Intended for healthcare professionals


Tramadol is not "opioid-lite"

BMJ 2019; 365 doi: (Published 14 May 2019) Cite this as: BMJ 2019;365:l2095
  1. Cathy Stannard, consultant in complex pain/Pain Transformation Programme clinical lead
  1. NHS Gloucestershire CCG, Gloucester Business Park, Brockworth GL3 4FE, UK
  1. cathy.stannard{at}

Prescribe with care and review treatment regularly

For newspapers, broadcasters, and even researchers, the US opioid crisis is a story that keeps on giving. This modern day scourge, killing 130 Americans a day,1 is a health catastrophe, but just as its antecedents and evolution are infinitely complicated, broad brush comments and solutions are unhelpful in turning the tide of opioid related deaths in North America and in mitigating against disaster in other countries where opioids are liberally prescribed.2 In the linked paper (doi:10.1136/bmj.l1849), Thiels and colleagues should be applauded for their focused and cautiously interpreted study of the relation between opioids prescribed after surgery and long term use.3

They followed the opioid use trajectory of 357 844 people treated with opioids following operations. Although tramadol was infrequently prescribed, patients receiving it were more likely to fill a further opioid prescription using one of three definitions of prolonged use; notably, the largest group was of those filling an additional prescription between 90 and 180 days after surgery.

The long opioid-free interval after surgery makes the clinical significance difficult to interpret. …

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