Acute Toxicity Related to Misuse (Non-Medical Use) of Tramadol: Experience of the European Drug Emergencies Network Plus (Euro-DEN Plus) Project.

Following the development of the tramadol crisis currently affecting countries in the Middle East, and Africa, there has been increasing international interest in the regulation of tramadol. This study investigates the misuse of tramadol in patients presenting to emergency departments across Europe. Data from 32 emergency departments in 21 countries were extracted from the Euro-DEN Plus database for the 4-year period from 1st January 2014 to 31st December 2017. Of the reported 24,957 emergency department presentations, tramadol misuse was reported in 105 (0.4% presentations). Tramadol misuse was most common in Bratislava (Slovakia) (n=11, 7.5% of all presentations to this centre), Riga (Latvia) (n=4, 4.9%) and Munich (Germany) (n=17, 2.9%). On arrival, 14 (13.3%) of presentations were in coma/GCS≤8 and nine of these had a respiratory rate <12 per minute. These presentations potentially pose a significant burden on EDs with a large proportion requiring admission to hospital for ongoing care.