NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Tramadol and changes to Controlled Drug Legislation

Tramadol to be a Schedule 3 Controlled Drug

The Home Office has announced changes to CD classification for a number of drugs which should be implemented from 10th June 2014. More detailed information on the practical implications will follow when the date of the change is confirmed.

 

Tramadol is a synthetic analogue of codeine and, like other opioids, can be liable to misuse. The Advisory Council on the Misuse of Drugs recommended that tramadol should be re-classified as a Class C Schedule 3 drug; prompted by increasing reports of misuse and harm. Of the 581 drug related deaths in Scotland in 2012, tramadol was present or implicated as a contributory factor to the death in 48 cases.

 

Although safe storage and register keeping will not be required, tramadol will need the full CD prescription writing requirements including the quantity in both words and figures. Prescriptions will only be valid for 28 days. Work is ongoing in the acute service to understand changes required to ordering procedures.

 

Tramadol has a unique dual-action, pharmacological profile. Its analgesic action results mainly from its agonist effects at opioid receptors with an added influence from its inhibition of the re-uptake of serotonin and noradrenaline. This dual mechanism increases the potential for adverse effects, especially in overdose.

 

Tramadol overdose results in drowsiness, constricted pupils, agitation, tachycardia, hypertension and nausea, vomiting and sweating. Seizures occur in up to 15% of cases; this is more common than with other opioids. In severe poisoning coma, seizures and hypotension can occur. Overdose can also cause serotonin syndrome which is potentially fatal.

 

Other changes to CD legislation include:

  • Lisdexamfetamine is being classed as schedule 2 (requiring safe storage and register keeping).
  • Temazepam prescription writing exemptions to be removed. This means the quantity must be in words and figures, prescriptions will only be valid for 28 days. Temazepam will continue to require safe storage.
  • Zopiclone and zaleplon to be classed as schedule 4 CDs with the benzodiazepines.
  • A consultation will follow on a proposal to classify ketamine as schedule 2.

 

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