Substance Dependence and Hepatitis among Tramadol Prescription Users: A Study of Former Adolescent Psychiatric Inpatients in Northern Finland.

We investigated the association between tramadol use, co-morbid substance use disorders and hepatitis in former adolescent psychiatric inpatients. The study sample consisted of 508 adolescents, admitted to psychiatric inpatient care between 13 and 17 years of age. Follow-up information of tramadol prescriptions, substance use disorders and hepatitis were obtained from the Finnish national health care registers. The users of prescription tramadol were categorized as follows: single users (one tramadol purchase), mild users (2-5 purchases) and heavy users (≥6 purchases). About one tenth (11.0%, n = 56) of study participants were tramadol users. Heavy users of tramadol had mothers with psychiatric problems (p = .039), and a diagnosis of substance use disorder (p < .001) in adolescence. Heavy use of tramadol was predicted with adolescent substance use disorder (OR = 8.31, 95%Cl 2.10-32.91, p = .003) and with mother´s psychiatric problems (OR = 5.85, p = .003). Hepatitis C (n = 54, 10.6%) associated with mild and heavy tramadol use (p < .001). Comorbid diagnosis of opioid dependence prevailed among heavy tramadol users (p <.001). Tramadol should only be prescribed to adolescents after careful evaluation. Particular caution is required in adolescents with a history of substance use disorders.