Tramadol may be effective for opioid withdrawal symptoms, according to new research. In a small study of 103 patients (mean age 29 years) with opioid use disorder, participants were stabilized on subcutaneous morphine, 30 mg four times a day. Then, patients were randomized to a seven-day taper with clonidine, tramadol, or buprenorphine. Patients then were crossed over to double-blind placebo during post-taper. Several metrics were measured regarding opioid withdrawal symptoms during the taper phase. Use of tramadol was associated with fewer withdrawal symptoms compared to clonidine and was comparable to buprenorphine. The authors suggested that data warrant further examination of long-acting tramadol as a method to manage opioid withdrawal. This study is important because it may offer an alternative to clonidine and buprenorphine for medically supervised detox. Clonidine must be administered several times a day and can cause hypotension and sedation. Buprenorphine is a schedule III drug that is effective but has abuse potential and requires a special Drug Enforcement Agency certification for this indication. Tramadol is schedule IV and inexpensive, with minimal side effects. The extended-release formulation may be dosed once a day. (JAMA Psychiatry 2017 July 12. doi:10.1001/jamapsychiatry.2017.1838)