Tramadol versus methadone for the management of acute opioid withdrawal: an add-on study

Background: opioid agonists such as methadone have been used widely in controlling opioid withdrawal symptoms.tramadol, a partial opioid agonist, also has been prescribed to manage acute and chronic pain. we sought to comparethe efficacy of tramadol and methadone in reducing the severity of opioid withdrawal symptoms.methods: in a double blind clinical trial 70 opioid dependent patients who used daily opium equal to 15 mg methadonerandomly were assigned in two groups. in one group, methadone was started at 15 mg/day while in the othergroup 450 mg/day tramadol was prescribed. both drugs were tapered in a week and placebo was prescribed in the 2ndweek. the severity of withdrawal symptoms were assessed five times by short opioid withdrawal scale (sows). datawere analyzed by repeated measures analysis of variance, mann-whitney u, and wilcoxon tests.results: there were statistically significant differences between two groups in the severity of anxiety (p = 0.015), irritability(p = 0.044), palpitation (p = 0.018), agitation (p = 0.037), and dysphoria (p = 0.044) that all were more commonin methadone group. comparison of side effects revealed statistically significant differences in sweating (p = 0.003) anddrowsiness (p = 0.019) between two groups that were more frequent in methadone group.discussion: tramadol was more efficacious in controlling opioid withdrawal symptoms with lower side effects.