What would be the impact of tighter regulation of tramadol in Asia?

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In India, tramadol is a controlled medicine, which reduces its potential for abuse. It is not a replacement for morphine in cancer pain, but is the only analgesic available in remote areas of the country. Whilst we recognise the concerns countries have over the increasing abuse of tramadol as a recreational drug, any decreased availability of the drug as an analgesic would have catastrophic effects in India. This would be disastrous for our patients where tramadol is the common – and sometimes only – strong analgesic available. International scheduling and the Narcotic Drugs and Psychotropic Substances Act in India has set us back thirty years by skewing the balance against safe medical use of morphine. We are worried that international scheduling of tramadol would push us further into the domain of poor availability of analgesics and unsafe practices.

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Tramadol is extensively used throughout South and Southeast Asia as a general purpose analgesic drug, for moderate to severe pain, both for Acute and Chronic pain. The strict regulations that are in place for the more potent opioids such as morphine and oxycodone, makes tramadol the only readily available analgesic drug in many parts of this region. Particularly in the rural areas. Although generally used for nociceptive pain it also has a role in the management of neuropathic pain, such as diabetic peripheral neuropathic pain and this is due to his unique dual mechanism of action. Although there has been reports of illegal and recreational use of tramadol is some parts of the world, many of us who practise in South and Southeast Asia have not seen it as a major cause of concern in our parts of the world. Tramadol is currently a prescription drug, not on the same schedule as morphine. Changing the schedule status of the medication will definitely have a great impact on its availability to the general public who suffer from pain - whether it is acute or chronic pain including cancer pain, although it is not an ideal drug for severe cancer pain. Changing the schedule status will also increase the use of NSAIDS for chronic pain - which in turn will lead to increase in adverse events associated with it - both cardiovascular and gastrointestinal effects. With a growing ageing population in the developing world, this is definite cause for concern. International control will also not reduce the illegal and recreational use of tramadol.

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