title: Tramadol deaths in Northern Ireland: a review of cases from 1996 to 2012.
abstract: In the UK tramadol is a frequently prescribed opioid analgesic which is becoming increasingly popular as a drug of misuse. Its use varies worldwide and in the last decade it has been upgraded to a controlled substance in several countries, due to an increased number of deaths associated with its use. A review of all deaths associated with tramadol in Northern Ireland was performed and this highlighted 127 cases from 1996 to the end of 2012. A 10% increase in deaths due to tramadol was noted. In 2001 tramadol deaths represented 9% of all drug misuse deaths rising to 40% in 2011. The majority of the deaths occurred in males (62%), with a median age of 41 years, living in the Belfast city area (36%). Tramadol fatalities were found in combination with other drugs/medicines (49%), alcohol (36%) or alone (23%). Most of those who died did not reach hospital, with only 2% presenting with multi-organ or acute liver failure. In just over half of the deaths tramadol had not been prescribed by a medical practitioner (53%). Depression, addiction and seizures were recognised risk factors. An increase in awareness of tramadol toxicity is needed amongst the public and doctors.
authors.affiliation: State Pathologist's Department, Institute of Forensic Medicine, Grosvenor Road, Belfast BT12 6BS, Northern Ireland, UK. Electronic address: charlotte.randall@statepathni.org.uk.
authors.forename: C
authors.initials: C
authors.lastname: Randall
authors.affiliation: State Pathologist's Department, Institute of Forensic Medicine, Grosvenor Road, Belfast BT12 6BS, Northern Ireland, UK.
authors.forename: J
authors.initials: J
authors.lastname: Crane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000633:toxicity*; D003863:Depression / Q000453:epidemiology; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000401:mortality*; D064226:Prescription Drug Diversion; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000401:mortality; D014147:Tramadol / Q000633:toxicity*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol
keywords: Overdose; Tramadol