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{
    "pk": 1133,
    "title": "Buprenorphine for High-dose Tramadol Dependence: A Case Report of Successful Outpatient Treatment",
    "subtitle": null,
    "abstract": "Introduction:\n During the coronavirus disease 2019 pandemic caused by the severe acute respiratory syndrome coronavirus 2, deaths from opiate drug overdoses reached their highest recorded annual levels in 2020. Medication-assisted treatment for opiate use disorder has demonstrated efficacy in reducing opiate overdoses and all-cause mortality and improving multiple other patient-centered outcomes. Treatment of tramadol dependence in particular poses unique challenges due to its combined action as opioid agonist and serotonin-norepinephrine reuptake inhibitor. Tramadol puts patients with dependence at risk for atypical withdrawal syndromes when attempting to reduce use. Little evidence is available to guide treatment of tramadol dependence.\nCase Report: \nWe present a case of high-dose tramadol addiction that began with misuse of medically prescribed tramadol for treatment of musculoskeletal back pain. The patient’s use reached oral consumption of 5000-6000 milligrams of illicit tramadol daily. She complained of common complications of tramadol use disorder including memory impairment, excessive sedation, and tramadol-induced seizures. The patient was referred to the emergency department in a withdrawal crisis seeking treatment where she was successfully managed with buprenorphine and phenobarbital and then linked to ongoing outpatient treatment.\nConclusion\n: Our report adds to the limited guidance currently available on the acute management of tramadol withdrawal and treatment of tramadol use disorder. Our case suggests the initiation of high-dose buprenorphine may be an effective and feasible option for emergency clinicians.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "case report"
        },
        {
            "word": "tramadol addiction"
        },
        {
            "word": "serotonin-norepinephrine reuptake inhibitor (SNRI) withdrawal symptoms"
        },
        {
            "word": "buprenorphine induction"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/3162k8xf",
    "frozenauthors": [
        {
            "first_name": "Leslie",
            "middle_name": "",
            "last_name": "Mukau",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Emergency Medicine, San Diego, California; El Centro Regional Medical Center, Department of Emergency Medicine, El Centro, California",
            "department": "None"
        },
        {
            "first_name": "Kadia",
            "middle_name": "",
            "last_name": "Wormley",
            "name_suffix": "",
            "institution": "Highland Hospital – Alameda Health System, Department of Emergency Medicine, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "Christian",
            "middle_name": "",
            "last_name": "Tomaszewski",
            "name_suffix": "",
            "institution": "University of California, San Diego, Department of Emergency Medicine, San Diego, California; El Centro Regional Medical Center, Department of Emergency Medicine, El Centro, California",
            "department": "None"
        },
        {
            "first_name": "Bushra",
            "middle_name": "",
            "last_name": "Ahmad",
            "name_suffix": "",
            "institution": "Imperial County Behavioral Health Services, Division of Substance Use Disorder Treatment Program, El Centro, California",
            "department": "None"
        },
        {
            "first_name": "Rais",
            "middle_name": "",
            "last_name": "Vohra",
            "name_suffix": "",
            "institution": "University of California, San Francisco-Fresno, Department of Emergency Medicine, Fresno, California",
            "department": "None"
        },
        {
            "first_name": "Andrew",
            "middle_name": "",
            "last_name": "Herring",
            "name_suffix": "",
            "institution": "Highland Hospital – Alameda Health System, Department of Emergency Medicine, Oakland, California; University of California, San Francisco, Department of Emergency Medicine, San Francisco, California",
            "department": "None"
        }
    ],
    "date_submitted": "2022-01-29T06:06:07Z",
    "date_accepted": "2022-01-29T06:06:07Z",
    "date_published": "2022-01-29T06:08:45Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/1133/galley/873/download/"
        }
    ]
}