Following a review of the popular pain treatment Tramadol, the medication has recently been reclassified as a Schedule 3 Controlled Drug (CD) in the UK. This change now means that Tramadol can only be prescribed using special prescription pads, which are unique to the signing doctor. The change came after just a three-week notice period was given to doctors and pharmacies. We take a look at?what this change will mean for patients who have been prescribed Tramadol by an online doctor.
In the past Tramadol was a Prescription Only Medicine (POM) and was available from GPs on the usual NHS prescription form or privately on a doctor's letter headed paper. These could then be transferred electronically to the pharmacy to be dispensed. CD's, on the other hand, need to be prescribed on special prescription pads, which carry a unique prescriber identification number.
These can only be obtained from NHS England, who verify the identity of the prescriber and check that they have not prescribed CD's inappropriately in the past. Once this has been investigated the prescriptions can be ordered from the printer, then securely delivered to the doctor.
A CD prescription can only be written for a maximum of one month's supply and has to state the total quantity in words and figures. Once dispensed these special, private CD prescriptions have to be sent by the pharmacy to the pricing arm of the NHS (NHSBSA) to monitor the prescription writing habits of the signing doctor. This means that both the prescriptions the doctor is writing for CD's and the patient's for whom they are prescribed will be monitored. It is going to be patients who seek their tramadol online who will be affected the most. Understandably doctors will be more reluctant to sign prescriptions for a CD when this is done remotely and will expect much more interaction with the patient than in the past.
The classification change has been made after researchers found that the recreational use of the medication had caused a rise in complications and deaths. Tramadol was listed as a contributing factor in 154 deaths during 2011. The reclassification of Tramadol has led to a number of challenges for online pharmacies and patients alike. Most concerning is the timetable associated with the change, as only three weeks notice was given. This short amount of time is not sufficient for patients to change treatments.
The nature of Tramadol means that it needs to be discontinued gradually in order to avoid withdrawal effects. Long-term users of Tramadol may need to reduce their dose over a period of several months although for others, who have been on short-term use or low dosages, this may be achieved over a much shorter time. We were faced with a dilemma, how could we best fulfill our duty of care to patients when the normal dose-reduction pathway had been removed? As a short-term solution we decided to allow patients to place a double order and also add two new opioids to our website, codeine and dihydrocodeine. Tramadol is popular with doctors as an effective treatment for pain.
According to figures published in the Guardian newspaper, around 11 million doses of Tramadol are prescribed in England every day. The popularity of the pain relief treatment indicates how effective the drug is for helping people experiencing moderate to severe pain. The Home Office, who are responsible for drug classifications, expects that the new controls placed on Tramadol will help to reduce overdoses and death caused by the medication. However these changes will also make pain management more difficult for people living with pain who have not been properly informed about the changes. The three-week changeover period is insufficient for patients to make informed decisions about how they wish to continue their pain management regimens.
Despite good intentions, the Tramadol reclassification could result in significant suffering for these people. In conclusion it is important for those who have been taking Tramadol to manage their pain to visit their GP as soon as possible to discuss their options moving forward.