{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:45:15Z","timestamp":1768571115995,"version":"3.49.0"},"posted":{"date-parts":[[2025,11,6]]},"group-title":"Addiction Medicine","reference-count":46,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Tramadol, an opioid analgesic, is liable to abuse and implicated in drug overdose deaths in the U.S. However, tramadol use and its driving factors have not been intricately examined. This study aims to evaluate the tramadol utilization trends by dosage and county, and social determinants of health (SDoH)-related factors associated with the utilization rates.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The retrospective study utilized 2015-2022 WV controlled substances monitoring program, CDC opioid dispensing rate, and County Health Ranking and Roadmaps data. Average tramadol daily dose and morphine milligram equivalent were calculated. Annual tramadol dispensing and use rate per 100 population were calculated for WV and each county. Pooled Poisson regression model was used to analyze the relationship between tramadol dispensing rate, opioid dispensing rate, and SDoH variables.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Tramadol dispensing rate declined by 35% (2015-2022), but varied within counties with Grant (34.10), McDowell (28.91), and Wyoming (26.67) average annual rates exceeding the overall WV rate (17.90). High tramadol dispensing rate was associated with a high percentage of the population with poor\/fair health (\n                    <jats:bold>\u03b2=0.07, p=0.01)<\/jats:bold>\n                    , physically inactive (\n                    <jats:bold>\u03b2=0.10, p=0.0003<\/jats:bold>\n                    ), uninsured (\n                    <jats:bold>\u03b2=0.09, p=0.001)<\/jats:bold>\n                    , and elevated primary care provider (PCP) rate (\n                    <jats:bold>\u03b2=0.10, p=0.0003<\/jats:bold>\n                    ) and opioid dispensing rate (\n                    <jats:bold>\u03b2=0.14, p&lt;0.0001<\/jats:bold>\n                    ).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our study found heterogenous trends of tramadol dispensing rate within WV and was associated with county-wise health status, physical inactivity, insurance, PCP, and opioid dispensing rates. Considering these factors in local surveillance might improve health, and reduce disease burden, drug, and health resource utilization.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.11.03.25339433","type":"posted-content","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T20:40:18Z","timestamp":1762461618000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluating tramadol utilization and patterns by county-level social determinants of health characteristics from 2015 to 2022"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1447-5504","authenticated-orcid":false,"given":"Chisom","family":"Eze","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Abate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordon","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5943-0748","authenticated-orcid":false,"given":"Zheng","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5798-9994","authenticated-orcid":false,"given":"Nathan","family":"Wood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9509-4414","authenticated-orcid":false,"given":"Mohammad","family":"Al-Mamun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025110902150894000_2025.11.03.25339433v1.1","unstructured":"Dhesi M , Maldonado KA , Patel P , Maani CV. Tramadol. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 June 25]. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537060\/"},{"key":"2025110902150894000_2025.11.03.25339433v1.2","doi-asserted-by":"crossref","unstructured":"Dunn KE , Bergeria CL , Huhn AS , Strain EC . A Systematic Review of Laboratory Evidence for the Abuse Potential of Tramadol in Humans. Front Psychiatry. 2019 Sept 26;10:704.","DOI":"10.3389\/fpsyt.2019.00704"},{"key":"2025110902150894000_2025.11.03.25339433v1.3","unstructured":"Federal Register [Internet]. 2013 [cited 2024 Sept 24]. Schedules of Controlled Substances: Placement of Tramadol Into Schedule IV. Available from: https:\/\/www.federalregister.gov\/documents\/2013\/11\/04\/2013-25933\/schedules-of-controlled-substances-placement-of-tramadol-into-schedule-iv"},{"key":"2025110902150894000_2025.11.03.25339433v1.4","unstructured":"Parisi T. Addiction Center. 2024 [cited 2024 June 24]. 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