Ohio reclassifies tramadol as Schedule IV

Joining 12 other states and the U.S. military, Ohio will reclassify tramadol and products containing tramadol as Schedule IV controlled substances effective September 1, 2014.

The Ohio State Board of Pharmacy (OSBP) recently issued a guidance explaining the rational behind the change.

Tramadol, an opioid analgesic, has been available under the trade name Ultram. It’s available in generic, combination, and extended release products. As law enforcement officials have cracked down on illegal sales of hydrocodone products, many abusers have switched to tramadol products, which are uncontrolled.

According to the Ohio Automated Rx Reporting System, since 2007 tramadol prescriptions throughout the state have increased 93%; compared to a 0.7% increase for hydrocodone combination products and a 29.9% increase for oxycodone products.

Studies have shown that tramadol mimics the effects of controlled substance opioid analgesics and has abuse potential that’s similar to Scheduled IV controlled substances. OSBP said the reclassification and guidance “seeks to educate prescribers and patients on the potential adverse effects of this medication and to provide additional legal and regulatory oversight to protect the health and safety of Ohioans.”

“[The trend] used to oxycontin, but it’s kind of fallen to the wayside. Now it’s tramadol,” said a law enforcement official quoted in the OSBP report. “I think maybe what’s happened, or why tramadol has increased, is with oxycontin getting changed. [Abusers] can’t crush it like they used to.”

The OSBP report also contained a letter from the Greater Warren County Drug Task Force. Part of it read: “A contributing factor associated with tramadol investigations….is most people believe tramadol is not addictive. Most physicians do not understand the pharmacology of tramadol and do not understand that tramadol is an addictive pain medication.”

In addition to the military, Arkansas, Georgia, Illinois, Kentucky, Mississippi, New Mexico, New York, North Dakota, Oklahoma, Tennessee, and Wyoming have also reclassified tramadol products as Schedule IV.