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A claims analysis of the utilization of tramadol for acute pain in patients prescribed buprenorphine/naloxone for opioid use disorder

Kellye Donovan, PharmD, PhD, MHA, Stephen Kogut, PhD, MBA, Ashley Buchanan, DrPH, MS, Xuerong Wen, PhD, MPH, Robert Crausman, MD, MMS


Objective: To determine the prevalence of tramadol prescribing among commercially insured adults receiving medication-assisted therapy (MAT) with buprenorphine/naloxone.

Design: The authors conducted a cross-sectional descriptive study to evaluate the use of tramadol among patients prescribed buprenorphine/suboxone for MAT.

Setting: This study utilized data from 2010 to 2013 Optum® Clinformatics® Data Mart. This cohort is an administrative health claims database from a large national insurer. These data included pharmacy and medical care utilization and information describing patient enrollment.

Patients/participants: Patients were 12-64 years of age and had complete and available medical, pharmacy, and administrative records in the Optum Clinformatics Data Mart during the study period.

Main outcome measures: Patients who received at least one paid claim for buprenorphine/naloxone from 2010 to 2013 and also received at least one overlapping pharmacy dispensing for tramadol were identified for analysis. The authors determined if the concurrent buprenorphine/naloxone and tramadol dispensings were from the same or a different prescriber.

Results: In this analysis of 18,734 US commercially insured patients receiving MAT with buprenorphine/naloxone, the authors identified 1,198 (6.4 percent) patients who received at least one overlapping dispensing for tramadol during a 4-year period spanning 2010-2013. Among these patients, 266 (1.42 percent) were co-prescribed buprenorphine/naloxone and tramadol from the same provider.

Conclusions: These results suggest that the use of tramadol among patients receiving buprenorphine/naloxone is not uncommon. Further study is warranted to further determine the benefits and risks associated with the use of tramadol for pain management among patients prescribed buprenorphine/naloxone.


buprenorphine, suboxone, medication-assisted therapy, tramadol, opioid use disorder

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