Toxicologist Swedish National Board of Forensic Medicine Linköping, Sweden
Background: In Sweden, Tramadol was classified as an illicit drug in 2007. Since then, prescribed use of tramadol has steadily decreased in 2012 about 270000 patients were prescribed tramadol and about 67000 patients in 2012. However, tramadol intoxications still make up about 7.5% of all fatal intoxications in Sweden.
Objectives: To investigate the prevalence of fatal tramadol intoxications in Sweden and whether these individuals had a valid prescription for tramadol at the time of death.
Methods: In this study, all fatal tramadol intoxications in Sweden during 2012-2020 were included from the National Board of Forensic Medicine databases. For the study population, information on tramadol prescriptions was retrieved from the Swedish prescribed drug register. A valid prescription was defined as having a dispensed prescription within two years before the date of death.
Results: In 564 cases tramadol was assessed by the forensic pathologist as contributing to the fatal intoxication. On average 63 fatal tramadol intoxcations occurred each year and decreasing trend could be observed. Most of the individuals who died from a fatal tramadol intoxication were male (63%, 353 cases) and the median age was 41 years. Women were older compared to the men (median age 50 compared to 36 years). Among all the 564 fatal intoxications caused by tramadol, 49% (275 cases) did not have a valid prescription for tramadol. During the study period, the proportion of the fatal intoxcations with a prescription decreased from 63% in 2012 to 32% in 2020. Men had less often a valid prescription for tramadol compared to women (44% and 64%, respectively). A valid prescription was more common among suicides compared to accidents (65% and 38%, respectively).
Conclusions: Almost 50% of the individuals who died from tramadol intoxications in Sweden did not have a valid prescription for tramadol at the time of death. A tramadol prescription was lacking more often among men and in individuals with accidental intoxications.
