Tramadol: fewer pills in boxes in France in bid to reduce addiction

Number of pills of the painkiller to be at least halved after multiple deaths were linked to the drug

A box of tramadol tablets handed out in France, containing 30 tablets.
New boxes will only have 10 or 15 pills inside

The number of pills in a box of Tramadol – a powerful opioid prescribed to combat pain – will be reduced from 30 to at most 15 in France, following concerns over the number of cases of addiction related to the drug. 

The decision has been made following recommendations from France’s national medicine safety body, with the smaller boxes already beginning to arrive in pharmacies. 

“Pain must be treated. When paracetamol, which is the reference drug, isn't enough, it's important to have alternatives,” said Philippe Besset, President of the Fédération des syndicats pharmaceutiques de France (French pharmacists union) to FranceInfo.

However, prescribing these drugs “has to be done in a minimal context and for as short a time as possible… there are sometimes serious side-effects", he added.

Tramadol is one of the most powerful opioids that can be prescribed.

In many instances the drug is prescribed to combat a pain that will not last more than a few days, leaving patients with a surplus of the highly addictive medicine.

They may continue to take it – believing it is important to finish the box – or leave it in the medicine cabinet to use as a general painkiller. 

Both actions are advised against, however, and you should only take the drug for the time it has been prescribed to you.

Read more: What is the hold-up in dealing with medicine shortages in France?

Hundreds of cases of addiction, seven deaths 

Addiction to Tramadol – and other prescribed opioids – is a growing concern in the United States, with thousands of people affected. 

The problem also exists in Europe, albeit at a lower level, and in 2022 more than 200 cases of addiction in France directly referenced Tramadol as the primary cause. 

Out of these, around 100 were classed as ‘serious’ addictions, with 16 patients facing life-threatening convulsions due to taking the drug.

Seven people died in France in 2022 from Tramadol overdose or an addiction to opioids that began after being prescribed the drug. 

In light of this, the ANSM asked 26 producers of the drug who provide the medicine to French pharmacies to change the packaging of the boxes. 

New packets will have 10 or 15 pills inside.

Read also: €5 penalty proposed for missing a medical rendez-vous in France

Over-prescription can cause long-term issues

Prescribing too many painkillers runs the “risk of prolonging the intake of the drug,” as patients quickly believe they need the medicine to cope, said Dr Philippe Vela, Medical Director of the French Medicines Agency.

This can lead to “an increase in the doses [taking the medicine multiple times a day],” or demands for repeat prescriptions, creating "a situation of dependence even though the pain has diminished or there is no more pain,” he added. 

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The reduced number of pills in the new box will lower the risk of patients having leftover Tramadol for less serious pains, and require healthcare professionals to more frequently observe them before re-prescribing the drug.

“If, despite everything, there are still tablets in the medicine cabinet, bring them back to a pharmacy to be destroyed,” said Mr Besset.