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DEA Schedules Tramadol as a Class IV Controlled Substance

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Pill Bottle, concept for Healthcare And MedicineOn August 18, 2014, the pain reliever tramadol (Ultram®) will be scheduled as a Class IV controlled substance by the U.S. Drug Enforcement Administration.1 Tramadol is a synthetic, opioid pain reliever similar in strength to codeine. In 2012, more than 40 million tramadol prescriptions were written in the United States, more than any other opioid medications except for hydrocodone and oxycodone.2

In 1994, clinical data suggested tramadol had a very low abuse potential.3 Research has since shown that tramadol can produce a euphoric high similar to oxycodone. At doses greater than prescription levels, tramadol has addiction reinforcing effects similar to morphine and oxycodone.

Between 2004-2012, emergency department visits related to illicit tramadol use increased from 4,800 incidents to more than 16,000.1 Adverse effects of tramadol include sedation, dizziness, respiratory depression, seizures, apnea, and death.4

Withdrawal symptoms often occur following both abrupt and tapered discontinuation of tramadol use, suggesting an issue of drug dependence for tramadol users.

In the year 2000, tramadol was present in only 82 law enforcement drug seizures. This number increased to 1806 by 2012.1 A 2002 study found that 87 out of 140 healthcare professionals testing positive for tramadol use obtained the drug with illegal prescriptions.

Tramadol is available in both single dose (25-100 mg) and extended release (100-300 mg) forms. Tramadol abusers can crush extended release tablets and ingest them for an instant, high-dose euphoria similar to OxyContin but without the cognitive impairment.2

Fingernail testing detects tramadol use for up to six months, while hair provides a three month look-back. Tramadol testing is available in USDTL’s extended drug panels. If you have questions or need more information about tramadol testing, contact our Client Services group at 800•235•2367 or at

1. Office of Diversion Control, Drug and Chemical Evaluation Section. (May 2013). Schedules of Controlled Substances: Placement of Tramadol into Schedule IV. Retrieved from
2. Nadia Awad. (2014). Now What? DEA Tosses Tramadol in Schedule IV. Retrieved from
3. John Fauber. (2013). Killing Pain: Tramadol the “Safe” Drug of Abuse. Retrieved from
4. Senay, E.C., Adams, E.H., et al. (2003). Physical Dependence on Ultram (tramadol hydrochloride): Both opioid-like and atypical withdrawal symptoms occur. Drug and Alcohol Dependence, 69:233-241.  DOI: 10.1016/s0376-8716(02)00321-6