Impact of the Raqeeb narcotic controlling system on tramadol prescriptions in surgical patients: A pre-post...

Tramadol hydrochloride, a Schedule III opioid, is the primary take-home narcotic for postoperative pain in Saudi Arabia, with a misuse prevalence of 11.4%-20%. On February 1, 2024, the Saudi Food and Drug Authority implemented the Raqeeb electronic monitoring system for real-time prescription tracking to curb abuse while maintaining legitimate access.

To evaluate Raqeeb's impact on tramadol prescribing in surgical patients and compare outcomes with international prescription drug monitoring programs (PDMPs).

Retrospective cohort study of all adult patients (≥18 years) receiving tramadol prescriptions at a tertiary hospital in Saudi Arabia (April 2023 to June 2025), divided into pre-Raqeeb and post-Raqeeb periods. All tramadol prescriptions (acute postoperative and chronic/non-surgical indications) were included. Monthly rates were normalized; comparisons used t-tests and chi-square tests.

Monthly tramadol prescription rates in surgical patients decreased 43% (from 10.6 to 6.1 prescriptions/month). Mean dispensed quantity increased from 17.0 ± 7.6 to 21.5 ± 12.9 tablets (P = 0.003). Prescriptions issued by the surgical team fell from 86% to 48% (P < 0.001); prescriptions linked to a recent surgical procedure declined from 67% to 51% (P = 0.033). Anorectal procedures dropped 81%, while breast surgery increased 117%. Mean patient age rose from 50 ± 16 to 56 ± 15 years (P = 0.012). Repeat prescriptions remained stable (33% vs. 29%).

Raqeeb achieved a 43% reduction in tramadol prescriptions among surgical patients-exceeding typical PDMP postoperative reductions (5%-30%)-with a shift toward older patients and chronic indications, without apparent barriers to legitimate access.