Tramadol is a weak opioid analgesic that is commonly prescribed for moderate to severe pain. At therapeutic doses, it has less potential to cause respiratory depression, constipation and dependence relative to morphine which is the classic opioid analgesic. Tramadol dependence can occur at high doses and at therapeutic doses when used for prolonged periods of time (weeks to months).  In recent times, cases of tramadol abuse and dependence have been on the increase globally. In Nigeria, the alarming number of cases of tramadol abuse led to the ban of the 225mg and higher doses which were commonly abused in 2018. We report a case of a 25-year old university student who presented to our clinic with withdrawal symptoms from 4 years of tramadol abuse.

It is important for physicians to know that, due to the mixed receptor activity of tramadol, patients may just present with symptoms of serotonin-norepinephrine toxicity rather than the classical opioid overuse symptoms. Although naloxone is a recognized opioid antagonist and may be useful in acute toxicity, the mainstay for management of tramadol abuse remains supportive therapy.

Clinicians should look out for people at risk of tramadol toxicity before prescribing while at the same time, advocating for continuous awareness programmes. Moreover, institutions should put in place procedures to detect students who are potential drug abusers or currently on drugs and there is the need to establish rehabilitation centers to properly manage those already dependent.