Impact of the Raqeeb narcotic controlling system on tramadol prescriptions in surgical patients: A pre-post implementation study

Background: Tramadol hydrochloride, a Schedule III opioid, is the primary take-home narcotic for postoperative pain in Saudi Arabia, with a misuse prevalence of 11.4%–20%. On February 1, 2024, the Saudi Food and Drug Authority implemented the Raqeeb electronic monitoring system for real-time prescription tracking to curb abuse while maintaining legitimate access. Objectives: To evaluate Raqeeb’s impact on tramadol prescribing in surgical patients and compare outcomes with international prescription drug monitoring programs (PDMPs). Methods: Retrospective cohort study of all adult patients (≥18 years) receiving tramadol prescriptions at a tertiary hospital in Saudi Arabia (April 2023 to June 2025), divided into pre-Raqeeb and post-Raqeeb periods. All tramadol prescriptions (acute postoperative and chronic/non-surgical indications) were included. Monthly rates were normalized; comparisons used t -tests and chi-square tests. Results: Monthly tramadol prescription rates in surgical patients decreased 43% (from 10.6 to 6.1 prescriptions/month). Mean dispensed quantity increased from 17.0 ± 7.6 to 21.5 ± 12.9 tablets ( P = 0.003). Prescriptions issued by the surgical team fell from 86% to 48% ( P < 0.001); prescriptions linked to a recent surgical procedure declined from 67% to 51% ( P = 0.033). Anorectal procedures dropped 81%, while breast surgery increased 117%. Mean patient age rose from 50 ± 16 to 56 ± 15 years ( P = 0.012). Repeat prescriptions remained stable (33% vs. 29%). Conclusion: Raqeeb achieved a 43% reduction in tramadol prescriptions among surgical patients—exceeding typical PDMP postoperative reductions (5%–30%)—with a shift toward older patients and chronic indications, without apparent barriers to legitimate access.