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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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Jamison RN, Sheehan KA, Scanlan E, et al.: Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers. J Opioid Manag. 2014; 10(6): 375-382.

Mills S, Torrance N, Smith BH: Identification and management of chronic pain in primary care: A review. Curr Psychiatry Rep. 2016; 18(22).

Seal K, Becker W, Tighe J, et al.: Managing chronic pain in primary care: It really does take a village. J Gen Intern Med. 2017; 32(8): 931-934.

Yaksh T, Wallace M: Opioids, analgesia and pain management. In Brunton LL, Chabner BA, Knollman BJ (eds.): Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill, 2011: 569-619.

Mattick RP, Breen, C, Kimber J, et al.: Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014; (2): CD002207. doi:10.1002/14651858.CD002207.

Volkow ND, Frieden TR, Hyde PS, et al.: Medication-assisted therapies—Tackling the opioid-overdose epidemic. N Engl J Med. 2014; 370: 2063-2066.

Hser YI, Mooney LJ, Saxon AJ, et al.: Chronic pain among patients with opioid use disorder: Results from electronic health records data. J Subst Abuse Treat. 2017; 77: 26-30.

Huxtable C, Roberts L, Somogyi A, et al.: Acute pain management in opioid-tolerant patients: A growing challenge. Anesth Intensive Care. 2011; 39(5): 804-823.

Vowles KE, McEntee ML, Julnes PS, et al.: Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain. 2015; 156(4): 569-576.

Rosier PK: Acute pain management in the patient with a substance use disorder. Nurs Crit Care. 2017; 12(1): 40-46.

Van Wormer K, Davis DR: Additional Treatment: A Strengths Perspective. 4th ed. Boston, MA: Cengage Learning, 2018.

Kampman K, Jarvis M: American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. J Addict Med. 2015; 9(5): 358-367.

Greenwald MK, Comer SD, Fiellin DA: Buprenorphine maintenance and mu-opioid receptor availability in the treatment of opioid use disorder: Implications for clinical use and policy. Drug Alcohol Depend. 2014; 144(1): 1-11.

Scimeca MM, Savage SR, Portenoy R, et al.: Treatment of pain in methadone-maintained patients. Mt Sinai J Med. 2000; 67: 412-422.

New oral analgesic, tramadol, gains marketing approval. Am J Health-Syst Pharm. 1995; 52(11): 1153-1154.

Lee CR, McTavish D, Sorkin EM: Tramadol: A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states. Drugs. 1993; 46(2): 313-340.

Raffa RB, Friderichs E: The basic science aspects of tramadol hydrochloride. Pain Revs. 1996; 2: 249-271.

Grond S, Sablotzki A: Clinical pharmacology of tramadol. Clin Pharmacokinet. 2004; 43: 879-923.

Paar WD, Frankus P, Dengler HJ: The metabolism of tramadol by human liver microsomes. Clin Investig. 1992; 70: 708-710.

Benzon H: Practical Management of Pain. 5th ed. St. Louis, MO: Mosby, 2014.

Express Scripts: Express Scripts Drug Trend Report 2016. Available at Accessed September 3, 2017.

Seago S, Hayek A, Pruszynski J, et al.: Change in prescription habits after federal rescheduling of hydrocodone combination products. Bayl Univ Med Cent Proc. 2016; 29(3): 268-270.

Daubresse M, Saloner B, Pollack H, et al.: Non-buprenorphine opioid utilization among patients using buprenorphine. Addiction. 2017; 112(6): 1045-1053. doi:10.1111/add.13762.

Gordon AJ, Lo-Ciganic WH, Cochran G, et al.: Patterns and quality of buprenorphine opioid agonist treatment in a large Medicaid program. J Addict Med. 2015; 9: 470-477.

Janssen Pharmaceuticals, Inc.: Ultram (tramadol hydrochloride) [package insert]. Revised/2017, 2003. Available at Accessed August 7, 2017.

Ardakani YH, Rouini MR: Pharmacokinetics of tramadol and its three main metabolites in healthy male and female volunteers. Biopharm Drug Dispos. 2007; 28(9): 527-534.

Young J, Juurlink D: Five things to know about tramadol. Can Med Assoc J. 2013; 185(8): E352.

Dean L: Tramadol therapy and CYP2D6 genotype. Medical Genetic Summaries. Bethesda, MD: National Center for Biotechnology Information (US), 2015. Available at Accessed August 7, 2017.

Bradford L: CYP2D6 allele frequency in European Caucasians, Asians, Africans and their descendants. Pharmacogenomics. 2002; 3(2): 229-243.

Abraham BK, Adithan C: Genetic polymorphism of CYP2D6. Indian J Pharmacol. 2001; 33: 147-169.

National Human Genome Research Institute: Frequently Asked Questions about Pharmacogenomics. May 2016. Available at Accessed September 4, 2017.

The Mayo Clinic: Center for Individualized Medicine: CYP2D6/ Tramadol Pharmacogenomic Lab Test. 2017. Available at Accessed September 4, 2017.

Overholser B, Foster D: Opioid pharmacokinetic drug-drug interactions. Am J Manag Care. 2011; (suppl 11): S276-S287.

Kallen B, Reis M: Use of tramadol in early pregnancy and congenital malformation risk. Reprod Toxicol. 2015; 58: 246-251.



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