Abuse of combinations of carisoprodol and tramadol

Neither carisoprodol (Soma) nor tramadol (Ultram) is a controlled substance at the federal level. However, evidence indicates that these medications may have abuse potential, particularly in patients with a history of substance abuse. We report three cases in which a combination of carisoprodol and tramadol was used illicitly to obtain psychotropic effects. Carisoprodol or tramadol should be prescribed with caution for patients at risk for substance abuse, and extreme caution should be used when prescribing both drugs simultaneously for any patient.