OBJECTIVES: Although Tramadol has been widely used and considered as a relatively safe medication, recent studies have documented safety concerns when misused. The primary objective of the study was to investigate and characterize the usage of Tramadol among the West Virginians.

METHODS: A retrospective study was conducted among 622,746 US adults who were either dispensed or filled a tramadol prescription in West Virginia recorded in Controlled Substances Monitoring Program (CSMP) from 2015 to 2022. Opioid dispense rate from 2015 to 2020 was obtained from CDC monitoring and visualization tool. Rates of Tramadol use was calculated for each county based on population estimates derived from the U.S. Census Bureau. The rates of high-dose tramadol (>400 mg per day) and low dose were calculated. County-level rates of tramadol use, and high-dose Tramadol use, were compared with other opioids.

RESULTS: About 60% of the Tramadol was dispensed by female. Approximately 57% of high-dose Tramadol user group were female. Tramadol use was found to be consistent between 3.5 to 4 dispenses per 100 population and opioid dispense rates were decreased from 103 dispenses in 2015 to 42 dispenses in 2020 per 100 population. The highest prescribers of tramadol and opioids were southern counties including Logan, Boone, Cabell, Wyoming and Wood. About 10 to 13% of the total prescribers were from out of state. The top 3 counties prescribing tramadol from out of state were Winchester County in Virginia, Washington County in Ohio and Washington County in Maryland.

CONCLUSIONS: Our findings suggest that Tramadol prescription remains steady while opioid dispense rates decreased sharply due to tightening opioid regulations. Further investigation is needed for better understanding of patterns of Tramadol dispense rate in the southern counties in WV where the drug overdose rates are higher.