Tramadol Dependence in a Tunisian Patient with No Previous Substance Misuse History

Introduction Tramadol is an atypical, centrally acting, synthetic, analgesic. Its anti-nociceptive effects are mediated by a combination of μ-opioid agonist effects, and norepinephrine and serotonin reuptake inhibition. Initially, tramadol was said to have a low-abuse potential. However, its abuse liability and diversion were soon recognized, with several reports on physical dependence. Methods A case report and review of literature by a research on medline database. Key words: 'Tramadol”, 'opiate dependence”, 'tramadol withdrawal”, 'tramadol addiction” Case Report Mr. L.M. is a 24 year-old man without past history of substance abuse. In 2012, he underwent leg surgery after gunshot wounds. He was started on Tramadol treatment for his pain. He progressively increased Tramadol dosage and was taking 250mg to 750mg intravenous injections per day. He tried several times to stop taking Tramadol but each time his developed nausea, muscle aching, dysphoric mood and insomnia. His withdrawal symptoms had bad impact on his daily life and resulted in family life breakdown. Discussion Tramadol has long been considered to have a very low abuse potential. According to the US Food and Drug Administration, the rate of addiction was 1 in 100,000 during the last 18 months period of surveillance. Most of the cases had been in patients with a prior history of substance abuse. This case shows that Tramadol addiction may also occur in patients with no psychiatric or substance abuse history.