The Home Office has announced changes to CD classification for a number of drugs which should be implemented from 10th June 2014. Tramadol will become a Class C Schedule 3 drug in the UK. This will mean that only original prescriptions will be accepted by pharmacies (not scans or photocopies) and the maximum length of time a prescription can be valid for is 28 days. However, Tramadol will be exempt from the usual Schedule 3 safe custody regulations i.e. storage in a locked receptacle such as a safe.
Tramadol is a synthetic analogue of codeine and, like other opioids, can be liable to misuse. The Advisory Council on the Misuse of Drugs recommended that tramadol should be re-classified as a Class C Schedule 3 drug; prompted by increasing reports of misuse and harm.
Of the 581 drug related deaths in Scotland in 2012, tramadol was present or implicated as a contributory factor to the death in 48 cases. Although safe storage and register keeping will not be required, tramadol will need the full CD prescription writing requirements including the quantity in both words and figures. Prescriptions will only be valid for 28 days. Work is ongoing in the acute service to understand changes required to ordering procedures.
Tramadol has a unique dual-action, pharmacological profile. Its analgesic action results mainly from its agonist effects at opioid receptors with an added influence from its inhibition of the re-uptake of serotonin and noradrenaline. This dual mechanism increases the potential for adverse effects, especially in overdose.
Tramadol overdose results in drowsiness, constricted pupils, agitation, tachycardia, hypertension and nausea, vomiting and sweating. Seizures occur in up to 15% of cases; this is more common than with other opioids. In severe poisoning coma, seizures and hypotension can occur. Overdose can also cause serotonin syndrome which is potentially fatal.