Tramadol-Related Deaths Over a 10-Year Period-An Autopsy Study From Western Denmark

Due to recently emerging concerns about the nonmedical use of tramadol in Denmark, we hypothesized increasing tramadol detections in medico-legal autopsy cases, with more nonprescribed use and fatal poisonings over time, particularly among young individuals. In 2013-2024, we detected tramadol in 205 decedents. Fourteen (7%) had age ≤ 25 years. Apparently, 82 (40%) had no prescription. Tramadol poisoning caused death in 60 (29%), including 4 (2%) with age ≤ 25. There were 12 accidental poisonings with tramadol alone (age (median [interquartile range]): 52 [46-55] years, tramadol concentration: 3.5 [1.8-5.2] mg/kg, number of detected drugs: 3 [2.5-9]), and 25 accidental poisonings with tramadol and other drugs (age: 43 [32-47] years, tramadol concentration: 0.78 [0.13-1.3] mg/kg, number of detected drugs: 7 [5-10]). Tramadol-positive decedents, decedents without prescription and tramadol poisonings peaked in 2017, with no subsequent increase. Conclusively, data from our area showed no consistent rise in tramadol-positive decedents, nonprescribed use or related poisonings. Accidental tramadol fatalities mostly occurred in middle-aged people and/or were associated with polydrug use. Young decedents were infrequent. However, serious consequences of nonmedical tramadol use other than death, which are not captured in medico-legal autopsy data, can occur. Therefore, preventive measures are still crucial to curb nonmedical tramadol use.