{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T16:45:01Z","timestamp":1726505101738},"reference-count":16,"publisher":"California Digital Library (CDL)","issue":"1","license":[{"start":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T00:00:00Z","timestamp":1643328000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: During the coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2, deaths from opiate drug overdoses reached their highest recorded annual levels in 2020. Medication-assisted treatment for opiate use disorder has demonstrated efficacy in reducing opiate overdoses and all-cause mortality and improving multiple other patient-centered outcomes. Treatment of tramadol dependence in particular poses unique challenges due to its combined action as opioid agonist and serotonin-norepinephrine reuptake inhibitor. Tramadol puts patients with dependence at risk for atypical withdrawal syndromes when attempting to reduce use. Little evidence is available to guide treatment of tramadol dependence.\nCase Report: We present a case of high-dose tramadol addiction that began with misuse of medically prescribed tramadol for treatment of musculoskeletal back pain. The patient\u2019s use reached oral consumption of 5000-6000 milligrams of illicit tramadol daily. She complained of common complications of tramadol use disorder including memory impairment, excessive sedation, and tramadol-induced seizures. The patient was referred to the emergency department in a withdrawal crisis seeking treatment where she was successfully managed with buprenorphine and phenobarbital and then linked to ongoing outpatient treatment. \nConclusion: Our report adds to the limited guidance currently available on the acute management of tramadol withdrawal and treatment of tramadol use disorder. Our case suggests the initiation of high-dose buprenorphine may be an effective and feasible option for emergency clinicians.<\/jats:p>","DOI":"10.5811\/cpcem.2021.12.54602","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T06:32:42Z","timestamp":1644301962000},"page":"83-86","source":"Crossref","is-referenced-by-count":1,"title":["Buprenorphine for High-dose Tramadol Dependence: A Case Report of Successful Outpatient Treatment"],"prefix":"10.5811","volume":"6","author":[{"given":"Leslie","family":"Mukau","sequence":"first","affiliation":[{"name":"University of California, San Diego, Department of Emergency Medicine, San Diego, California; El Centro Regional Medical Center, Department of Emergency Medicine, El Centro, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kadia","family":"Wormley","sequence":"additional","affiliation":[{"name":"Highland Hospital \u2013 Alameda Health System, Department of Emergency Medicine, Oakland, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"University of California, San Diego, Department of Emergency Medicine, San Diego, California; El Centro Regional Medical Center, Department of Emergency Medicine, El Centro, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bushra","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Imperial County Behavioral Health Services, Division of Substance Use Disorder Treatment Program, El Centro, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rais","family":"Vohra","sequence":"additional","affiliation":[{"name":"University of California, San Francisco-Fresno, Department of Emergency Medicine, Fresno, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Herring","sequence":"additional","affiliation":[{"name":"Highland Hospital \u2013 Alameda Health System, Department of Emergency Medicine, Oakland, California; University of California, San Francisco, Department of Emergency Medicine, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2022,1,28]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021. Available at https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm. Accessed July 24, 2021.","DOI":"10.15620\/cdc:101132"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Hawk K, Hoppe J, Ketcham E, et al. Consensus recommendations on the treatment of opioid use disorder in the emergency department. Ann Emerg Med. 2021;78(3):434-42.\u00a0","DOI":"10.1016\/j.annemergmed.2021.04.023"},{"key":"ref2","unstructured":"Drugbank. Tramadol Pharmacodynamics. 2005. Available at https:\/\/go.drugbank.com\/drugs\/DB00193#reference-A182279. Accessed July 24, 2021."},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Hassamal S, Miotto K, Dale W et al. Tramadol: understanding the risk of serotonin syndrome and seizures. Am J Med. 2018;131(11):1382.e1-1382.e6.","DOI":"10.1016\/j.amjmed.2018.04.025"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Cupples N and Moore TA. A case of tramadol dependence and successful treatment with buprenorphine\/naloxone.\u201d\u00a0Mental Health Clinician.\u00a02013;(3):283-5.","DOI":"10.9740\/mhc.n183348"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ritvo JI, Koonce R, Thurstone C, et al. Letters to the Editor: tramadol dependence: treatment with buprenorphine\/naloxone.\u00a0Am J Addict. 2007;16(1):67-8.","DOI":"10.1080\/10550490601080118"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Substance Abuse and Mental Health Services Administration. 2019 National Survey on Drug Use and Health. 2020. Available at: https:\/\/www.samhsa.gov\/data\/report\/2019-nsduh-detailed-tables. Accessed August 16, 2021.","DOI":"10.1037\/e501902006-001"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Vosburg SK, Severtson SG, Dart RC, et al. Assessment of tapentadol API abuse liability with the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System. J Pain. 2018;19(4):439\u201353.","DOI":"10.1016\/j.jpain.2017.11.007"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Harrison M and Walsh TL. The effect of a more strict 2014 DEA schedule designation for hydrocodone products on opioid prescription rates in the United States. Clin Toxicol (Phila). 2019;57(11):1064-72.","DOI":"10.1080\/15563650.2019.1574976"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Thiels CA, Habermann EB, Hooten WM, et al. Chronic use of tramadol after acute pain episode: cohort study. BMJ. 2019;365:l1849.","DOI":"10.1136\/bmj.l1849"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Zeng C, Dubreuil M, LaRochelle MR, et al. Association of tramadol with all-cause mortality among patients with osteoarthritis. JAMA. 2019;321(10):969-82","DOI":"10.1001\/jama.2019.1347"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Lanier RK, Lofwall MR, Mintzer MZ, et al. Physical dependence potential of daily tramadol dosing in humans. Psychopharmacology (Berl). 2010;211(4):457-66.","DOI":"10.1007\/s00213-010-1919-3"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Senay EC, Adams EH, Geller A, et al. Physical dependence on Ultram (tramadol hydrochloride): both opioid-like and atypical withdrawal symptoms occur. Drug Alcohol Depend. 2003;69(3):233-41.","DOI":"10.1016\/s0376-8716(02)00321-6"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Herring AA, Vosooghi AA, Luftig J, et al. High-dose buprenorphine induction in the emergency department for treatment of opioid use disorder.\u00a0JAMA Netw Open.\u00a02021;4(7):e2117128.","DOI":"10.1001\/jamanetworkopen.2021.17128"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Dunn KE, Tompkins DA, Bigelow GE, et al. Efficacy of tramadol extended-release for opioid withdrawal: a randomized clinical trial. JAMA Psychiatry. 2017;74(9):885-93.","DOI":"10.1001\/jamapsychiatry.2017.1838"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Chawla JM, Pal H, Lal R, et al. Comparison of efficacy between buprenorphine and tramadol in the detoxification of opioid (heroin)-dependent subjects. J Opioid Manag. 2013; 9(1): 35-41.","DOI":"10.5055\/jom.2013.0145"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T19:58:59Z","timestamp":1645819139000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/3162k8xf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,28]]},"references-count":16,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,2,3]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2021.12.54602","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2022,1,28]]}}}