Restrict sale of addictive painkiller Tramadol

In a recent media expose, Tramadol, a highly addictive drug being was found to be sold openly in pharmacies all over the country. CAP is shocked at how easily a narcotic posing as a painkiller is being openly sold to schoolchildren and drug addicts for as little as RM1 each.

We question why the Ministry of Health has yet to respond to the Addiction Medicine Association of Malaysia’s (AMAM) call to classify the drug as a scheduled item. Tramadol is a fully synthetic opiate with alkaloids similar to the ones found in the resin of the opium poppy. It also contains synthetic elements of codeine, another alkaloid produced from opium through the synthesis of morphine. Tramadol is even known to be administered with morphine in some injectable forms. Needless to say, these components are sufficient to create dependence and the enslavement of addiction. Although Tramadol is supposed to treat moderate to moderately severe pain and most types of neuralgia, health professionals have not endorsed its use for these disorders as proven in the research papers of Life Sciences in 1998 and the Journal of Psycho-pharmacology in 2001. Tramadol comes in many forms, including capsules, tablets, extended-release capsules and tablets, chewable tablets, low-residue and/or uncoated tablets, suppositories, effervescent tablets and powders, ampoules of sterile solution for subcutaneous, intramuscular and intravenous injections, preservative-free solutions for injection by the various spinal routes, powders for compounding, liquids both with and without alcohol for oral and sublingual administration and tablets and capsules containing aspirin and other agents.

Here in Malaysia, Tramadol is known and sold in the different forms by various names such as Acugesic and Mabron and in generic forms like Urgendol, Tramundin Retard, Tramadol Stada, Sefmal, Tracidol, Tramium, Tramadolor, Pengesic SR, Tramox, TRD Contin, Tramal, Trabilin, Domadol, Tramada, Analab and Ultracet. Some 19 different pharmaceutical companies are allowed by the Ministry of Health to import, produce or distribute these highly addictive drugs which masquerade as pain killers. The new report pointed out that a recent survey indicated that half the doctors treating heroin abuse detected Tramadol abuse as well. With its easy availability, it is not surprising that Tramadol is a convenient substitute for heroin. Unfortunately, its addictive properties are similar if not worse than heroin. Although pharmacologically considered as non-addictive, abuser’s of this synthetic drug have found it to produce a stronger sense of euphoria than other opiates such as morphine or heroin. It creates a powerful emotional, psychological and physical dependence. Powerful enough to result in severe withdrawals on cessation and a high probability of relapse. Tramadol is also used by addicts as a cheap alternative to counter the degressive effects of other drugs. Tolerance to the effects of Tramadol is fairly rapid. An abuser could increase his or her intake from 50mg a day (the lowest known available dose) to many times that in a few years and suffer various adverse effects such as brain damage, respiratory depression and seizure’s with the seizure threshold increasing after every episode.

The easy availability of Tramadol by over the counter purchases at local pharmacies and its ridiculously cheap pricing will soon allow its use to be widespread among hardened addicts who seek a cheap alternative and young schoolchildren seeking to experiment with drugs. As rightly pointed out by AMAM President, Dr. Chow Kim Weng, Tramadol abuse has the potential to reach epidemic proportions.

To rectify poor regulation that allows drugs like Tramadol to bypass legalities, CAP calls upon the Government to immediately amend further the Dangerous Drug Act 2004 (Amendment) to classify products which have derivates (natural and synthetic) of the substances mentioned there which include Codeine and Opium as Dangerous Drugs and not just products which contain the substances intrinsically.

The Ministry of Health has already seen fit to categorise Tramadol as a Group B poison. CAP now calls upon the Ministry of Health to urgently classify Tramadol as a controlled substance and scheduled item to restrict its sale. We also urge the Ministry, its Drug Control Authority of the National Pharmaceutical Control Bureau and the Pharmacy Enforcement Division to enforce all rules, regulations and laws pertaining to the restriction of Tramadol by way of proactive monitoring of all pharmacies and medical outlets and by prosecuting trafficker’s who unscrupulously sell this insidious narcotic to the public.

If you are concerned with the effects of medicines you are taking, find out more in the CAP Guide, Do’s & Don’ts Of Medicines