title: An independent assessment of MEDWatch reporting for abuse/dependence and withdrawal from Ultram (tramadol hydrochloride).
abstract: OBJECTIVE
  Assess the validity of medical products reporting program (MEDWatch) reports of abuse/dependence and withdrawal associated with Ultram (tramadol).
  
  
  METHODS
  Reports of possible abuse/dependence or withdrawal associated with Ultram during 13 quarters following launch were spontaneously reported to the manufacturer Ortho-McNeil Pharmaceutical (OMP) and also solicited from 255 NIDA grantees and addiction treatment professionals by an Independent Steering Committee (ISC). Reports were classified by the ISC using DSM-IV criteria, by the Drug Safety and Surveillance (DSS) units of Robert Wood Johnson Pharmaceutical Research Institute (PRI) using World Health Organization Adverse Reaction Terms (WHOART) terms, and reported to the food and drug administration (FDA) via MEDWatch. Rates of abuse/dependence and withdrawal per 100000 persons exposed were calculated separately for classifications made by the PRI and the ISC, and confidence intervals calculated to determine the degree to which they agreed.
  
  
  RESULTS
  For 681 reports submitted to PRI, confidence intervals of ISC ratings contained PRI ratings 12 of 13 times for abuse/dependence, and 12 of 13 times for withdrawal. For 242 reports submitted to the ISC, confidence intervals of ISC ratings contained PRI ratings 10 of 13 times for abuse/dependence, and 12 of 13 times for withdrawal. Proactive surveillance increased the total number of cases of abuse/dependence but not withdrawal. Many cases of withdrawal without signs or symptoms of abuse/dependence were identified.
  
  
  CONCLUSIONS
  There was good/excellent concordance between MEDWatch and ISC classifications. Proactive surveillance increased cases of abuse/dependence but not withdrawal. Withdrawal with no signs or symptoms of dependence was common. More use of proactive surveillance is likely to improve assessments of public health risks associated with adverse events.
authors.affiliation: Treatment Research Institute, School of Medicine, Philadelphia Va/University of Pennsylvania, 600 Public Ledger Building, 150 South Independence Mall (W), Philadelphia, PA 19106 3475, USA. woody@tresearch.org
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
authors.forename: Edward C
authors.initials: EC
authors.lastname: Senay
authors.forename: Anne
authors.initials: A
authors.lastname: Geller
authors.forename: Edgar H
authors.initials: EH
authors.lastname: Adams
authors.forename: James A
authors.initials: JA
authors.lastname: Inciardi
authors.forename: Sidney
authors.initials: S
authors.lastname: Schnoll
authors.forename: Alvaro
authors.initials: A
authors.lastname: Muñoz
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Cicero
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D001330:Electronic Data Processing; D006801:Humans; D016365:Liability, Legal; D019221:Mandatory Reporting; D011634:Public Health; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000209:etiology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D014147:Tramadol / Q000009:adverse effects*; D014481:United States; D014486:United States Food and Drug Administration; D014944:World Health Organization
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol