Tramadol is a widely used central synthetic opioid analgesic for moderate to moderate severe pain. Tramadol’s analgesic activity comes from at least two complementary mechanisms of action, including binding of the mu opioid receptor and weak inhibition of norepinephrine and serotonin reuptake. 1-3. Tramadol Dosage
In 1995, tramadol was first introduced in the United States under the trade name Ultram. It was initially marketed as a safer, uncontrolled analgesic, with a lower likelihood of abuse than opioids. Despite reports of abuse over the years, the use of tramadol has become increasingly common, increasing from 23.3 million in 2008 to 43.8 million in 2013, an increase of 88%. 2-3 tramadol has become the second most commonly used analgesic, second only to hydrocodone / acetaminophen products3
DEA schedule changes
In August 2014, almost two decades after tramadol was used in the United States, the US Drug Enforcement Agency (DEA) officially listed all products containing tramadol as Schedule IV controlled drugs. 2In October 2014, the DEA took additional steps to curb prescription drug abuse by rescheduling all hydrocodone-containing products as Schedule II controlled drugs. 4 As a result, the available amount of oral non-scheduled II analgesics is limited to tramadol and codeine products.
In many states, practitioners (NPs) or physician assistants (PAs) can only prescribe III-IV controlled drugs. Potential unintended consequences of changes to these prescription drugs are an increase in tramadol, codeine, and non-steroids in the elderly due to limited or no prescription authorization for prescription drugs, or other analgesics for these prescription drugs II. Anti-inflammatory drugs are prescribed, and older people are also most vulnerable to these drugs.
Long-term care (LTC) centers often have some of the most vulnerable elderly patients, which raises other issues. Long-term care centers make extensive use of NP and PA to provide basic care to long-term care residents. The limited choice of analgesics available for NP and PA, combined with other DEA requirements, has made the prescription of controlled drugs more challenging for LTC care centers, so the elderly are more likely to receive other less suitable analgesics.
Nursing with planned narcotics:
Better coordination between health care providers, including hospitals, care centers and pharmacies, can help ensure that patients have the most appropriate painkillers in a timely manner and reduce the likelihood of negative outcomes. Prescribers who are discharged from hospitals and emergency departments (ED) should take steps to provide controlled drug prescriptions when they are discharged from the hospital or from the ED. Hospital discharge planners and nursing home admission coordinators should work closely together to ensure that patients receive a controlled substance prescription upon admission, so that the prescription is sent to the pharmacy upon admission, to prevent unnecessary delays in the delivery of these drugs from the pharmacy. After the patient is admitted to the hospital, prescribers, nurses, and pharmacists should implement procedures to routinely assess when the supply of controlled substances will be depleted in order to grasp the prescription of these drugs and send them to the pharmacy before the last dose is used. When writing a new order or emergency control medication order, the nurse should remind the prescriber that the pharmacy needs a prescription.