Background and Importance Tramadol is an opioid analgesic drug for moderate pain. From 8 November 2022 the Minister of Health of a European country ordered the inclusion of tramadol (only for parenteral administration (Inj.)) in the narcotic table of Pharmacopoeia. The drug was inserted on a narcotic register, allowing consumption to be controlled like other narcotics. This measure reflects the concerns by the World Health Organization regarding the potential abuse of tramadol (Inj.), whose dependence is comparable to morphine and methadone.

Aim and Objectives The objective of the study was to evaluate the effects of the decree on the consumption of tramadol (Inj.) on the wards of a general hospital, compared to other painkillers.

Material and Methods The analysis of the consumption of tramadol (100mg/2ml) compared to ketorolac (30mg/ml), diclofenac (75mg/3ml) and paracetamol (10mg/ml) was carried out in the period between 8 May 2022 and 8 May 2023, considering the 13 wards with the highest tramadol consumption. We compared the quantity of tramadol requested to the pharmacy 6 months before and 6 months after the decree was issued.

Results All the analysed wards reduced use of tramadol (Inj.) (∆%:90.2; 2150 vs 210 vials, before and after the decree, respectively). The wards with a total reduction of consumption resulted orthopedic (∆%:100; 760 vs 0) and emergency room (∆%:100(555 vs 0). These wards simultaneously recorded an increase of 26.6% respectively (2,970 vs 2,346) in requests of non-steroidal anti-inflamatory drugs (NSAID) (diclofenac and ketorolac) and a 39.1% increase (1,476 vs 2,054) in diclofenac. In general, paracetamol underwent the most significant increase in 92.8% of the wards (12/13) with a ∆%:110.6% (2810 vs 5918). The wards with the most significant increases were vascular surgery (∆%:233.3;90 vs 300), thoracic surgery (∆%:167.7;270 vs 723) and trauma centre (∆%:173;150 vs 410).

Conclusion and Relevance The decree limited the use of tramadol (Inj.). Before the drug was delivered upon simple wards request without supervision. The inclusion in the narcotics register has instead allowed the pharmacist to supervise their consumption by the wards who now have to submit a request on a specific form. This led to a discussion with the clinical on the choice of an alternative therapy in the treatment of moderate pain, moving to NSAIDs and paracetamol when possible.

Conflict of Interest No conflict of interest.