Tramadol appears to be associated with low rates of abuse (ACR 2000 ; Cicero, Inciardi, Adams, et al 2005 ). A pharmacoepidemiologic surveillance study, conducted between 1994 and 2004 among 309 drug abuse experts and 100 police agencies, reported that the rate of tramadol abuse was very low, ranging from 0.5 to 2.0 cases per 100,000 patients over the 10-year study period (Cicero, Inciardi, Adams, et al 2005 ). Introduction of new branded and cheaper generic formulations in 2002 had no effect on the rate of tramadol abuse (Cicero, Inciardi, Adams, et al 2005 ). In contrast, the Research Abuse, Diversion, and Addiction-Related Surveillance (RADARS) system showed abuse rates for controlled-release oxycodone of at least 5 cases per 100,000 patients between 2002 and 2004 (Cicero, Inciardi, Munoz, et al 2005 ). Nevertheless, because tramadol exerts its analgesic effects in part through opioid binding, its potential for abuse should always be considered when prescribed for the treatment of chronic pain.