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    In developed countries, addressing the growing opioid addiction epidemic is focused on preventive measures, developing better overdose-reversal medications and designing newer strategies to treat addiction. Primary prescribers of the therapeutic use of opioids might play a definite role in the aetiology of the epidemics. Developing countries could be affected by similar issues; however, given that no updated statistics are available, it is possible that their populations undergo problems similar to those for which current data is available. Concerns have arisen regarding synthetic opioid tramadol which, given its fast and potent analgesic effects, low cost and easy availability is widely prescribed. A debate remains as to whether tramadol induces addictive effects like those of stronger analogues such as oxycodone or fentanyl. Here we present a case of tramadol dependence in an Ecuadorian patient and find that substance abuse can occur in normal individuals affected by chronic pain, otherwise treatable with standard methods. © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.


    Jorge A Roa, Alexandra Guevara, Carolina Guevara, Jaime Guevara-Aguirre. Physician's role in prescribing opioids in developing countries. BMJ case reports. 2019 Jun 02;12(6)

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    PMID: 31160299

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