title: Rates of abuse of tramadol remain unchanged with the introduction of new branded and generic products: results of an abuse monitoring system, 1994-2004.
abstract: OBJECTIVE
  The analgesic Tramadol HCl (Ultram) was approved in 1994 as a non-scheduled drug under the CSA provided that a novel risk-management program would be developed by an Independent Steering Committee (ISC). The risk-management program began in 1995 with the launch of Ultram, and has been modified over the past decade to accommodate Ultracet (Ultram and acetaminophen) in 2001 and generic tramadol in 2002. This provided a unique opportunity to study the potential changes in abuse as the generic and combination products became available.
  
  
  METHODS
  To proactively detect cases of abuse and diversion, the ISC developed a comprehensive questionnaire which was completed quarterly by an extensive network of drug abuse experts (n = 309) and police agencies (n = 100) who were asked to indicate how many diversion cases involving Ultram, Ultracet, and generic tramadol were identified during the preceding 3 months and what were the ten most commonly diverted drugs in their catchment area during that period.
  
  
  CONCLUSIONS
  The data generated demonstrate that the abuse of tramadol remained very low despite new branded and generic formulations. Contrary to the hypothesis that cheaper generic drugs would lead to higher rates of abuse, we found no increase in abuse with the introduction of generic tramadol. Ultracet abuse rates, unlike those found with other widely used hydrocodone and oxycodone combination products, have been even lower than that observed for tramadol. Since the FDA has now mandated that proactive risk-management plans be implemented for new drugs, the tramadol risk-management plan may be useful as a prototypic model which can be modified to accommodate other drugs with abuse potential.
authors.affiliation: Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA. cicerot@wustl.edu
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Cicero
authors.forename: James A
authors.initials: JA
authors.lastname: Inciardi
authors.forename: Edgar H
authors.initials: EH
authors.lastname: Adams
authors.forename: Anne
authors.initials: A
authors.lastname: Geller
authors.forename: Edward C
authors.initials: EC
authors.lastname: Senay
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
authors.forename: Alvaro
authors.initials: A
authors.lastname: Muñoz
mesh_terms: D000082:Acetaminophen; D000701:Analgesics, Opioid / Q000191:economics; D011307:Drug Prescriptions / Q000191:economics; D016568:Drugs, Generic / Q000191:economics; D006801:Humans; D009294:Narcotics / Q000191:economics; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy; D011358:Product Surveillance, Postmarketing / Q000706:statistics & numerical data; D014147:Tramadol / Q000191:economics; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D016568:Drugs, Generic; D009294:Narcotics; D000082:Acetaminophen; D014147:Tramadol