Thailand Tightens Controls on Painkiller Tramadol Amid Misuse Crisis

 

The Thai Ministry of Public Health has announced that oral Tramadol will be reclassified as a "Specially Controlled Drug" following its growing misuse as an illicit substance.

 

While the name may be unfamiliar to many, the drug itself has likely been consumed by numerous individuals, prompting questions about its journey from painkiller to street drug.

 

Tramadol is a moderate to severe painkiller prescribed for post-operative pain, accident-related injuries, or chronic conditions. It acts similarly to morphine. However, high doses of Tramadol can lead to severe side effects, including hallucinations, seizures, and potentially death.

 

Furthermore, symptoms such as muscle spasms, high blood pressure, disseminated intravascular coagulation (DIC), and acute kidney failure have been observed.

 

When combined with other illicit drugs, particularly ecstasy or methamphetamine, Tramadol's effects are intensified, leading to even more severe adverse reactions.

 

Currently, Tramadol is being unlawfully sold online, particularly to teenagers. It is widely misused, especially among youth who mix it with soft drinks, energy drinks, or alcohol to induce euphoria.

 

Continuous use can lead to physical and psychological addiction, akin to opium or heroin.

 

Consequently, the Ministry of Public Health declared oral Tramadol a "Specially Controlled Drug," mandating that it can only be dispensed with a doctor's prescription.

 

 

This new regulation will come into effect within 180 days of its announcement on 14 July 2025.

 

Tramadol is not the sole medication consumers should be wary of regarding misuse that contributes to drug-related problems.

 

Beyond substance abuse, Thailand also faces a significant challenge with irrational drug use, which adversely impacts both public health and the national budget.

 

According to World Health Organisation (WHO) data, pharmaceutical expenditure in Thailand escalated from 86,544 million Baht in 2008 to 180,585 million Baht in 2018.

 

This average spending is comparable to many developed countries. Key contributing factors are the unnecessary use of medication and a lack of public understanding.

 

Correct medication use is often overlooked, with risky behaviours frequently observed, such as taking overdoses in the mistaken belief it will accelerate recovery, requesting unnecessary antibiotics, or unknowingly taking duplicate medications from multiple sources.

 

These practices not only lead to side effects like allergic reactions or antibiotic resistance but also burden the country's public health system by increasing expenditure on drug purchases and medical treatment costs.

 

Pharmacist Pentipa Kaewkatethong, president of the Community Pharmacy Association, cited examples of the prolonged use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), often for joint or muscle pain, without adjusting lifestyle behaviours such as prolonged sitting, heavy lifting, or excessive exercise. This can ultimately lead to kidney failure.

 

 

 

 

Many also mistakenly believe that a sore throat requires antibiotics, whereas 80-90% of sore throats are caused by viruses, which typically resolve on their own within two to three days with sufficient rest and hydration.

 

Unnecessary antibiotic use or prematurely stopping a course of medication can lead to antibiotic resistance, rendering infections untreatable and potentially leaving no future treatment options.

 

These are just a few examples of common misunderstandings surrounding medication use.

 

At the community level, there is also the problem of irrational self-medication, with antibiotics, "medication sets" (pre-packaged mixed drugs), and traditional medicines containing steroids readily available in general markets because the public can easily access them from pharmacies, general stores, or even mobile vendors.

 

Therefore, rational drug use must become a daily reality for the public.

 

The Chiang Mai Provincial Office of the Consumers' Council, a provincial-level consumer organisation, has collaborated with a network of consumer organisations from six upper northern provinces (Chiang Mai, Chiang Rai, Phayao, Phrae, Lamphun, and Lampang) to launch a project promoting public knowledge on medication use, particularly among patients with chronic diseases and the elderly.

 

Lamduan Mahawan, head of the Chiang Mai Provincial Office of the Consumers' Council, highlighted the role of consumer organisations in empowering the public with knowledge and advocating for the right to access drug information as a fundamental right that all consumers should access equally.

 

The project covers over 25 sub-districts, involving home visits and community forums to provide education on commonly used medications such as antibiotics, anti-inflammatory drugs (NSAIDs), and steroids, as well as understanding drug advertisements.

 

As a result, over 2,500 consumers have gained knowledge and changed their behaviour, such as stopping the use of medication sets or unnecessary steroids.

 

Furthermore, a network of consumer organisations is emerging, capable of advocating for policies in collaboration with government agencies.

 

"Because safe medication use is not solely a matter for medical practitioners or pharmacists; it is a consumer's right to access accurate information and receive support from all sectors," she concluded.