Today, attempts to form the state’s policy towards drugs and other psychoactive Drugs taking mainly non-governmental organizations engaged in advocacy of human drug users. But these organizations own, very specific interest in the subject is very different from the interests of people who are not dependent on drugs (and it is still a big part of the population). Suffice it to say that one of the main goals of these organizations is as much as possible large-scale introduction in our country substitution therapy of drug addicts using drugs again, methadone and buprenorphine …

The author is deeply convinced that our country has enough qualified specialists in order to build on best international practice, to form an effective system the state’s policy towards drugs and other psychoactive drugs.

Go at that, because the study door knocking again. Apparently, another victim of Tramodol family needs help ..

First: is to solve a very private and highly specific question to a special resolution of the Cabinet of Ministers? Does this mean that the appearance of any new psychoactive substance in the pharmaceutical market of Ukraine will be accompanied by such dramatic events as the need to bring the Cabinet to address the issue?

Secondly, the “root of evil”, namely: lack of discipline in the prescription pharmaceutical network of the country, remained intact.

Third: The output of tramadol for 2008, approved by order of the country’s Health Ministry № 236 from 5.05.2008 (6.5 million vials + 19,5 million capsules (tablets) = 26 million doses), appears to have the result of painstaking compromise between the real needs of the country’s health and wishes of the representatives of the pharmaceutical lobby. In any case, the data volumes (26 million doses) of 6,5 times more than the above requirements in this preparation (4 million doses).

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The above is well illustrated by the story of tramodol, certain milestones which are presented below.

15.07.2005 – Ministry of Health decided that the medication tramodol and tramalgin transferred to a special mode of distribution.

Four months later (16/11/2005) Meeting with representatives of the Committee on Drug Control, the State service of medical products, MIA, SSU and NGOs noted that the problem of non-medical use of tramodol remains a threat to national security.

After six months (20.04.2006) the problem still not solved – Ministry of Internal Affairs of Ukraine requested the Cabinet of Ministers of the country to ban the sale of tramodol. The call went unanswered, and the Ministry of Internal Affairs of Ukraine 11.12.2006, represented by chief of department for combating illegal drug trafficking Nikolai Andreyev, announces that the number produced in the country Tramodol (75 million doses) is almost 19 times greater than the need of the population in this drug (4 million doses).

14.02.2007 – Deputy Health Minister Valery Poor announces the introduction of strict control over the handling Tromadol. Ministry of Health has prepared a number of regulatory instruments that will solve the issue of illegal treatment tramadol online pharmacies and medical facilities.

30.03.2007 – Ministry of Health documents are registered with the Ministry of Justice and Interior Minister Vasyl Tsushko said that the production of Tramadol in the country reached 90 million doses per year (all the same needs of the population 4 million doses per year).

These figures mean that every day in the country issued about 236 thousand “extra” doses. Usually, the purpose of intoxication used therapeutic doses of 5.10 simultaneously. Simple calculations show that the domestic pharmaceutical industry conducted daily tramadolovym intoxicating 23,6-47,2 thousands of consumers, or, in the language of war, from 2 to 4 infantry divisions …

18.02.2008 – adopted amendments to the 321 th article of the Criminal Code (Illegal production, manufacture, purchase, transport, transfer, possession for sale or distribution of toxic or potent substances, or toxic or potent drugs “), and issued orders to the Ministry of Health which contains a list of these medicines, which entered and tramadol.

Finally, 22.02.2008 – Cabinet of Ministers of Ukraine by its decree number 89 approved quota production Tramadol in 2008.

However, along with the usual recipe, lack of which patients to a pharmacy successfully ignored in domestic practice, there are other, so to speak, “superretsepty. They prescribe the drugs to be strictly quantifiable. The latter includes all drugs and other means of possessing intoxicating properties.

These “superretsepty” (blank forms number 2 and number 3, approved by order of the Ministry of Health of Ukraine № 117 dated 30.06.1994 g.) – another extreme, the national drug policy. The fact that the classification of any drug to the list of drugs and other equivalents, with modern legal regulation of their circulation, leads to substantially limit their availability not only for drug addicts, but also for those to whom they are vitally important for health reasons, in particularly for cancer patients. Mindful of the bulky (need signatures of three persons), and fraught with legal complications of the procedure for prescribing the forms of number 2 and number 3, doctors and managers of health facilities deliberately restrict themselves to the appointment of these drugs, which naturally leads to a deterioration in quality of care and suffering of seriously ill people .

Not an exception to this rule, and tramodol. Professionals from the very beginning it was clear that its uncontrolled use would inevitably lead to the formation of painful addiction. Therefore, tramodol has been generally attributed to the group of medicines that patients without a doctor’s prescription is not dispensed. This measure was enough to prevent spread of abuse tramadol in virtually all countries of the world. In addition to Ukraine and some other CIS countries.

