Canada has seen a dramatic spike in prescriptions for tramadol, but one drug-safety researcher says people who’ve been prescribed the popular painkiller are often never told it’s an opioid that can be addictive.
Dr. David Juurlink, head of pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre, says Health Canada’s failure to register tramadol under the Controlled Drugs and Substances Act has helped create a perception that the drug is safer than other opioids, like codeine or Percocet.
“The reason why tramadol has taken off is because sometimes doctors don’t appreciate that it’s an opioid,” Juurlink said. “They see it as some kind of special pain medicine that doesn’t have the harms of anti-inflammatories and must not be as risky as opioids.”
Tramadol is a completely synthetic drug, but when it’s metabolised in the liver it’s converted to an opioid, said Juurlink.
“It’s an unpredictable drug with an unpredictable response,” he said. “Health Canada decided not to classify it as an opioid, which was a mistake. There is no debate around this.”
New statistics released Wednesday from the Canadian Institute for Health Information (CIHI) show that while prescriptions for opioids like codeine, oxycodone, morphine and fentanyl have all decreased between 2012 and 2016, tramadol prescriptions rose 30 per cent and the defined daily dose – an assumed average dose per day – for tramadol rose 23 per cent. Hydromorphone rose 22 per cent.
While the U.S. has classified tramadol as an opioid, Health Canada allows the drug to be marketed as a non-narcotic, according to CIHI, even though the health agency recognized in 2007 that higher-dose formulations of tramadol “may be abused or misused in the future.”
Robert, who asked Global News not to use his real name for medical privacy reasons, works in Toronto’s financial sector and started taking tramadol in December of 2015 for shoulder pain.
He said he started taking the pill to avoid drugs like Percocet.
By March 2016, Robert said his shoulder was feeling better and he stopped taking tramadol, but that’s when the nightmare began.
“I was literally sleeping one hour a night, and then I would wake up. I would fall asleep and I would wake up and I would get pains throughout my back. I would get the shakes,” he said. “It was a very terrible experience.”
Robert said his doctor never warned him that he could become dependent on tramadol.
Health Canada said it is reviewing tramadol and whether to change the classification of the drug, which would put it in the same category as opioids such as morphine, hydromorphone and oxycodone.
“In response to recent data regarding increasing tramadol prescriptions and quantities dispensed, Health Canada launched a review of scientific evidence and current use patterns with tramadol,” the department said in an email. “Once this review is complete, Health Canada will consider whether scheduling tramadol under the CDSA is appropriate. Scheduling decisions are done in consultation with stakeholders, in order to balance all views.”
However, Juurlink believes corporate lobbying helped contributed to the federal government’s decision not to list it in the first place.
“They didn’t classify it I think because they got pressure from the companies that make tramadol, including Purdue Pharma … the manufacturer of oxycontin,” he said. “It’s an excellent example of corporate meddling in a regulatory process.”
Robert is urging doctors take a closer look at the painkiller and discuss it with their patients.
“Doctors should fully engage the patients as to what they’re getting into, that there is a possibility of addiction, that it affects everybody differently for sure,” he said. “That I understand. That wasn’t raised to me.”