ABSTRACT Due to recently emerging concerns about the nonmedical use of tramadol in Denmark, we hypothesized increasing tramadol detections in medico‐legal autopsy cases, with more nonprescribed use and fatal poisonings over time, particularly among young individuals. In 2013–2024, we detected tramadol in 205 decedents. Fourteen (7%) had age ≤ 25 years. Apparently, 82 (40%) had no prescription. Tramadol poisoning caused death in 60 (29%), including 4 (2%) with age ≤ 25. There were 12 accidental poisonings with tramadol alone (age (median interquartile range): 52 46–55 years, tramadol concentration: 3.5 1.8–5.2 mg/kg, number of detected drugs: 3 2.5–9), and 25 accidental poisonings with tramadol and other drugs (age: 43 32–47 years, tramadol concentration: 0.78 0.13–1.3 mg/kg, number of detected drugs: 7 5–10). Tramadol‐positive decedents, decedents without prescription and tramadol poisonings peaked in 2017, with no subsequent increase. Conclusively, data from our area showed no consistent rise in tramadol‐positive decedents, nonprescribed use or related poisonings. Accidental tramadol fatalities mostly occurred in middle‐aged people and/or were associated with polydrug use. Young decedents were infrequent. However, serious consequences of nonmedical tramadol use other than death, which are not captured in medico‐legal autopsy data, can occur. Therefore, preventive measures are still crucial to curb nonmedical tramadol use.
Kamronn et al. (Tue,) studied this question.