31 Mar 2022 Finally: Tramadol becomes part of Canada’s Controlled Drugs and Substances Act
In July 2021 we published a Therapeutics Letter on tramadol and advised our readers that “Health Canada has announced that it will add tramadol to Schedule I of the Controlled Drugs and Substances Act and to the Narcotic Control Regulations in March 2022.” See: Order Amending Schedule I to the Controlled Drugs and Substances Act (Tramadol): SOR/2021-44, Canada Gazette, Part II, Volume 155, Number 7, published March 31, 2021.
Today (March 31, 2022) this order finally comes into force on the first anniversary of the day on which it was published in the Canada Gazette, Part II.
Tramadol has long been a controversial opioid and last year we wrote that “in Africa and the Middle East, abuse of tramadol is a recognized international crisis, in part because of its marketing as a ‘safer opioid.’”
The Canadian product monograph for tramadol includes serious warnings of addiction, abuse, misuse, overdose, and death. In 2018 the WHO Expert Committee on Drug Dependence concluded that tramadol incurs a risk of addiction similar to other opioids such as morphine.
The Therapeutics Letter concluded that:
- Compared with acetaminophen, NSAIDs or other opioids, tramadol has no therapeutic advantage but some disadvantages.
- Tramadol’s unpredictable metabolism and complex pharmacology are associated with unique and serious adverse effects.
- As with other opioids, even short prescriptions for tramadol can engender tolerance, dependence, withdrawal, and abuse.
- Tramadol (+/- acetaminophen) significantly increases costs to patients and insurers.
Read Therapeutics Letter 131: Tramadol: Where do we go from here?
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