Iatrogenic skin popper: tramadol dependence in a patient with no previous substance history

Abstract

Tramadol, a synthetic codeine analogue having a weak μ receptor agonist action has been widely used for relief of mild to moderate pain. Most commonly, tramadol addiction or abuse is reported among doctors or people with previous history of drug abuse. However, rare cases of tramadol dependence have been described in patients without prior substance abuse history. We are describing one such case of a 35-year-old male who presented with history of using injection tramadol regularly for three years where there was no prior history of drug abuse but who was prescribed tramadol for medical reason. The frequency of one ampule of tramadol increased from once in two to three days to almost daily up to 12-14 ampules/day. The management was a serious challenge. We admitted the patient for inpatient detoxification. He required tramadol injections to manage his withdrawal symptoms, along with lorazepam and clonidine which were gradually tapered over a period of 14 days. This case highlights that tramadol dependence though very rare but still can happen in a patient without substance abuse history. Also, the physician should be aware of the abuse potential of tramadol and should keep in mind short and judicious prescription, and educating the person regarding the risk of abuse can help to minimise this debilitating and sometimes fatal addiction.

Keywords

• substance abuse
• opioid
• chronic pain