{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:12:16Z","timestamp":1781511136830,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,8,2]],"date-time":"2018-08-02T00:00:00Z","timestamp":1533168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Increasing use of tramadol for chronic non\u2010cancer pain is concerning since tramadol users may be at risk of developing recurrent opioid use with increasing opioid consumption and co\u2010medication. Therefore, we investigated a complete national cohort of tramadol users.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population (154\u00a0042 adult individuals in Norway, who redeemed \u2265 one tramadol prescription in 2012) was stratified into four groups according to their opioid use 2\u00a0years before their first tramadol prescription in 2012 and followed until 2016. Information on all dispensed opioid analgesics, benzodiazepines (BZDs), and BZD\u2010related Z\u2010hypnotics were retrieved from the Norwegian Prescription Database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six percent of opioid na\u00efve tramadol users (no opioid use 2\u00a0years before tramadol use in 2012) became recurrent users (received opioids annually during 4\u2010year follow\u2010up), almost doubled their mean opioid consumption (66 to 108 defined daily doses [DDD]). One\u2010quarter proceeded to strong opioids or was co\u2010medicated with BZDs, one\u2010third with Z\u2010hypnotics. Among former weak opioid users, 39.8% became recurrent users, 18.7% proceeded to strong opioids, mean opioid consumption increased slightly, one\u2010third used BZDs, or Z\u2010hypnotics concurrently. Among former strong opioid and users in palliative care; 61%, 70% became recurrent users and developed a similar prescription pattern (high and increasing mean opioid consumption, 301 to 318, 413 to 430 DDD); half of them proceeded to strong opioids and\/or used BZDs or Z\u2010hypnotics concurrently.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Many patients who developed recurrent opioid use received prescriptions which substantially conflicted with existing guidelines and might lead to problematic opioid use.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.4626","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T04:31:44Z","timestamp":1533616304000},"page":"54-61","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Tramadol use in Norway: A register\u2010based population study"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5923-2170","authenticated-orcid":false,"given":"Hanne","family":"Birke","sequence":"first","affiliation":[{"name":"Department of Oncology Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Ekholm","sequence":"additional","affiliation":[{"name":"National Institute of Public Health University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Sj\u00f8gren","sequence":"additional","affiliation":[{"name":"Department of Oncology Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav","family":"Fredheim","sequence":"additional","affiliation":[{"name":"Department of Circulation and Medical Imaging, Akershus University Hospital Norwegian University of Science and Technology  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Clausen","sequence":"additional","affiliation":[{"name":"Norwegian Centre for Addiction Research Faculty of Medicine Institute of Clinical Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Skurtveit","sequence":"additional","affiliation":[{"name":"Department of Psychiatric Illness Norwegian Institute of Public Health  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,2]]},"reference":[{"issue":"1","key":"e_1_2_9_2_1","first-page":"135","article-title":"General pharmacological studies on tramadol, a potent analgetic agent","volume":"28","author":"Osterloh G","year":"1978","journal-title":"Arzneimittelforschung"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.36076\/ppj.2012\/15\/ES67"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001683"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2007.02.007"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.09.018"},{"key":"e_1_2_9_7_1","first-page":"1","article-title":"The investigation of tramadol dependence with no history of substance abuse: a cross\u2010sectional survey of spontaneously reported cases in Guangzhou City","author":"Zhang H","year":"2013","journal-title":"China Biomed Res Int"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jflm.2014.01.006"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.5.881"},{"key":"e_1_2_9_10_1","unstructured":"Danish Health Authority.Kortl\u00e6gning af opioidforbruget i Danmark [Internet].2016[cited 2016 Sep 1]. p.1\u201385. 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