DRUG ABUSE AND DEPENDENCE OF TRAMADOL

• Although tramadol can produce drug dependence of the ?-opioid type (like codeine or dextropropoxyphene) and potentially may be abused, there has been little evidence of abuse in foreign clinical experience.

• In clinical trials, tramadol produced effects similar to an opioid, and at supratherapeutic doses was recognized as an opioid in subjective/behavioral studies. 

• Tolerance development has been reported to be relatively mild and withdrawal when present, is not considered to be as severe as that produced by other opioids. 

• Part of tramadol's activity and some extension of the duration of ?-opioid activity. Delayed ?-opioid activity is believed to reduce a drug's abuse liability.

• An assay for tramadol is not included in routine urine screens for drugs of abuse.