of a nationwide initiative led by U.S. Health and Human Services Secretary Sylvia M. Burwell to reduce prescription opioid and heroin related overdose, death and dependence. The President’s FY 2016 budget includes critical investments to intensify efforts to reduce opioid misuse and abuse, including $133 million in new funding to address this critical issue. Additional information on this initiative is available at: http://aspe.hhs.gov/sp/reports/2015/OpioidInitiative/ib_OpioidInitiative.cfm

The SAMHSA report about tramadol adverse reactions, Emergency Department Visits for Adverse Reactions Involving the Pain Medication Tramadol is available at: http://www.samhsa.gov/data/sites/default/files/report_1965/ShortReport-1965.pdf.

SAMHSA’s report concerning the misuse of tramadol, Emergency Department Visits for Drug Misuse or Abuse Involving the Pain Medication Tramadol is available at http://www.samhsa.gov/data/sites/default/files/report_1966/ShortReport-1966.pdf.

Both reports were developed from data collected from SAMHSA’s Drug Abuse Warning Network – a public health surveillance system that monitored visits to hospital emergency departments across the nation for urgent care related to adverse events attributed to drug use.

For more information about SAMHSA, please visit: http://www.samhsa.gov/

For more information, contact the SAMHSA Press Office at 240-276-2130.


The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

Last Updated: 08/19/2015