The first patient, non-medical use of tramodol, appeared in the Ukrainian drug treatment clinics at the turn of the century. First, it was about opium addicts who had used the drug in cases where the time could not get the usual poppy straw. But very soon there were those who began his path in Anesthesia precisely with tramodol. Then their numbers grew rapidly, and today in many drug treatment clinics in the country’s face, which is primarily dependent on Tramodol, up from one third to half of all patients.

We are witnessing the abuse withdrawal syndrome characterized by mild tramadol pronounced somato-vegetative symptoms, compared with the classical opium withdrawal symptoms, but the long duration and subjective severity for the patient. A number of patients were observed for a long time (up to 2 months or more after discontinuation of tramadol) senesto-hypochondriacal complaints of vague pain, burning in the internal organs, joints, muscles, they are readily surveyed doctors physical and neurological profile. The motive for the doctor was often receiving tramadol in relieving pain.

Thus, the possibility of dependence on tramadol calls for a revision of the verification regime for its trafficking [4]. The similarity of the clinical picture depending on the tramadol with other opiates clearly places the breach caused them under the rubric of F11, but the fact that he attributed to strong, but not drugs (in contrast to other opiates) generates a casuistic term “Opium substance abuse.”

Patients previously consuming artisanal opiates taking tramodol for:
1) ease of cancellation after eating handmade acetylated opiates,
2) vicarious tramadol drug addiction (sometimes combine techniques from a number of benzodiazepine tranquilizers),
3) a deliberate technique to samokupirovaniya state cancel Tramadol [4]. It is interesting to note that some patients claimed that the “jump off” with Tramodol it harder than with “junk”. Some patients reported a combined dependence on tramodol and other opiates. Thus, there are reports of patients who once tried to stop yourself Anesthesia heroin with tramodol, started to use tramadol combined with heroin. At the same time to achieve a comfortable state needed a reception after the two drugs. This may indicate that tramodol, along with the ability to communicate with the mu-opioid receptor has other mechanisms of dependence other than heroin.

The relative availability of Tramadol and its ability to induce euphoria, even at doses exceeding the therapeutic and led to rapid and widespread abuse of tramadol among adolescents.

Many adolescents reported that the first drug taken to achieve the euphoria was tramadol. Never trying other opiates, they became dependent on opioid substances. Some of them later moved to receive handmade acetylated opiates.

It is interesting to note that originally tramodol attributed to narcotic analgesics. Some authors, however, after prolonged use of therapeutic doses of Tramodol with former drug addicts and opiate-dependent individuals have shown an extremely rare development of tolerance and drug addiction and failure to use a substitution effect, when according to the heroin or morphine [3].

Under our observation were 30 patients with dependence on opiates taking tramadol without a medical prescription. The patients’ age 18-39 years, all patients are male.

Patients with dependence on opiates tramadol abuse can be divided into two groups.

Group 1 – teenagers who are not used before receiving tramodol other opiates.

Group 2 – patients with addiction to opiates, for economic (high cost of artisanal acetylated opiates), or other reasons (conflict with the law and the fear of being detained against illicit trafficking in drugs).

Patients with established dependence tramodol often practiced occasional use of other opiates, primarily various extracts from poppy straw handmade. Only a small part can be diagnosed tramadol substance abuse in its pure form (only three patients had categorically denied the use of other opiates). It must be emphasized that patients who in the past has endured other opioid withdrawal syndrome, comparing it with the state of the abolition of tramodol, noted their similarity.

Along with common features during opioid withdrawal, with the use of tramodol observed a number of differences. Thus, the rate of development and intensity of somato-autonomic manifestations of withdrawal syndrome in individuals who consumed tramodol objectively lower than in patients who consumed hand-made preparations of opium. In addition, injecting tramadol is able to cancel it was no diarrhea, so typical of opioid withdrawal. Despite this, it is estimated the majority of the surveyed our group of patients, with equivalent doses of anesthesia and comparability of seniority, duration and subjective severity of the abolition of tramodol was more than able to cancel the other opioids.

The studies yielded the following conclusions :

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1. Tramodol has a noticeable addictive potential, that must be considered when using tramodol to relieve pain in the structure of opioid withdrawal.
2. Arising from non-medical use of tramodol mental and behavioral disorders in many respects similar to the disorders, including other opioids (F11 disorder according to ICD-10).
3. The only indication for use of tramodol in patients with opiate addiction can be a pain in muscles and / or joints that are not cropped by other means.
4. Time of Tramodol in the hospital, patients with opioid dependence, should be strictly limited to the duration of pain.
5. Adaptive method of therapy is desirable, providing a steady decrease in doses of tramodol as alleviation of pain, while limiting the dose used should not be above the maximum therapeutic.
6. At least two or three days before discharge patients from hospital tramodol should be abolished to ensure there are no manifestations of opioid withdrawal.