Tramadol: A Toxic Adulterant Found in Illicit Street Drugs

Tramadol is a synthetic opioid analgesic approved in 1995 by the United States Food and Drug Administration (FDA) for moderate to moderately severe pain. Its mechanism of action involves opioid and non-opioid pharmacological activities. Tramadol is a μ-opioid receptor agonist, producing opioid-like effects of analgesia, and respiratory and CNS depression. It also acts as a serotonin and norepinephrine reuptake inhibitor, which can cause excitatory neurological effects. Tramadol is metabolized by CYP2D6 to O-desmethyltramadol, an active metabolite that is more potent and has a longer half-life than the parent drug. Tramadol is approximately equipotent to its structural analog codeine. In 2014, the FDA classified tramadol as a schedule IV controlled substance due to its potential for abuse. Tramadol is available as immediate-release and extended-release tablets. Trade names include ConZip®, Ultram®, Ultracet®, Ryzolt®, and Rybix ODT®.
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