text: As a practicing physician I find several things about this situation  to be questionable. The regulations about tramadol changed almost 2 years ago. To be prescribing it and not to be aware of this is an error of exceptional proportions. It suggests that the prescriber is not adequately familiar with the medication. Tramadol is not a risk free medication. It has been known to cause seizures and induce delirium. Using it to treat opiate withdrawal is not medically supportable with the current information base. It is not approved for this purpose and there are no studies of adequate quality to justify its use in this way.
  Additionally, having a provider with no DEA certification prescribing medications for the relief of  substance withdrawal is not acceptable practice. The medications used to treat alcohol withdrawal, in particular,  have ALWAYS required it.
  More investigation needs to be done regarding the safety, validity and effectiveness  of the treatment that these clinics provide.