title: Effect of scheduling tramadol as a controlled substance on poison center exposures to tramadol.
abstract: BACKGROUND
  There is limited information on the effect of scheduling a drug as a controlled substance with comparable data from both a pre-scheduling and post-scheduling time period.
  
  
  OBJECTIVE
  To investigate the temporal changes on poisoning cases involving tramadol in 4 states: 2 states where it has been scheduled and 2 where it is not scheduled.
  
  
  METHODS
  Databases were searched for all cases involving tramadol reported from 2003 through 2009 at 6 regional poison centers that served Arkansas, Kentucky, Ohio, and West Virginia. To allow for comparison based on population, state population estimates were obtained from the US Census Bureau.
  
  
  RESULTS
  Over the 7-year study period, the number of tramadol cases increased from 401 per year to 1009 cases per year. The mean annual increase in tramadol cases for all 4 states ranged from 8.8% to 14.1%. Post-scheduling in Arkansas and Kentucky, there was a mean decrease in cases of 4% and 31%, respectively. During this same period, the comparison states of West Virginia and Ohio showed a continued increase of 14% and 23%, respectively. The mean annual increase in tramadol cases per 100,000 population for all 4 states ranged from 16% to 31%. Post-scheduling of tramadol, there was an annual decrease in tramadol human exposures of 5% to 31% in Arkansas and Kentucky, respectively. During this same period, West Virginia and Ohio showed a continued annual increase of 14%.
  
  
  CONCLUSIONS
  The decrease in the number of cases of tramadol exposure following its addition to the schedule of controlled substances in Kentucky and Arkansas suggests that adding a drug to the schedule of controlled substances may result in a decrease in poisoning exposures related to that drug.
authors.affiliation: Kentucky Regional Poison Center, Louisville, KY 30232, USA. Henry.spiller@nortonhealthcare.org
authors.forename: Henry A
authors.initials: HA
authors.lastname: Spiller
authors.forename: J M
authors.initials: JM
authors.lastname: Scaglione
authors.forename: Alfred
authors.initials: A
authors.lastname: Aleguas
authors.forename: Howell
authors.initials: H
authors.lastname: Foster
authors.forename: Lynn
authors.initials: L
authors.lastname: Durback-Morris
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Scharman
authors.forename: S David
authors.initials: SD
authors.lastname: Baker
mesh_terms: D001131:Arkansas; D016208:Databases, Factual / Q000639:trends*; D004335:Drug and Narcotic Control / Q000639:trends*; D006801:Humans; D007629:Kentucky; D009820:Ohio; D011039:Poison Control Centers / Q000639:trends*; D014147:Tramadol / Q000506:poisoning*; D014903:West Virginia
chemical_list: D014147:Tramadol