The painkiller tramadol is considered a narcotic (opioid) and a controlled substance by the U.S. federal government. Controlled substances are regulated by the government to prevent abuse and misuse and lower the risk of overdose.

A synthetic opioid, tramadol is a Schedule IV drug according to the Controlled Substances Act. There are five schedules in this Act, with Schedule 1 being the most tightly regulated. Schedule IV drugs like tramadol have a medical purpose, a low potential for abuse and a low risk of dependence compared to other controlled substances.

In terms of regulations, tramadol prescriptions in all 50 states may only be refilled up to five times within a six-month period after the date that the prescription was issued. A new tramadol prescription is required after five refills or after six months.

When compared with other opioids, tramadol is less likely to be obtained under false pretenses or sold and bought by non-medical users on the street. In addition, the rate of snorting tramadol is 4 to 7 times lower than it is with other opioids. The rate of injecting tramadol is 14 to 34 times lower than other opioids like morphine and oxycodone. Snorting or injecting opioids allows users to get high quicker.

Tramadol is also most likely obtained by a patient’s own prescription, while other opioids are more likely to be obtained via diversion through dealers or family and friends.

In case of overdose, individuals who are prescribed tramadol should always have a rescue medication called naloxone on hand. This medication can block the effects of opiates to reverse an overdose.