Tramadol pain reliever placed under close surveillance

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Tramadol soon to be placed under close surveillance. As of April 15, this opioid pain reliever can no longer be prescribed for more than three months, instead of a year earlier. Way for the National Medicines Safety Agency (ANSM) to draw all the consequences from the report it published in February 2019 on the consumption in France of this type of medication, causing a health crisis devastating in the United States: some 17,000 deaths recorded in 2016.

The prescriptions for these opioid analgesics have been increasing steadily for fifteen years in France. Derived from opium, these synthetic molecules are used to manage certain acute and chronic pain, especially in the treatment of cancer: powerful and effective, they activate the morphine receptors of the brain and effectively reduce suffering. But the downside is that their addictive power is greater than that of heroin. They therefore expose to a risk of dependence, overdose and respiratory depression which can lead to death. France has observed the progression of these perverse effects in recent years: the number of hospitalizations linked to the use of opioid drugs almost tripled (+ 167%) between 2000 and 2017, while the number of deaths jumped 146% between 2000 and 2015, with “At least four deaths per week”, according to the ANSM.

Number 2 of falsified prescriptions after codeine

Tramadol, a weak opioid like codeine and only available on prescription since 2017, is not exempt from liability in this table. The ignorance of some practitioners: “There are still doctors and pharmacists who do not know that tramadol is an opioid, regrets Nathalie Richard, deputy director of analgesic and narcotic drugs at ANSM. It’s not the most powerful, but the risk of addiction is the same regardless of the opioid. ”

Read also Opioids: against overdoses, an antidote under diffused

It is also the fault of a growing misuse. According to surveys by the addictovigilance network, tramadol is the first opioid analgesic drug cited in a 2018 survey on problematic uses both among drug users but also in the general population for the treatment of pain. In the event of cessation, withdrawal syndromes are observed even without exceeding the recommended doses and over a short period. Until prompting patients to continue taking it even if their pain is gone. Sign of this drift: tramadol is the second most frequent analgesic found on falsified prescriptions presented in pharmacies, behind codeine (Osiap survey, 2018 data).

Hence the end of the ANSM. Beyond three months, continuing treatment with tramadol (oral), alone or in combination with other molecules (such as paracetamol), will require a new prescription, specifies the health agency. “To renew the prescription the patient will have to return to the doctor: this will reassess the pain, if he does not take too much and risks becoming addicted”, explains Nathalie Richard. Prohibition, however, does not matter: “Pain should continue to be treated and there is always a favorable risk / benefit ratio for tramadol, provided it is used correctly.”

Nathalie Raulin

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