Dr. Yates Replies

To the Editor: The letter by Dr. Brinker et al. provides further insight into the abuse potential of tramadol. The number of reported cases of abuse and dependence reported to the FDA demonstrates the clinical relevance of this issue. The revision of the product label in August 2001 occurred after the Journal publication of the case. This revision underscored that the FDA reporting data confirm the experience of abuse and dependence in some patients without a personal history of substance abuse.

Although Dr. Brinker et al. note that this case is not unique or uncommon, the case did have significant implications for psychiatrists. Since many psychiatrists do not routinely prescribe tramadol, they may have limited experience with the clinical pharmacology of this compound. Additionally, psychiatrists working in an emergency room setting or treating patients with comorbid substance abuse may encounter similar cases.