RT Journal Article SR Electronic T1 Physician’s role in prescribing opioids in developing countries JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e227072 DO 10.1136/bcr-2018-227072 VO 12 IS 6 A1 Jorge A Roa A1 Alexandra Guevara A1 Carolina Guevara A1 Jaime Guevara-Aguirre YR 2019 UL http://casereports.bmj.com/content/12/6/e227072.abstract AB In developed countries, addressing the growing opioid addiction epidemic is focused on preventive measures, developing better overdose-reversal medications and designing newer strategies to treat addiction. Primary prescribers of the therapeutic use of opioids might play a definite role in the aetiology of the epidemics. Developing countries could be affected by similar issues; however, given that no updated statistics are available, it is possible that their populations undergo problems similar to those for which current data is available. Concerns have arisen regarding synthetic opioid tramadol which, given its fast and potent analgesic effects, low cost and easy availability is widely prescribed. A debate remains as to whether tramadol induces addictive effects like those of stronger analogues such as oxycodone or fentanyl. Here we present a case of tramadol dependence in an Ecuadorian patient and find that substance abuse can occur in normal individuals affected by chronic pain, otherwise treatable with standard methods.