TY - JOUR
T1 - Tramadol as a fentanyl adulterant
T2 - Prevalence and management in a ToxIC Fentalog study prospective cohort
AU - On behalf of the Toxicology Investigators Consortium Fentalog Study Group
AU - Dicker, Frank
AU - Lothet, Emilie
AU - Schwarz, Evan
AU - Aldy, Kim
AU - Brent, Jeffrey
AU - Wax, Paul
AU - Culbreth, Rachel
AU - Campleman, Sharan
AU - Krotulski, Alex
AU - Logan, Barry
AU - Amaducci, Alexandra
AU - Judge, Bryan
AU - Levine, Michael
AU - Calello, Diane
AU - Shulman, Joshua
AU - Hughes, Adrienne
AU - Hendrickson, Robert G.
AU - Meaden, Christopher W.
AU - Manini, Alex F.
N1 - Publisher Copyright: © 2024 Elsevier Inc.
PY - 2025/3
Y1 - 2025/3
N2 - Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive. Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study. Patient serum was analyzed via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect opioids, novel psychoactive substances, and adulterants. Patients were separated into groups of those with tramadol detected versus no tramadol detected. Differences in naloxone administration, intubation, performance of cardiopulmonary resuscitation (CPR), or death between those exposed or not exposed to tramadol were evaluated. Results: From September 21, 2020 – October 31, 2021; 2298 patients were screened and 537 met inclusion criteria. Eighty-one patients (15 %) tested positive for tramadol. There was no significant difference found between those who reported chronic prescription opioid use (p = 0.81) or reported chronic pain (p = 0.27). Additionally, no difference was found between groups in the number of patients receiving a single, second, or third dose of naloxone (p = 0.25; 0.92; 0.59) or the proportion initiated on a naloxone infusion (p = 0.84). Similarly, there was no difference in outcomes of intubation, CPR, or death (p = 0.26; 0.75; 0.29). Conclusions: Tramadol was identified in a subset of patients presenting to the Emergency Department with opioid overdoses suggesting adulteration of illicitly manufactured fentanyl with tramadol. Its presence was not associated with a lack of treatment response, difference in severity of overdose, or increased risk of complications.
AB - Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive. Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study. Patient serum was analyzed via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect opioids, novel psychoactive substances, and adulterants. Patients were separated into groups of those with tramadol detected versus no tramadol detected. Differences in naloxone administration, intubation, performance of cardiopulmonary resuscitation (CPR), or death between those exposed or not exposed to tramadol were evaluated. Results: From September 21, 2020 – October 31, 2021; 2298 patients were screened and 537 met inclusion criteria. Eighty-one patients (15 %) tested positive for tramadol. There was no significant difference found between those who reported chronic prescription opioid use (p = 0.81) or reported chronic pain (p = 0.27). Additionally, no difference was found between groups in the number of patients receiving a single, second, or third dose of naloxone (p = 0.25; 0.92; 0.59) or the proportion initiated on a naloxone infusion (p = 0.84). Similarly, there was no difference in outcomes of intubation, CPR, or death (p = 0.26; 0.75; 0.29). Conclusions: Tramadol was identified in a subset of patients presenting to the Emergency Department with opioid overdoses suggesting adulteration of illicitly manufactured fentanyl with tramadol. Its presence was not associated with a lack of treatment response, difference in severity of overdose, or increased risk of complications.
KW - Adulterant
KW - Fentanyl
KW - Opioid
KW - Tramadol
UR - http://www.scopus.com/inward/record.url?scp=85213237507&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85213237507&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2024.12.038
DO - 10.1016/j.ajem.2024.12.038
M3 - Article
C2 - 39729684
SN - 0735-6757
VL - 89
SP - 169
EP - 173
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -