Tramadol vs placebo/ methadone/ buprenorphine/ clonidine for the treatment of opioid withdrawal

In a meta-analysis including 8 randomized clinical trials which evaluated the effect of tramadol for the treatment of opioid withdrawal and used an opioid withdrawal scale to assess the change in opioid withdrawal symptoms was found: 

• no significant difference between tramadol and comparators like placebo (SMD: -1.12; 95%CI: -2.69 to 0.45) buprenorphine (SMD: -0.21; 95%CI: -0.43 to 0.01), clonidine (SMD: -0.26; 95%CI: -0.55 to 0.02) and methadone (SMD: -0.84; 95%CI: -1.78 to 0.10).

There were no significant differences in treatment retention at the end of studies between tramadol and comparators. 

The efficacy of tramadol in reducing opioid withdrawal symptoms is not significantly different from comparators with low certainty of evidence against placebo, moderate against methadone, whereas with high certainty of evidence against buprenorphine and clonidine.