Tramadol dispensing patterns and trends in Canada, 2007-2016

Area of Science:

• Pharmacology and Public Health
• Drug Policy and Epidemiology

Background:

• Opioid use, mortality, and morbidity have risen in Canada.
• Tramadol, an atypical opioid, is not subject to the same controls as other strong opioids.

Purpose of the Study:

• To investigate if tramadol was increasingly dispensed as a substitute for other opioids under stricter controls.
• To analyze population-level dispensing trends of tramadol versus scheduled strong opioids in Canada.

Main Methods:

• Examined annual retail dispensing data for tramadol and strong opioids (2007-2016) from a national pharmacy sample.
• Converted dispensing data to defined daily doses (DDD)/1000 population/day.
• Utilized segmented regression analysis to identify trend breakpoints.

Main Results:

• Tramadol dispensing increased significantly until 2009, then decelerated or plateaued.
• Strong opioid dispensing increased until 2011, then decelerated or decreased.
• Tramadol dispensing levels were consistently lower than strong opioids.

Conclusions:

• Both tramadol and strong opioids showed similar bifurcated use trends with initial increases and subsequent inflections.
• Reductions in tramadol dispensing occurred earlier than for strong opioids.
• No evidence suggests tramadol was used as a substitute for restricted strong opioids in Canada.