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Tramadol is not a federally controlled substance but some states have made it a Schedule IV. Be very careful though, it is addictive and has some strong withdrawal symptoms. Tramadol is a synthetic opioid, which means it has the structure of narcotics like hydrocodone or oxycodone without the strong euphoric effect.

It can cause euphoria if taken in high doses but high doses causes seizures. Also, please be VERY CAREFUL if you are taking any other anti-depressants like Wellbutrin, Cymbalta, Effexor or other SSRIs. These anti-depressants effect the level of Serotonin in the brain. Too much and it causes “Serotonin Syndrome”, which can also cause seizures among other things.

Q: Why is Fiorinal® considered a controlled substance while Fioricet® is not?

A: The Controlled Substance Act regulates five classes of drugs: narcotics, depressants, hallucinogens, stimulants, and anabolic steroids. These compounds are then placed into categories known as “Schedules”, based on their potential for abuse. Each varies in its
ability to produce physical dependence and addiction. Schedule I contains substances that have the highest potential for abuse, but have no currently accepted medical use in the United States and little safety data is available. Unlike Schedule I, Schedule II consists of drugs with high abuse potential that currently have an accepted medical use in the United States. Schedules III through V have progressively less abuse potential and produce limited physical dependence.

Exceptions from the above scheduling have been made if the drug meets the requirements of section 201(g) (3) (A) of the Controlled Substances Act. This section relates to combination products such as Fiorinal® and Fioricet®. The exemption requires that one of the active ingredients be a non-narcotic controlled substance and one of the others be a non-scheduled compound. The potential for abuse is decreased if a sufficient amount of a non-controlled substance (aspirin, acetaminophen, and ibuprofen) is added. The ratio
required for exemption is 70 mg of acetaminophen to 15 mg of butalbital.

In contrast, the ratio of aspirin to butalbital is 188 mg to 15 mg. Fioricet® contains 325 mg acetaminophen, 50 mg butalbital, and 40 mg caffeine. Therefore, the acetaminophen to butalbital ratio is approximately 97mg to 15 mg. This is greater than the 70mg:15mg ratio, thus the drug is exempt from scheduling. On the other hand, Fiorinal® contains 325 mg aspirin, 50 mg butalbital, and 40 mg caffeine. Therefore, the aspirin to butalbital ratio is approximately 97mg to 15mg. This combination is less than the 188mg:15mg ratio, so the drug is classified as a Schedule III substance.