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Tramadol-Related Deaths Over a 10-Year Period-An Autopsy Study From Western Denmark
Terese Matthesen Kamronn1,2, Asser Hedegaard Thomsen2, Sabine Solveig Aftret2
1Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.
Basic & Clinical Pharmacology & Toxicology
|January 20, 2026
Summary
Concerns about nonmedical tramadol use in Denmark were not supported by autopsy data. Tramadol detections, nonprescribed use, and fatal poisonings did not consistently increase over time, with few young individuals affected.
Area of Science:
- Forensic Toxicology
- Public Health
- Pharmacovigilance
Background:
- Emerging concerns regarding nonmedical tramadol use in Denmark.
- Hypothesized increase in tramadol detections and fatalities in medico-legal autopsies.
- Focus on nonprescribed use and poisonings, particularly among young individuals.
Purpose of the Study:
- To investigate trends in tramadol detections in medico-legal autopsy cases.
- To assess the prevalence of nonprescribed tramadol use and tramadol-related fatalities.
- To analyze demographic patterns, including age, in tramadol-related deaths.
Main Methods:
- Retrospective analysis of medico-legal autopsy cases from 2013-2024.
- Detection of tramadol in biological samples.
- Categorization of cases based on prescription status, cause of death (poisoning vs. accidental), and age.
Main Results:
- Tramadol detected in 205 decedents; 40% had no prescription.
- Tramadol poisoning caused 29% of deaths; only 2% of these were in individuals ≤25 years.
- Peak in tramadol-positive cases, nonprescribed use, and poisonings occurred in 2017, with no subsequent rise. Accidental fatalities were more common in middle-aged individuals, often with polydrug use.
Conclusions:
- Data do not support a consistent rise in tramadol-positive cases, nonprescribed use, or related poisonings in the studied region.
- Accidental tramadol fatalities predominantly affected middle-aged individuals, frequently involving polydrug use.
- While fatalities among young individuals were infrequent, preventive measures against nonmedical tramadol use remain essential due to potential non-fatal serious consequences.
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